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

4. List Establishment Owner(s) Name(s) & Mailing Addresses Below

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

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 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

Permit Type Annual Payment Late Fee (Pro-Rating) after July 1st Tattoo Artist or Body Piercer $ 75.00 $ 93.75 $ 37.50 (Permit expires on December 31 of each year.)

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.

By signing below, I am agreeing to all conditions listed herein and verify the information provided is accurate.

Signature of applicant(s): ______Date Signed: ______

OFFICE USE ONLY Receipt Number ______Permit Number______Artist Verified with Facility (date & initials) ______Date Entered ______Clerk ______

Permit Application for Tattoo/Body Piercing Artist 7-67 Food & Consumer Protection SS Updated 10/30/2019 MRW-MRH 14 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

Opening a Tattoo or Body Piercing Establishment General Guidelines

If you are planning to open a new tattoo or body piercing facility in Allen County, please refer to the following list of major requirements taken from the applicable state code and local ordinance:

1. Your establishment cannot be attached to a house or open into a living area.

2. A working sink equipped with hot and cold water must be readily accessible to every work area (i.e.; staff should not have to walk through a door, move a curtain, etc., to access the sink for use).

3. There can be no carpet in the tattoo/body piercing work areas. All surfaces in these work areas must be smooth, nonporous, and easily cleanable.

4. You must provide personal protective equipment for every employee as applicable.

5. Call our office at 260-449-7126 for an inspection at least one week before the date you would like to open your establishment so that our Department can conduct a preliminary inspection and ensure you are in compliance with all applicable rules.

6. The autoclave must be spore-tested and documentation stating it has passed the test must be provided at the time of the inspection. The only exception to the requirement for use of an autoclave is if your facility plans on using single-use equipment only and does no body piercing.

7. You must obtain a Tattoo & Body Piercing establishment permit from the Allen County Department of Health prior to any operation of the establishment. A permit will not be issued until an inspection is conducted and approval to open is given by the Health Department.

8. Every person performing tattoo or body piercing activities in the establishment must obtain an artist permit from the Department of Health. A current blood borne pathogen training certificate must be presented when applying. All artists will also need to show proof of completion of the Hepatitis B vaccination series or decline the vaccine in writing (a declination form will be provided at the time of application).

9. A copy of the infectious waste hauler agreement for the establishment must be submitted with the application.

This is not an all-inclusive listing of items required before opening a tattoo and body piercing facility. All 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 Requirements for the Sanitary Operation of Tattoo Parlors (410 IAC 1-5) must be met before a permit will be issued. Please contact our office with any questions or to schedule your inspections as needed.

Guidelines for New Tattoo Facility 7-73 Food & Consumer Protection Division SS/AMA 9/14/12 MRW-MRH 1-9-2020 13 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

Model Policies for Tattoo and /or Body Piercing Facilities

This “fill-in-the-blank” model policy was prepared by the Indiana State Department of Health to assist tattoo and/or body piercing facilities in developing written policies to comply with 410 IAC1-5. Citations from the law are written in italics. Bullet points without any “fill-in-the-blanks” are policies that all facilities must observe. The operator must signify that the policies are in place and have been implemented by placing his/her initials on the line immediately after these bullet points. Information that the facility must provide is to be placed in the blanks.

Disclaimer: The attached material should be used by the operator as a starting point in the preparation of written policies. Review of applicable law and/or consultation with the operator’s legal counsel on specific matters of concern is recommended. This document addresses only the requirements of 410 IAC1-5.

Name of Facility:______Address: ______Policies were prepared by: ______Preparer’s Relationship to the Facility: ______Date Prepared: ______

This policy must be reviewed annually. Please list the month and day that the plan was reviewed for the years listed below. Indicate if changes were made, and list the name of the person reviewing the plan. Do not indicate the month and day of the review until the review has been completed.

Year Month and day of Place check mark Name of reviewer review If changes were made 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

410 IAC 1-5-24 Operator training responsibilities Sec. 24. An individual or entity that is an operator shall comply with the following training responsibilities: (1) Ensure that the training described in the Indiana occupational safety and health administration's blood borne pathogens standard (as found in 29CFR 1910.1030) is provided to all tattoo artists and body piercers, anyone employed by the

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 1

facility or anyone acting on behalf of the facility, who has a reasonably anticipated risk for skin, eye, mucous membrane, or parenteral contact with blood or OPIM. (2) Ensure that training on the handling of infectious waste is provided to all tattoo artists and body piercers, or anyone employed by the facility or anyone acting on behalf of the facility who has a reasonably anticipated risk for skin, eye, mucous membrane, or parenteral contact with blood or OPIM. (3) Ensure that a record of training described in subdivision (1) is maintained, as required under the Indiana occupational safety and health administration's blood borne pathogens standard (as found in 29CFR 1910.1030) of an individual's participation in the training that is provided. The record shall be made available to the department for inspection upon request. (4) Ensure that a record of training described in subdivision (2) is maintained.

• _____Bloodborne Pathogens training and training on handling infectious waste in this facility is provided yearly. A list of individuals at the facility who may have contact with blood or other potentially infectious materials, the date that the individual began working at the facility, the date and location (i.e. Red Cross) of their training, and the date the individual quit working at the facility is included in this written policy. • _____Training records are kept at the facility for _____ years.

