REPs Facility Audit Form If you have over 15 staff you need to download and complete this via a spreadsheet. click here If you have 15 or fewer staff please continue to complete this form online. Name of person submitting this form(Required) Name Email of person submitting this form(Required) Contact phone number for person submitting this form(Required)Name of Facility Please list all team members who provide exercise advice (including contractors, employees and owners). #1 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #1 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#2 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #2 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#3 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #3 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#4 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #4 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#5 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #5 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#6 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #6 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#7 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #7 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#8 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #8 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#9 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #9 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#10 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #10 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#11 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #11 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#12 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #12 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#13 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #13 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#14 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #14 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that apply#15 Persons Name This should be either the legal name if you know it. Please include any known as names in (brackets). Samantha (Sammy) Smith. #15 Level Personal Trainer (Contractor) Personal Trainer Employee Exercise Consultant Level 2 Exercise Consultant Level 1 Group Exercise - Pre choreographed (Contractor) Group Exercise - Pre choreographed Group Exercise - Own Choreography (Contractor) Group Exercise - Own Choreography Exercise Specialist Exercise Specialist (Contractor) Yoga Teacher Yoga Teacher (Contractor) Please tick ALL that applyConsent I agree that:All Employees, contractors and others who are prescribing exercise advice at above mentioned facility are listed and have their appropriate levels selected. REPs will randomly undertake other types audits to ensure complete declarations are made. Failure to complete this form may result in your registered facility status being revoked.