Title Page

  • Address / Council ID

  • Conducted on

  • Prepared by

  • Location

Audit & Entry


  • Property Name

  • Property Owner

  • Date & Time

  • Entry available?

  • Safe to enter?

  • Owner/tenant available?

  • Comments

  • Type of Inspection


  • Type of system

  • Bedrooms servicing

  • Occupants?

  • Tank structure

  • Comment

  • T-piece?

  • Prevents the spread of disease by micro-organisms?

  • Prevents persons coming into contact with untreated sewage or effluent?

  • No smell present?

  • Prevents insects and vermin from entering system?

  • Add media

Disposal Area

  • Type of disposal

Surface irrigation

  • Sprinkler head meets AS/NZS (1547:2012)?

  • How many sprinklers?

  • Does the effluent hose meet AS/NZS (1547:2012)?

  • Are effluent sprinklers within approved area?

  • No pooling present?

  • No smell present?

  • Correct signage?

  • >6m up-gradient & >3m down-gradient of driveways/property boundaries

  • >6m to swimming pools

  • >15m to dwellings

  • Satisfactory?

  • Comment

ETA bed/Trench

  • Can you identify the ETA bed/Trench?

  • Size?

  • No signs of failure?

Buffer distances

  • Distance to permanent water source

  • Distance to ground water well

  • Distance to other water sources (dams, intermittent waterways, drainage channels)

  • Comments

  • Add media

Inspection Summary

  • Satisfactory?

  • Risk rating

  • Fees

  • Comment

  • Date of reinspection if applicable

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.