Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Host Visit and Room InspectionInspection Date & TimeDateTimeInspected byFirstLastAddressAddress Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryFront of the House Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Carer InformationHow many Carers?12Carer 1 NameFirstLastCarer 2 NameFirstLastIs there any pet?YesNoIf yes, please specify(inside, outside and type)Pet photo Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Main Living Area Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Kitchen Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Dining Area Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. How many rooms are currently available for student?012345Room Available dateStudent Room 0 InformationOwn furnished bedroom with a window and inside the family home (not a separates dwelling)Adequate facilities including smoke alarm in the bedroomBedding to suit the seasonSufficient heating and cooling in the bedroomStudent Room 0 Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Additional Information for Student Room 0Student Room 1 InformationOwn furnished bedroom with a window and inside the family home (not a separates dwelling)Adequate facilities including smoke alarm in the bedroomBedding to suit the seasonSufficient heating and cooling in the bedroomStudent Room 1 Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Additional Information for Student Room 1Student Room 2 InformationOwn furnished bedroom with a window and inside the family home (not a separates dwelling)Adequate facilities including smoke alarm in the bedroomBedding to suit the seasonSufficient heating and cooling in the bedroomStudent Room 2 Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Additional Information for Student Room 2Student Room 3 InformationOwn furnished bedroom with a window and inside the family home (not a separates dwelling)Adequate facilities including smoke alarm in the bedroomBedding to suit the seasonSufficient heating and cooling in the bedroomStudent Room 3 Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Additional Information for Student Room 3Student Room 4 InformationOwn furnished bedroom with a window and inside the family home (not a separates dwelling)Adequate facilities including smoke alarm in the bedroomBedding to suit the seasonsufficient heating and cooling in the bedroomStudent Room 4 Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Additional Information for Student Room 4Student Room 5 InformationOwn furnished bedroom with a window and inside the family home (not a separates dwelling)Adequate facilities including smoke alarm in the bedroomBedding to suit the seasonsufficient heating and cooling in the bedroomStudent Room 5 Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Additional Information for Student Room 5Outdoor Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Family InformationIs Carer 1 Australian? Yes, born in AustraliaYes, migratedNoWhat nationality is Carer 1? How long has Carer 1 been in Australia? Is Carer 2 Australian?Yes, born in AustraliaYes, migratedNoWhat nationality is Carer 2?How long has Carer 2 been in Australia?Are resident information same as application?YesNoDid you ask host(s) for updating the resident information onto the system?YesNoHow many people live in this place excluding carer(s)?012345 or moreResident 1 - NameFirstLastResident 1 - RelationResident 1 - GenderMaleFemaleResident 1 - Date of BirthResident 1 - OccupationResident 1 - InstitutionResident 1 - Valid WWCCYesNoUnder 18Resident 1 - WWCC SRN No.Resident 1 - WWCC Expiry dateResident 2 - NameFirstLastResident 2 - RelationResident 2 - GenderMaleFemaleResident 2 - Date of BirthResident 2 - OccupationResident 2 - InstitutionResident 2 - Valid WWCCYesNoUnder 18Resident 2 - WWCC SRN No.Resident 2 - WWCC Expiry dateResident 3 - NameFirstLastResident 3 - RelationResident 3 - GenderMaleFemaleResident 3 - Date of BirthResident 3 - OccupationResident 3 - InstitutionResident 3 - Valid WWCCYesNoUnder 18Resident 3 - WWCC SRN No.Resident 3 - WWCC Expiry dateResident 4 - NameFirstLastResident 4 - RelationResident 4 - GenderMaleFemaleResident 4 - Date of BirthResident 4 - OccupationResident 4 - InstitutionResident 4 - Valid WWCCYesNoUnder 18Resident 4 - WWCC SRN No.Resident 4 - WWCC Expiry dateResident 5 - NameFirstLastResident 5 - RelationResident 5 - GenderMaleFemaleResident 5 - Date of BirthResident 5 - OccupationResident 5 - InstitutionResident 5 - Valid WWCCYesNoUnder 18Resident 5 - WWCC SRN No.Resident 5 - WWCC Expiry dateAnyone in this place smoke?Yes, inside & outsideYes, outside onlyNoAware of Cultural DifferencesYesNoAware of Host responsibilitiesYesNoHouse InformationHome InformationSafe and secure environment - Residential Building RegulationsClean and tidyAdequate heating and coolingAccess to kitchen and laundry facilitiesAdequate living areasAccess to public transportInternet accessSufficient Home and Liability InsuranceAdditional Information for HomeIs there any other homestay student?012345Homestay Student 1 - NameFirstLastHomestay Student 1 - NationalityHomestay Student 1 - Institution Homestay Student 2 - NameFirstLastHomestay Student 2 - NationalityHomestay Student 2 - InstitutionHomestay Student 3 - NameFirstLastHomestay Student 3 - NationalityHomestay Student 3 - InstitutionHomestay Student 4 - NameFirstLastHomestay Student 4 - NationalityHomestay Student 4 - InstitutionHomestay Student 5 - NameFirstLastHomestay Student 5 - NationalityHomestay Student 5 - InstitutionDiscussionCheckboxesWhat is Homestay - Host Family GuidelineMinors - Child Protection Guideline for Homestay FamilyAccept Duty of Care for your student inside and outside the homeMonitor your student's health and well beingSupport your student's studyProvision of nutrition mealsStudent involvement / encouragementHouse rulesUse of Emergency NumberAwareness of Safety Regulation around the homeID CheckYesNoIf ID check is not available, DO NOT proceed it. Please re-arrange inspection date&time.Additional CommentsHost Agreement - Must be filled by HostHost As a homestay host, I understand and agree to the discussion points aboveSignature Clear Signature NameFirstLastConfirmed DateSubmit
