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.
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.
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.
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.