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Public Health Risk Activity Application (Person)
Public Health Risk Activity Application (Person)
Use this form if you a person who is performing skin penetration practices in Clarence.
Name of application
(Required)
First
Last
ABN/ACN
Date of Birth
DD slash MM slash YYYY
(for non-ABN/ACN holders)
Phone
(Required)
Email
(Required)
Address of applicant
(Required)
Street Address
Address Line 2
City
State / Province / Region
Post Code
Is your postal address different from above?
(Required)
Yes
No
Postal address of applicant
Street Address
Address Line 2
City
State / Province / Region
Post Code
Business Details
Business Trading Name
(Required)
Where the applicant will be carrying out this activity
Business Name
(Required)
Depicted on the street frontage of the premises
Business Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
Post Code
Name of Business Manager
First
Last
Emergency Contact Name
(Required)
First
Last
Emergency Contact Phone
(Required)
What Public Health Risk Activities do you propose to conduct on these premises?
(Required)
What training have you undertaken, or experience do you have, in relation to infection control? Please attach supporting documentation if available
(Required)
Are you renewing or applying for the first time?
(Required)
Renewing my application
Applying for the first time.
Questionnaire – Public Health Risk Activities
This questionnaire must be completed and submitted with the persons application.
Name three diseases that can be spread by infected blood or other body substances.
1
2
3
Add
Remove
What is ‘Cross Contamination’ and why it is important to avoid it?
Give two examples of how this can occur during tattooing/ear and body piercing procedures.
1
2
Add
Remove
If your customer starts to bleed, what basic actions/procedures must you take and why?
What type of records must you keep about a client and their procedure?
Name a solution that can be used to disinfect the skin.
Pick the description that best describes the following terms.
Sterilisation
A process that should eliminate all forms of microbial life, including bacterial spores.
A process of removing body substances and other debris and reducing the number of micro-organisms by a process such as washing in detergent.
A process of eliminating all micro-organisms except bacterial spores.
A process that includes all of the above processes.
Disinfection
A process that should eliminate all forms of microbial life, including bacterial spores.
A process of removing body substances and other debris and reducing the number of micro-organisms by a process such as washing in detergent.
A process of eliminating all micro-organisms except bacterial spores.
A process that includes all of the above processes.
Cleaning
A process that should eliminate all forms of microbial life, including bacterial spores.
A process of removing body substances and other debris and reducing the number of micro-organisms by a process such as washing in detergent.
A process of eliminating all micro-organisms except bacterial spores.
A process that includes all of the above processes.
Hand washing must occur:
Between customers.
After using the bathroom.
After cleaning.
After smoking.
Before putting gloves on and after taking them off.
All of the above.
When must gloves be disposed of?
After answering the telephone.
After contact with blood and body fluids.
After touching anything other than sterilised surfaces.
After answering the telephone or contact with blood and body fluids.
All of the above.
Surfaces and equipment can become contaminated when operators:
Adjust overhead light fittings.
Adjust settings on equipment or power packs.
Touch curtains, drapes or bin lids.
After answering the telephone
Adjust furniture and equipment.
All of the above.
Any creams or ointments used during or after tattooing must be dispensed by: (if applicable)
Placing the nozzle directly on the skin.
Using a clean finger to get it out and spread it around.
Using a clean, single-use applicator which is then disposed of in the infectious waste bin.
All of the above.
How must used items, such as cotton balls and gloves, be disposed?
How often must the linen/covers on the treatment table/area be changed?
Should a client showing signs of skin sores/infections at the site to be tattooed or pierced, undergo the procedure? Why?
When dye-dispensing, how would you transfer dye from the stock jar/bottle to the mixing cap? (if applicable)
Describe how you would clean the piercing equipment or tattoo machine after each use.
Can you re-use dye caps? Yes or No (if applicable)
What must be used to remove excess fluids (eg blood) from the area being tattooed or pierced?
What procedure will you use to ensure ‘cross contamination’ does not occur if you need to put the hand piece/machine down during a tattoo?
Is mobile tattooing or ear and body piercing permitted in Tasmania?
Declaration
(Required)
I declare that the information provided on this form is true and correct.
The personal information on this form is required by Clarence City Council for the Registration of a Public Health Risk Activity (Person) under the Public Health Act 1997. We will only use your personal information for this and related purposes. If this information is not provided, council may not be able to process this application. You may access and/or amend your personal information at any time. How we use this information is explained in our Privacy Policy, which is available at www.ccc.tas.gov.au/privacy or at Council Chambers.
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