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New Tattoo and Body Piercing Facility Application Packet Thank You for Your Interest in Opening a New Tattoo And/Or Body Piercing Facility

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New Tattoo and Body Piercing Facility Application Packet Thank You for Your Interest in Opening a New Tattoo And/Or Body Piercing Facility Food Protection Division 200 E. Berry Street, Suite 360 Fort Wayne, IN 46802 Phone: (260) 449-7126 Fax: (260) 449-3010 www.allencountyhealth.com New Tattoo and Body Piercing Facility Application Packet Thank you for your interest in opening a new Tattoo and/or Body Piercing Facility. In this packet, you will find all of the necessary paperwork and helpful documents that you will need in order to obtain approval for your new facility. Each document is explained in detail below. Feel free to contact our office if you have further questions. PERMIT APPLICATION FOR A TATTOO/BODY PIERCING ESTABLISHMENT Submission of this application, as well as the applicable fee, is required before the Department of Health will approve operation of a new tattoo and/or body piercing facility. Along with the application, you will need to submit proof of a current contract with an infectious waste removal company, as required per Chapter 12 of the Allen County Tattoo and Body Piercing Ordinance. PERMIT APPLICATION FOR A TATTOO/BODY PIERCING ARTIST Each tattoo and/or body piercing artist must obtain an artist permit from the Department of Health. All artists must meet the minimum training requirements and submit proof of the aforementioned training with the artist permit application. GUIDELINES FOR OPENING A NEW TATTOO AND BODY PIERCING FACILITY The purpose of this document is to provide general guidelines for those interested in opening a new tattoo and/or body piercing facility. These guidelines are not an all-inclusive list of the requirements for operation of tattoo and/or body piercing facilities, but will assist new operators with some of the general requirements. All tattoo and/or body piercing facilities are required to follow the regulations set forth in the Allen County Tattoo and Body Piercing Ordinance (Allen County Code, Title 10, Article 7) as well as the Indiana State Department of Health Rule for the Sanitary Operation of Tattoo Parlors (410 IAC 1-5). IOSHA STANDARDS – WRITTEN POLICIES FOR TATTOO AND BODY PIERCING FACILITIES 410 IAC 1-5 requires that all tattoo and/or body piercing facilities provide a written policy that meets the requirements of the Indiana Occupational Safety and Health Administration’s (IOSHA) bloodborne pathogen standard. This document is to be written by the owner/operator of the tattoo and/or body piercing facility and must be submitted before approval to operate is given by the Department of Health. UNIVERSAL PRECAUTIONS 410 IAC 1-5 requires that all tattoo and/or body piercing facilities display these Universal Precautions as means of an approach to infection control. PATRON RIGHTS 410 IAC 1-5 requires that all tattoo and/or body piercing facilities display written information for patrons to know where to report violations. ALLEN COUNTY TATTOO & BODY PIERCING ORDINANCE – FAQ This document is comprised of frequently asked questions (FAQ) as they relate to the Allen County Tattoo & Body Piercing Ordinance. To view the Ordinance in its entirety, visit our website at www.allencountyhealth.com DECLINATION OF HEPATITIS B VACCINE All tattoo and/or body piercing artists are required to submit proof of completion of the Hepatitis B Vaccination series or may decline the vaccine in writing. For those interested in completing the Hepatitis B Vaccination series and unsure where to obtain it, you may contact our Department for information with regard to the cost and availability of receiving the vaccination at our Medical Annex location. That contact number is 260-449-7514. New Tattoo or Body Piercing Facility Application Packet Cover Sheet 7-72 Food & Consumer Protection Division 9/17/12 AMA Rev. 1/9/2020 MRW – MRH 15 Allen County Department of Health Food Protection Division 200 E. Berry Street, Suite 360 Fort Wayne, IN 46802 Phone: (260) 449-7126 Fax: (260) 449-3010 www.allencountyhealth.com PERMIT APPLICATION FOR A TATTOO/BODY PIERCING ESTABLISHMENT Name of Establishment Establishment Address Street City State Zip Code Telephone Email Fax Please Answer the Following Questions 1. Days and Hours of Operation 2. Number of Artists Employed at Establishment 3. List all Artists Names & Mailing Addresses Below (use back of sheet for additional space) Name Address Phone Name Address Phone 4. List Establishment Owner(s) Name(s) & Mailing Addresses Below Name Address Phone Name Address Phone 5. Please circle the services your facility provides Tattooing Body Piercing Both Other 6. Name of Infectious Waste Removal Company **Proof of a current contract with the infectious waste removal company must be submitted prior to approval of permit If the