Online Form - Application for Skin Penetration Procedure Establishment

Premises Details

Name of Business*

Address of Business*

Phone Number*

Email Address*

Hours of Operation

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Type of premises

Please indicate the type of premises you intend to operate*

Proprietor Details

Name*

Address

Phone Number

Email Address

Please attached copies of your relevant qualifications

Maximum size of ALL attachments is 976.56 MB

Select all procedures to be carried out on premises*

TattooingEar_and_Body_PiercingWaxingNail_Treatments
Cosmetic_TattooingAcupunctureSkin_NeedlingDry_Needling
Permanent_Hair_Removal(eg_IPL)

Please detail any other procedures performed which are not listed above

Food and Drink on Premises

Please indicate if food / drink will be prepared on the premises*

Yes
No

If yes to the above, please submit a Food Act 2008 Notification / Registration Form

Maximum size of ALL attachments is 976.56 MB

Procedures

How will you undertake equipment sanitisation?*

How will you undertake laundering towels and linen?*

How will you undertake cleaning and maintenance of premises?*

How will you dispose of sharp equipment?*

Please upload a site plan of the proposed layout of the establishment*

Maximum size of ALL attachments is 976.56 MB

Declaration

I/We declare that all details in this form are true and correct. Please be advised providing false information may be an offense.

An Assessment fee of $95 is applicable to this application.

Name of Applicant*

Contact Number*

Signature of Applicant*

Date*

I understand that I must submit a detailed site plan of the proposed premises including the following:

o Procedure area
o Hand washing facilities
o Work stations and preparation area
o Preparation area for refreshments
o Instruments and equipment storage area
o General waste and medical waste receptacles
o Laundry facilities
o Natural or mechanical ventilation

Please submit a detailed site plan*

Maximum size of ALL attachments is 976.56 MB