Schedule 1—Form of nomination of a place or object for inclusion in the Heritage Register
Section 27(2) of the Heritage Act 2017
Regulation 5
Nominator details
Details of owner or government asset manager of nominated place or object (if known)
If the nominator is not the owner or the government asset manager (or acting on behalf of the owner or the government asset manager) details of the owner or government asset manager of the place or object:
Nomination details
Nomination Type
*Place
*If place, do you also intend to nominate one or more objects integral to the place? *Yes/*No
*Object
Place or object details
Name of *place/*object:
Address or GPS coordinates of *place/*object:
Who is the responsible authority or, if the responsible authority is not the municipal council, the municipal council for the place or object?
Extent of nomination
For a place: briefly describe the place.
For an object: briefly describe the object or objects. Please include an inventory in the supporting documents if nominating a collection of objects.
Is the place located entirely on Crown land? *Yes/*No
Local Heritage Overlay information
Does this place have a local Heritage Overlay (HO) within a planning scheme? *Yes/*No
If yes, what is the HO number?
Supporting documents
You must provide the following (if applicable) when submitting your nomination—
• a copy of the certificate/s of title issued within 30 days before the nomination for the place is lodged (not necessary for places on Crown land or if nominating objects only);
• a simple and accurate extent diagram clearly showing the extent (boundaries) of the nominated place or object;
Note: This may take the form of spatial files or a copy of an existing map or plan with a clear hand drawn line around the extent showing the land, buildings and other key features you are nominating.
• copies of any heritage studies or guiding documents for the conservation and management of the nominated place or object if they exist;
• if you are nominating a collection of objects, please provide an inventory of those objects;
• recent photographs of the place or object (you may also include historical photographs).
Heritage significance
Heritage Council criteria
Which Heritage Council criteria does this place or object meet?
Note: For a place or object to be included in the Heritage Register it must be of State-level cultural heritage significance based on at least one of the Heritage Council assessment criteria. You must choose one or more of the relevant criteria and provide reasons why the place or object should be included in the Heritage Register based on the criteria chosen. The Executive Director may refuse a nomination if they are not satisfied that the place or object has a reasonable prospect of inclusion in the Heritage Register.
For further information on the Heritage Council criteria and thresholds please refer to the current website of the Heritage Council.
Reasons for State-level cultural heritage significance
Provide reasons why the place or object is of State-level cultural heritage significance based on the criteria selected:
Statement of cultural heritage significance
Please describe the place or object according to the following, naming the most significant elements:
What is significant?
How is it significant?
Why is it significant?
Other information
History of the place or object
Please provide a comprehensive history of the place or object which explores its historical associations and details its development over time.
Comparative analysis
Provide comparisons (relevant to State-level cultural heritage significance) to similar places or objects included in the Heritage Register or describe how the place or object differs from similar places or objects which are the subject of determinations to not include those places or objects in the Heritage Register.
Aboriginal cultural heritage values (if known)
Who are the traditional owners of this place or object?
Does this place or object have Aboriginal cultural heritage values in addition to non-Aboriginal cultural heritage values (shared values)? *Yes/*No
If yes, please provide details below.
Note: If the place or object is of cultural heritage significance only on the grounds of its association with Aboriginal tradition, Aboriginal traditional use, or Aboriginal archaeology, it may be more appropriate for registration in the Victorian Aboriginal Heritage Register. Please refer to the current website of the Victorian Aboriginal Heritage Register.
Please name key sources that may provide historical information about this place or object. This could include books, publications, websites, the names of experts or any other resource.
Condition, intactness and integrity of the place or object
Condition
The condition of the place or object is generally: *Excellent/*Good/*Fair/*Poor
Is there any damage to the fabric (the materials from which the place or object is made)? *Yes/*No
If yes, please specify which materials and the extent of damage:
Intactness and integrity
How much of the original form or appearance of the place or object remains?
What alterations are present and why was the place or object altered?
Is it still possible to interpret the heritage values of the place or object if it has changed or been altered?
Threat
Is the place or object under immediate or imminent threat? *Yes/*No/*Don't know
If yes, please describe the threat:
Has a demolition permit been issued under the Building Act 1993? *Yes/*No/*Don't know
Has a planning permit been issued by the responsible authority for the redevelopment of the land? *Yes/*No/*Don't know
Is there evidence of plant and equipment being mobilised to demolish the place? *Yes/*No/*Don't know
Is there evidence of an imminent proposal to destroy, remove or disassemble the object (or group of objects) or elements of the place? *Yes/*No/*Don't know
Are there any known proposals to relocate buildings or the object(s) to another location? *Yes/*No/*Don't know
Is the deteriorating condition of the place or object(s) posing a threat to its intactness or integrity? *Yes/*No/*Don't know
Please provide any other additional details about the threat:
Statement
Name of *nominator/*person acting on behalf of nominator:
Sch. 1A inserted by S.R. No. 3/2024 reg. 15, amended by S.R. No. 13/2025 reg. 12.
Schedule Sch 1 - Heritage Regulations 2017 - Form of nomination of a place or object for inclusion in the Heritage Register | Zoe