Under section 76 of the Building Act 2004  it is an offence for a person to use, or to permit another person to use, a regulated swimming pool (including a regulated spa pool) unless the requirements of the Building Act 2004 have been met, including the issue of a certificate of occupancy or use for the swimming pool where required. 

This form is to be used by certifiers to certify that pool fencing or other pool barriers are compliant with the 
Building (General) Regulation 2008, Schedule 1 (Exempt buildings & building work), Part 1.3, item 13, column 4, paragraph (c).

PART A 					PROJECT DETAILS 

Block	
	Section 		Suburb		Unit No.		

Description of pool fencing or other relevant barrier component, tick all that apply:

 metal rod or tube pool fencing			 building enclosing the indoor pool
 timber paling fencing				 exterior walls of a building
 metal sheet fencing				 window of a building
 glass panel fencing				 door or a building
 masonry fence or freestanding wall		 other  (please describe below)

______________________________________________________________________

PART B					DOCUMENTATION REQUIREMENTS	

A site plan showing:
•	the block or unit boundaries 
•	the location and description of the subject pool fencing or pool barrier

PARTC					CERTIFIERS DECLARATION	

I hereby certify that I have inspected the pool fence or other relevant barrier described herein. I am satisfied that they are all compliant with the Building Act 2004 and all the applicable deemed-to-satisfy provisions of the current edition of Building Code of Australia.

ACT Licence Number:	

Name of Certifier:	

Signature of Certifier:		
Date        /         /	

Privacy Notice
The personal information on this form is being collected to enable processing of your application and to enable auditing and compliance of builders and certifiers by the Government appointed auditor.  The information that you provide may be disclosed to the Australian Bureau of Statistics, ACT Revenue Office and the Taxation Office. The information may also be accessed by other government agencies and commercial organisations interested in building information.