Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Council:

  • Public Health Unit:


Premises Name:

  • Address:
  • Owner Name:

  • Occupier Name:

WWS Identification

  • Model:

  • Serial No.:

  • WWS Location on Site:

  • Registration Number:

  • Registration Details complete?

  • Registration details match with above? (Section 31 & Clause 11)

  • Commissioning Date:

  • Number of other WWS on site?


  • Type of WWS

  • Measured temperature of operation < 60°C?

Compliance with Section 28 of the Public Health Act 2010

  • Is O&M carried out by a duly qualified person? (S28)

  • Duly qualified person details :

  • Is the duly qualified person reasonably expected to be competent (S26)?

Compliance with Clause 7 & 8 Public Health Regulation – Operation & Maintenance and (AS/NZS3666.2:2002)

  • Safe and easy access? (Cl 7(3))

  • Operation manual provided on site? (2.6.3)

  • Maintenance manual provided on site? (2.6.3)

  • Manuals comply with AS/NZS 3666.2:2002? (2.6.1)<br>(Drawings, suppliers recommendations, cleaning and<br>dismantling instructions, start up and shut down procedures,<br>maintenance management program)

  • Maintenance records up to date? (2.6.2)

  • And on site? (2.6.3)

  • Equipped with a water treatment unit? (2.4.1) (optional)

  • Has the water storage tank (tepid system) been cleaned? (2.4.2)

Compliance with Clause 9 Public Health Regulation 2012

  • Are maintenance precautions being observed<br>when maintenance is being carried out?

Compliance with Clause 8(7) Public Health Regulation 2012  NSW Health Document “Requirements for the Provision of Cold and Heated Water”

  • Monthly temperature check?

  • Temperatures and colour codes comply?

  • If the WWS is a TMV has a service report in accordance<br>with the TMV Code of Practice been completed?

  • Has the TMV service interval exceeded 12 months?


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.