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Assessment Templates for Licensing Authorities

Find the template you need

These templates include questions based around:

  • The conditions attached to the Premises Licence
  • The provisions of the Gambling Act 2005
  • The social responsibility provisions contained within the Code of Practice
  • The Statement of Principles issued under Section 349 of the Gambling Act 2005 (specific to each Local Authority)

These templates are reviewed regularly to ensure that they reflect legislative change. They can be printed directly from this website or downloaded and customised to meet your own requirements. You may wish to replace our logo banner with your own council logo prior to use.

More information on templates

Below you will find links to each template, just click to download:

Statement on Entry

Where an ‘appropriate recipient’ (a person who occupies the premises or is responsible for their management) is present during an assessment, an inspector carrying out the assessment must communicate the following information at the earliest opportunity:

  • Any ‘interested person’ may make a request in writing for a written record of the inspection;
  • How requests can be made;
  • Who would be categorised as an interested person in relation to the premises.

If there is no appropriate recipient present during the inspection, the inspector must leave a written notice on the premises which contains the following information:

  • the fact that the premises have been inspected;
  • the name of any inspector who carried out the inspection;
  • the date of the inspection; and
  • the information referred to in bullet points above.


If a person at the premises refuses to answer a question posed by the authorised local authority officer, then the officer must verbally inform the person as follows:

“I am required to inform you that this question is being asked under the powers provided for in Section 317(1)(b) of the Gambling Act 2005 and that it is an offence under Section 326 if, without reasonable excuse, a person obstructs or fails to co-operate with the officer who is exercising or seeking to exercise a power under, or by virtue of Part 15 of the Gambling Act 2005.”

It is suggested (it is not required by the legislation) that this statement is explained with the following words:

“I am empowered by the Gambling Act 2005 to ask questions of any person on these licensed premises where it relates to assessing whether there is compliance with the provisions of the Gambling Act 2005, or to assess whether an offence under the Act is being committed.  If that person obstructs or fails to co-operate with me whilst I am doing this, then an offence is being committed under the Act” 

It might be useful to add:

“The maximum penalty on summary conviction for this offence is a fine of level 3 on the standard scale which is £1000.”

Evidence of Identity

The authorised local authority officer must provide evidence of their identity and authority to a person who appears to the officer to be the occupier of the premises or have responsibility for their management at the time of the inspection.  Any person accompanying an authorised local authority officer must also provide evidence of their identity (Gambling Act 2005 Section 321 and SI 2007 / 319 paragraph 3).