Odour Logsheet and Example

EXAMPLE ODOUR LOG SHEET Customer Details Health Services Office use only will fill this Name: Mr John Smith Customer Contact No.: section out Address: 1 Melbourne Street MELBOURNE 3000 Phone: 9658 9658

Nuisance Details Source of Odour: Vent in the side of a building Type of Odour: Sewage type smell Address of Odour: Building behind 1 Melbourne Street MELBOURNE 3000 Time Intensity Date Duration Remarks Start Finish Strong Faint 03/07/02 6.00am 10.00am 4hrs I was dry retching due to the awful odour 03/07/02 10.30am 2.30pm 4hrs

03/07/02 3.00pm 7.00pm 4hrs I was unable to open my windows

03/07/02 7.30pm 11.30pm 4hrs

04/07/02 6.00am 10.00am 4hrs

04/07/02 10.30am 2.30pm 4hrs I was dry retching due to the awful odour

04/07/02 3.00pm 7.00pm 4hrs

04/07/02 7.30pm 11.30pm 4hrs 05/07/02 - - - I was not at home 06/07/02 - - - 07/07/02 - - - 08/07/02 6.00am 10.00am 4hrs

How is this odour affecting you?

I am unable to go outdoors most days without feeling ill. The smell has also stopped my friends coming to visit.

Customer Signature

NOTE: All log sheets should be COMPLETELY FILLED OUT for a period of TWO WEEKS. Log sheets play an important role in assisting Health Services to help you. If the case is settled in court, log sheets will be used as evidence. DOCS#779387

ODOUR LOG SHEET Customer Details Office use only Name: Customer Contact No.: Address:

Phone:

Nuisance Details Source of odour: Type of odour: Address of odour:

Time Intensity Date Duration Remarks Start Finish Strong Faint Nuisance Details (cont.) Time Intensity Date Duration Remarks Start Finish Strong Faint

Nuisance Details (cont.)

Time Intensity Date Duration Remarks Start Finish Strong Faint How is this odour affecting you?

Customer Signature

DOCS#779387