Infection Control New Licence Application

About this form

This form is to be used to apply for an Infection Control Activity Licence under the Public Health Act 1997 (the Act). You can access the Act and it's regulation at the Legislation Register.

Important Information

A licence is issued to the applicant for the business, who is the person(s) who will have overall responsibility for the business including any contraventions of the Act. Accordingly:

  • Trusts will not be registered. Companies operating as trustees for a trust will be registered, in the Company name only.
  • Applications listing a partnership as the owner will not be accepted. If your business is operated by a partnership, one or more of the individuals in the partnership will need to be listed.

Attachments

This form requires you to submit the following attachments (PDF is the preferred format for these attachments):

  • One form of current photographic identification sighted and certified by an authorised witness must be provided. Acceptable forms of photographic Identification include Driver’s licence, Proof of age or identity card issued by a State/Territory, Passport. A list of authorised witnesses for true and correct copy can be found on the Attorney-General's Department website.
  • For Company applications a copy of the company’s current extract (issued within the previous 30 days) from the Australian Securities and Investment Commission (ASIC). This can be obtained on the ASIC website
  • A floor plan showing the layout of all fixtures and fittings of the premises.
  • If applying for a fee exempt licence, evidence of fee exempt status is required.

Contact

Health Protection Service

Phone: (02) 6205 1700
Email: hps@act.gov.au

Payment options

Visa and MasterCard logos

Payments up to $10,000 can be made with either Visa or MasterCard.

Your personal information

Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.