establishment owner/operator is also an artist, no separate artist permit must be obtained, but the following information must be completed below. All artists shall comply with minimum training requirements as required in Allen County Code Title 10, Article 7. I, ___________________________, hereby apply to practice as a Tattoo Artist, Body Piercing Artist or Both (as stated above) as part of my establishment permit for my Tattoo/Body Piercing Establishment in Allen County, Indiana. I also agree to strictly follow all of Allen County and the State of Indiana code(s), laws and regulations pertaining to the operation(s) of Tattoo/Body Piercing Establishments. Tattoo Artist and Body Piercer Responsibilities/Requirements state that each artist must provide documentation of the following information to the Allen County Department of Health. This documentation must also be on file at the licensed Tattoo/Body Piercing Establishment and available for inspection upon request. All applicable corresponding documentation below must be submitted with this permit application. Check the box which applies to you: I have completed the Hepatitis B vaccination series (and am submitting shot record/date verification) I have been offered, and declined, in writing, the Hepatitis B vaccination series (declination form required) I have not completed the Hepatitis B vaccination series but am providing documentation showing at least the first of the series of has been received and will show proof of completion of the series within six (6) months of issue of this permit In addition, I understand that I must maintain documentation of this information for all of the artists who work in my facility and will do so. Permit Type Annual Payment Late Fee (Pro-Rating) after July 1st Tattoo/ Body Piercing Facility $250.00 $312.50 $125.00 Make all checks or money orders payable to: Allen County Department of Health NOTE: Payments made by check that result in non-sufficient funds will result in the requirement for immediate payment to the Allen County Department of Health (plus an additional NSF check fee) via cash, money order or certified check within 24 business hours. If payment is not received within 24 business hours of notification, the establishment will be closed until fees are paid in full. COLLECTIONS NOTICE: Any and all charges for services and permits are your sole responsibility and are to be paid in full upon application. In the event any legal proceeding must be instituted to recover the amount due, the Allen County Department of Health shall be entitled to recover the cost of the collections, including reasonable attorney fees. By signing below, I am agreeing to all conditions listed herein and verify the information provided is accurate. Signature of applicant(s): ___________________________________________________ Date Signed: ________________ Examined and Approved by: OFFICE USE ONLY Receipt Number _________________________________ ___________ Permit Number Environmental Health Specialist Date Date Entered Clerk Permit Application Tattoo/Body Piercing Establishment 7-68 Food & Consumer Protection SS Updated 10/30/19 MRW-MRH 16 Allen County Dept. of Health Food Protection Division 200 E. Berry Street, Suite 360 Fort Wayne, IN 46802 Phone: (260) 449-7126 Fax: (260) 449-3010 www.allencountyhealth.com PERMIT APPLICATION FOR A TATTOO/BODY PIERCING ARTIST Owner/Operator. In the event that a Tattoo/Body Piercing Facility is a sole proprietorship and the owner shall also perform tattooing or body piercing for their business, the owner is only required to obtain a Tattoo/Body Piercing Establishment Permit and does not need to obtain a separate artist permit Name of Artist Home Address Street City State Zip Code Telephone Are you the Permitted Facility Owner? Yes No Email Facility Name Facility Address Street City State Zip Code Facility Phone Facility Fax or Email Please circle the services you are requesting licensure for: Tattooing Body Piercing Both All artists shall comply with minimum training requirements as required in Allen County Code Title 10, Article 7. I, , hereby apply for a permit to practice as a Tattoo Artist, Body Piercing Artist or Both (as stated above) in a permitted Tattoo/Body Piercing Establishment in Allen County, Indiana. I also agree to strictly follow all of Allen County and the State of Indiana code(s), laws and regulations pertaining to the operation(s) of Tattoo/Body Piercing Establishments. Tattoo Artist and Body Piercer Responsibilities/Requirements state that each artist must provide documentation of the following information to the Allen County Department of Health. This documentation must also be on file at the licensed Tattoo/Body Piercing Establishment and available for inspection upon request. All applicable corresponding documentation below must be submitted with this permit application. Check the box which applies to you: I have completed the Hepatitis
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