Information
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Name of Premises
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Address of premises
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Contact Name
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Contact Number
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Business email
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Council Food Registration No. (if applicable)
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Conducted on
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Prepared by
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Location
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Personnel
GENERAL RETAILERS
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1. Are tobacco products and packaging (cigarettes, cigarettes, cigars, loose tobacco and cigars inside humidifiers) covered and not visible to the public from anywhere inside or outside the retail premises?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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2. Is the health warning sign displayed?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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3. Is the 'We don't sell tobacco to U/18's' sign displayed?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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4. If a price board is displayed, is there a graphic warning sign displayed on or immediately next to the price board?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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5. Are staff being trained regarding cigarette sales to minors?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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6. Is there any tobacco advertising within the store (inc. non-branded tobacco advertising such as backlit sign of lighters and/or matches)?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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7. No 'discounted' or 'cheap' cigarette signs?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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8. Are staff aware of identification that should be sighted when someone purchasing cigarettes who may be under the age of 25?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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Only identification that provides photographic proof of age is acceptable. For example: Victorian or interstate proof-of-age card Victorian or interstate driver's license Australian or international passport Keypads Victorian learner's permit
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9. Not selling single cigarettes or packets of less than 20?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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10. Other
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
OVERALL ASSESSMENT RESULT
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Overall Tobacco Retailer Assessment result:
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Is a follow-up visit required?
FOLLOW-UP INSPECTION
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Follow-up visit due on:
ADDITIONAL COMMENTS
SIGN OFF
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On site representative
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Auditor's signature
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Public Health Unit ph: 9518 3539
