Odour Logsheet and Example

EXAMPLE

ODOUR LOG SHEET

Customer Details

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Office use only

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Name: / Mr John Smith / Customer Contact No.:
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
Date / Time / Intensity / 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

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NOTE:

All log sheets should be COMPLETELY FILLED OUTfor 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.

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:
Date / Time / Intensity / Duration / Remarks
Start / Finish / Strong / Faint
Nuisance Details (cont.)
Date / Time / Intensity / Duration / Remarks
Start / Finish / Strong / Faint
Nuisance Details (cont.)
Date / Time / Intensity / Duration / Remarks
Start / Finish / Strong / Faint
How is this odour affecting you?
Customer Signature