Public Health Risk Activity Application (Person)

ABN/ACN

Date of Birth

(for non-ABN/ACN holders)

Phone(Required)

Email(Required)

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

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)

Questionnaire – Public Health Risk Activities

This questionnaire must be completed and submitted with the persons application.

What is ‘Cross Contamination’ and why it is important to avoid it?

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.

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?

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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Public Health Risk Activity Application (Person)