Forms

Licensing forms are currently being reviewed. The following forms are current at December 2018 and can be downloaded and filled in electronically.

Form NoForm Title
GuideGuidance Information: Application for New Health Service Establishment Licence
Form 1Licence Application: New Health Service Establishment Licence
Form 1ALicence Application: Directors Statutory Declaration
Form 1BLicensee Conviction Check Consent Form
Form 2Licence Application: Clinical Governance Requirements
Form 2ALicence Application: Infection Prevention and Control Requirements
Form 2BLicence Application: Medical Advisory Committee Generic Terms of Reference
Form 18Reporting Form: Injuries, Transfers, Deaths and Other Sentinel Events

The following forms are being reviewed. Please contact the Regulation Unit at hselicensing@health.tas.gov.au if you require any of the following forms.

Form Title

Application for Transfer of Licence for a Private Hospital or Day Procedure Centre

Application for Approval to Alter or Extend a Private Hospital or Day Procedure Centre