Online Form - Application for Skin Penetration Procedure Establishment

Regulation 6 of the Health (Skin Penetration Procedure) Regulations 1998

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

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

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 *

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 *