Inspection Organisation Request Form - Energy Safe Victoria

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Inspection Organisation Request Form
SECTION TO BE COMPLETED BY ESV STAFF:
Inspectors Licence Number:
____________________
Allocated Inspection Organisation Number
:____________________
Completed by (Initials & Date)
_____________________
BELOW TO BE COMPLETED BY REQUESTING INSPECTOR:
Inspection Organisation:
__________________________________________________________________________
Address:
__________________________________________________________________________
Suburb:
________________________________
State:
________ Postcode: _________
Contact Details
Phone:
(___) ________________________
Fax: (___) __________________________
Contact Person Details
Title: _________________
First Name: _____________________________ Surname: __________________________
Position: ____________________________________________________________________
Phone:
(___) ________________________
Mobile: ____________________________
Fax:
(___) ________________________
Email: _____________________________
I confirm that I consent to my Inspection Organisation being added in order for my inspection company/business to be
able to be allocated inspections via the ESV Online Services
Signature: ________________________________________________________________________
The details on this form will be used to automatically notify you of requests for inspection. Once loaded to the ESV
system, your inspection company/business will automatically appear on the list of selection for allocation
Please Circle
Would you like ESV to Publish Your Information for the LEI Online Listing be available at
Y
N
Would you like your details passed onto an Inspection Company
Y
N
Inspector?
RETURN THIS FORM TO:
LICENSING SECTION, ENERGY SAFE VICTORIA PO BOX 262
COLLINS STREET WEST VIC 8007
OR BY EMAIL TO
licensing@esv.vic.gov.au
Process: ESV Office Use Only
Please Circle
Details Loaded to ESV System under Inspection Organisation
Y
N
ESV Systems have a matching record for the individual
Y
N
Confirm Allocated Number by Email
Y
N
Select Publish to Public & Via CMS Externally
Y
N
Confirm to Inspection Companies
Y
N
Scan & Attach to Inspectors CMS

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