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Application to Register a Health Premises
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There are issues with some of the information that you've provided
Proprietor Details
Is the proprietor a company or association?
Yes
No
Full Name
Authority
Your authority to submit this application on behalf of the company, for example 'Director of Company'
ABN
ACN
(optional)
Company Name
Your legal business name, not the Trading Name
Postal Address
Address line 1
Address line 2
Post code
Contact Number
Other Contact Number
(optional)
Business Fax
(optional)
Email
(optional)
Registration Details
Please select your business type
Personal Care and Body Art
Prescribed Accommodation
Personal Care & Body Art
Please select all of the procedures to be conducted:
Hairdressing
Application of cosmetics or makeup
Beauty Therapy
Please select specific beauty therapy activities that will be conducted:
Facials
Spray tan
Tinting
Manicure or pedicure
Artificial nails
Waxing
Electrolysis
IPL
Other
Please provide details of the beauty therapy services that you will be offering:
Colonic Irrigation
Tattooist, including cosmetic tattooing
Skin Penetration
Please select the specific skin penetration activities that will be conducted:
Ear piercing
Acupuncture or Skin Needling
Other
Please provide details of the other skin penetration activities:
Prescribed Accommodation
Please select your accommodation type:
Hotel or Motel
Holiday Camp
Hostel
Student Dormitory
Residential Accommodation
Rooming House
Other
Please provide details of the accommodation that you will be offering:
Premise Details
House Details
Trading Name or Shop Name
What is the proposed opening date?
DD/MM/YYYY
Street Address
Address line 1
Address line 2
Post code
Number of bedrooms
Total number of beds
Rooming house operator's licence number
Rooming house operator's licence expiry date
(optional)
DD/MM/YYYY
Do you supply any food with the service that you provide?
Yes
No
For example, breakfast included as part of a guest's stay
Please provide details of the food that you provide with your service.
Do you have a pool?
Yes
No
Is the Pool located outdoors?
Yes
No
House Owner Details
Full Name
Is the proprietor a company or association?
Yes
No
Authority
Your authority to submit this application on behalf of the company, for example 'Director of Company'
ABN
ACN
(optional)
Company Name
Your legal business name, not the Trading Name
Contact Number
Date of birth
eg. 31 01 1978
Day
DD
Month
MM
Year
YYYY
Trading Details
Do you have a liquor licence?
Yes
No
If yes, what is your licence number?
Trading Hours
Is your business open by appointment only?
Yes
No
Day of the Week
Trading Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Floorplan
Please upload a floor plan of your proposed premises.
This will be required to process your application and should include all rooms, equipment, furniture and dimensions. Please refer to the
Public Health and Wellbeing Act Information Kit
for further information on what is required.
Limited to 30MB. Only image files, Microsoft Word Documents and PDFs are accepted.
I will provide the floor plan of the premises separate to this application
Yes
No
Applicants please note:
You cannot trade at the premises until an Environmental Health Officer has inspected the premises and a certificate of a Public Health and Wellbeing Act Registration is issued to you.
Payment of the prescribed registration fee is required to complete your application. The prescribed fee is determined based on the details within your application, following submission of your application you will be sent a schedule of fees via your nominated email address.
It is a requirement under the Residential Tenancies Act 1997 for councils to enter information about the rooming houses they register within their municipality. Some of the information, specifically:
the rooming house address
the owner's name
the business owner's ABN or ACN
and the council in which the rooming house is registered
will be available to the public. Should a rooming house owner wish to have their personal details suppressed from public view on the register, they can apply in writing to the Director of Consumer Affairs Victoria, GPO Box 123, Melbourne, Victoria 3001
Declaration
The information provided in this application is true and complete to the best of my knowledge
This application is a legal document and penalties exist for providing false or misleading information
This initial registration may be less than 12 months, if so a pro rata fee will be charged
I understand that the operation of rooming houses is subject to additional regulatory requirements beyond this registration under the Public Health and Wellbeing Act that include the Rooming House Operators Act, Residential Tenancy Act, the Building Code of Australia and its associated regulations
Submit Registration Application
Collection Statement
Your personal information is being collected by City of Ballarat for the purpose of processing your application to register a health premises in accordance with the Public Health and Wellbeing Act 2008 and the Residential Tenancies Act 1997. Your information will be stored in Council’s Customer Database and used to identify you when communicating with Council and for the delivery of services and information. For further information on how your personal information is handled, refer to Council’s Privacy Policy at
www.ballarat.vic.gov.au/privacy
