• COM Number

  • Conducted on

  • Prepared by

  • Location


  • Inspection Type

  • Trading Name

  • Person Interviewed

  • Name of inspecting Environmental Health Officer


  • Vehicle Registration Number

  • Vehicle Make/Model

  • Type of Water Carted

  • Construction material of tank (eg. Stainless steel, fibre glass, aluminium, coated mild steel)

  • Backflow prevention device fitted

  • Tank securely mounted to frame?

  • Sufficient opening for inspection?

  • Ability to be fully drained?

  • Suitable water hoses fitted?

  • Drinking water signs installed on the rear of tank?

Cleanliness of Vehicle

  • External surfaces of tank are clean and sanitary?

  • Appropriate sanitising method used to clean internal of tank; - Tank is filled with a solution of drinking water and 5mg/L chlorine and allowed to sit for 30 minutes - Tank is drained then rinsed with drinking water?

  • Pipes and Fittings suitably cleaned every month; - Clean pipes and fittings with detergent - Sanitise using a solution of drinking water and 5mg/L chlorine and allowed to sit for 30 minutes - Rinsed pipes and fittings with drinking water

  • Date tank and tank fittings were cleaned and sanitised

  • Method and chemicals used to clean and sanitise the vehicle


  • Name of water corporation

  • Address and telephone number of water corportation

  • Dockets and invoices available?

  • Transport date, time, driver, and name of water carter business

  • Location of water source (Best practice)

Further Action

  • Inspection Result

  • Action Required

Additional Comments

  • Additional comments and actions


  • Proprietor/staff:
    The above information is true and correct

  • Signature of Proprietor/Staff

  • Signature of Environmental Health Officer

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.