Water Carter Assessment

• COM Number

• Conducted on

  Date

• Prepared by

• Location
  Address

GENERAL INFORMATION

• Inspection Type

  Routine

  Re-inspection

  Complaint

• Trading Name

• Person Interviewed

• Name of inspecting Environmental Health Officer

  Rachel Mann

  Jeremaia Marawa

  Alexander Habilay

Vehicle

• Vehicle Registration Number

• Vehicle Make/Model

• Type of Water Carted

  Select Potable Non-potable

  • Potable
  • Non-potable

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

  Stainless Steel

  Fibre glass

  Aluminium

  Coated Mild Steel

  Plastic

• Backflow prevention device fitted

  Yes

  No

  N/A

• Tank securely mounted to frame?

  Yes

  No

  N/A

• Sufficient opening for inspection?

  Yes

  No

  N/A

• Ability to be fully drained?

  Yes

  No

  N/A

• Suitable water hoses fitted?

  Yes

  No

  N/A

• Drinking water signs installed on the rear of tank?

  Yes

  No

  N/A

Cleanliness of Vehicle

• External surfaces of tank are clean and sanitary?

  Yes

  No

  N/A

• 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

Logbook

• Name of water corporation

• Address and telephone number of water corportation

• Dockets and invoices available?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Location of water source (Best practice)

Further Action

• Inspection Result

  Pass

  Fail

• Action Required

  Warning Letter

  Re-inspection

  Improvement Notice

  Prohibition Order

  Nil

Additional Comments

• Additional comments and actions

Declaration

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

• Signature of Proprietor/Staff

  Sign

• Signature of Environmental Health Officer

  Sign