Infection Control Activity Licence Variation Application

About this form

This form is to be used to apply for a variation to 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

If you are changing location or the licensee details, this variation form cannot be used. A Transfer or New Application form must be completed and submitted to the Health Protection Service.

Attachment information

A copy of the original licence must be attached to this application.

If this variation application is due to a refurbishment of the premises then a floor plan showing the layout of all fixtures and fittings of the premises must accompany this application.

Contact

Health Protection Service

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

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.