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These forms and templates have been created for use with respect to plumbing and drainage assessment process under the Plumbing and Drainage Act 2002.

Forms 1-9 must be lodged with local government

Forms for the Plumbing and Drainage Act 2002Type and size
1 Application for compliance assessment PDF icon 59 KB
1 Application for compliance assessment Word icon 250 KB
3 Verification of covered work PDF icon 64 KB
3 Verification of covered work Word icon 220 KB
4 Notifiable minor work PDF icon 103 KB
4 Notifiable minor work Word icon 266 KB
5 Application for compliance assessment - remote area PDF icon 74 KB
5 Application for compliance assessment - remote area Word icon 237 KB
6 Notice of compliance - remote area PDF icon 55 KB
6 Notice of compliance - remote area Word icon 249 KB
7 Notification of responsible person PDF icon 77 KB
7 Notification of responsible person Word icon 235 KB
8 Notice of compliance on-site sewerage work PDF icon 67 KB
8 Notice of compliance on-site sewerage work Word icon 231 KB
9 Report on inspection and testing of backflow prevention devices, registered air gaps and registered break tanks PDF icon 64 KB
9 Report on inspection and testing of backflow prevention devices, registered air gaps and registered break tanks Word icon 233 KB

Form 10 must be lodged with the department

Forms for the Plumbing and Drainage Act 2002Type and size
10 Application for chief executive approval PDF icon 73 KB
10 Application for chief executive approval Word icon 227 KB

Forms 21-35 must be lodged with the Plumbing Industry Council

Forms for the Plumbing and Drainage Act 2002 Type and size
21 Application for a licence PDF icon 414 KB
22 Application for renewal or restoration of a licence PDF icon 497 KB
23 Application for review of licence conditions PDF icon 486 KB
26 Notice of change in circumstances PDF icon 133 KB
26 Notice of change in circumstances DOC icon 267 KB
27 Proof of identity and document declaration form PDF icon 134 KB
27 Proof of identity and document declaration form DOC icon 269 KB
28 Mutual recognition declaration notice PDF icon 119 KB
28 Mutual recognition declaration notice DOC icon 245 KB
29 Trade experience form - plumbing PDF icon 483 KB
33 Declaration of plumbing qualifications and experience PDF icon 431 KB
34 Declaration of drainage qualifications and experience PDF icon 436 KB
35 Declaration of fire protection qualification and experience PDF icon 428 KB

Templates for the Plumbing and Drainage Act 2002Type and size
Compliance certificate Word icon 29 KB
Compliance permit Word icon 29 KB
Enforcement notice (licensee) Word icon 40 KB
Enforcement notice (owner) Word icon 43 KB
Information notice (compliance permit on conditions) Word icon 33 KB
Show cause notice (licensee) Word icon 28 KB
Show cause notice (owner) Word icon 29 KB
Site induction form - Plumbers and drainers Word icon 47 KB
Site induction form - Fire protection Word icon 46 KB