Application for Registration - Cooling Tower/Warm Water Systems

NSW Public Health Act 2010

System Details

Council Ref. No. (If Applicable)

Type of System *

Water cooling system
Warm water system

Identification Number/s

Serial Number/s

Number of Water Cooling Systems on Site

Number of Warm Water Systems on Site

Address of Premises on which the system is installed

Owner Details

Name of the Owner

Address of the Owner

Postal Address

Phone (BH)

Phone (AH)

Mobile

Email Address

Service Contractor Details

Name of Service Contractor

Address

Postal Address

Phone (BH)

Phone (AH)

Mobile

Email Address

Signature

Name of Owner/Manager/Occupier *

Email Address *

Declaration * I declare that to the best of my knowledge, the information provided in this application is accurate and correct.

Date *

Please Note: Building owners or occupiers are responsible for ensuring that the cooling tower or warm water system within your building is installed, maintained and operated in accordance with the law. All water-cooling systems can only be operated if they are equipped with a process designed to control microbial growth certified annually by a competent person and only if the process is in continuous operation.