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Online Forms

Application to Register a Health Premises

Your Details

Is the proprietor a company or association?
Your authority to submit this application on behalf of the company, for example 'Director of Company'
Your legal business name, not the Trading Name

Postal Address

Registration Details

Please select your business type

Personal Care & Body Art

Please select all of the procedures to be conducted:
Please select specific beauty therapy activities that will be conducted:
Please select the specific skin penetration activities that will be conducted:

Prescribed Accommodation

Please select your accommodation type:

Premise Details

House Details

Street Address

Do you supply any food with the service that you provide?
For example, breakfast included as part of a guest's stay
Do you have a pool?
Is the Pool located outdoors?

House Owner Details

Is the proprietor a company or association?
Your authority to submit this application on behalf of the company, for example 'Director of Company'
Your legal business name, not the Trading Name
Date of birth eg. 31 01 1978

Trading Details

Do you have a liquor licence?

Trading Hours

Is your business open by appointment only?
Day of the Week Trading Hours

Floorplan

Floor plan of the premises including all rooms, equipment, furniture and dimensions. Please refer to our Public Health & Wellbeing Construction Guideline for more 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
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

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/ac/privacy.aspx