410 IAC 1-5-25 Operator responsibilities Sec. 25. (a) The operator shall ensure that tattoo artists, body piercers, or anyone employed by the facility or anyone acting on behalf of the facility who has a reasonably anticipated risk for skin, eye, mucous membrane, or parenteral contact with blood have and use personal protective equipment and expendables needed to implement the precautions required by this rule and the Indiana occupational safety and health administration's blood borne pathogens standard (as found in 29CFR 1910.1030). (b) The operator shall require tattoo artists and body piercers, anyone employed by the facility, or anyone acting on behalf of the facility who has a reasonably anticipated risk for skin, eye, mucous membrane, or parenteral contact with blood to provide evidence of compliance with the universal precautions education requirements contained in section 27 of this rule. (c) The operator shall display a description of compliance with the requirements contained in subsection (d). (d) The operator shall display written materials prepared or approved by the department explaining universal precautions and patrons' rights under this rule. These materials shall include information on how to report violations of universal precautions and shall include information regarding the department's duties to investigate.

• List the personal protective equipment and expendables needed for tattooing and/or piercing (i.e. razors, gauze, soap, towels) that each tattoo artist or body piercer in the facility has available. The operator of the facility does not need to provide the supplies but must be sure that the supplies are available. Personal protective equipment and expendables available for tattoo artists are listed below:

______

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 2

• Personal protective equipment and expendables available for body piercers are listed below: ______

410 IAC 1-5-26 Operator written policies:

Sec. 26. The operator shall develop a written policy in compliance with this rule and the requirements of the Indiana occupational safety and health administration's bloodborne pathogen standard (as found in 29 CFR 1910.1030) that: (1) requires the use of universal precautions when performing tattooing or body piercing and any activity or duty that includes any reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM; (2) requires disinfection or sterilization of contaminated reusable items; (3) includes the safe handling of infectious waste; and (4) provides sanctions, including discipline and dismissal, if warranted, for failure to use universal precautions or handle infectious waste safely, or both.

• _____This facility requires the use of universal precautions. • _____This facility requires the safe handling of infectious waste. • Sanctions when persons who have contact with blood and/or other potentially infectious materials but do not follow the requirements of this law are as follows: ______

410 IAC 1-5-27 Tattoo artist and body piercer minimum training and certification requirements

Sec. 27. (a) All tattoo artists, body piercers, anyone employed by the facility, and anyone acting on behalf of the facility, who has a reasonably anticipated risk for skin, eye, mucous membrane, or parenteral contact with blood or OPIM shall complete the training program that is required under the requirements of the Indiana occupational safety and health administration's bloodborne pathogen standard (as found in 29 CFR 1910.1030). The programs under this section shall be as follows: (1) A bloodborne pathogen training session provided by the operator meeting the requirements under the Indiana occupational safety and health administration's bloodborne pathogens standard (as found in 29 CFR 1910.1030). (2) Any bloodborne pathogen continuing education program provided by a health care agency. (b) All tattoo artists, body piercers, anyone employed by the facility, and anyone acting on behalf of the facility, who has a reasonably anticipated risk for skin, eye, mucous membrane, or parenteral contact with blood or OPIM must be trained in the facility's policies on the handling of infectious waste.

• _____Tattoo artists and body piercers have received training regarding bloodborne pathogens and handling of infectious waste. See the “fill in the blanks” training record on the following page.

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 3

Bloodborne Pathogens Training Record for (Name of Facility) ______for the Year ______

Person that needs yearly bloodborne Date that the Date and location Date pathogen training (each person person began of training employee requiring training must provide the working at the quit working date and location of training every facility at the facility year)

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 4

410 IAC 1-5-28 Patron records

Sec. 28. Records of each patron shall be maintained by the operator for two (2) years. The record shall include the following, but not be limited to: (1) Patron's name. (2) Address. (3) Age. (4) Date tattooed or body pierced. (5) Design of the tattoo. (6) Location of the tattoo or body piercing on the patron's body. (7) The name of the tattoo artist or body piercer who performed the work. (8) Jewelry or other decoration used.

• Training records are kept for ____ years in the following location at the facility: ______• ____ The record meets the requirements of the law.

410 IAC 1-5-29 Illness.

Sec. 29. Tattoo artists or body piercers who are experiencing symptoms of acute disease that include, but are not limited to: (1) diarrhea; (2) vomiting; (3) fever; (4) rash; (5) productive cough; (6) jaundice; or (7) draining (or open) skin infections, boils, impetigo, or scabies; shall refrain from providing tattoos or body piercing.

• ____Tattoo artists or body piercers who are acutely ill with any of the illnesses listed in the law are not allowed to work.

410 IAC 1-5-30 Handwashing

Sec. 30. (a) Handwashing facilities shall be readily accessible where tattooing or body piercing, or both, is provided. (b) Hands shall be washed with soap and running water immediately before putting on gloves and after removal of gloves or other personal protective equipment. (c) Only single-use towels shall be used.

• ____ Handwashing sinks are accessible and the tattoo artist or body piercer can reach the sink without contaminating any object. • ____ Hands are washed with soap and running water immediately before putting on gloves and after taking gloves or other personal protective equipment off. • ____ Only single use towels are used.

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 5

410 IAC 1-5-31 Personal protective equipment

Sec. 31. Appropriate personal protective equipment shall be worn as follows: (1)A clean protective clothing layer shall be worn whenever there is a reasonably anticipated risk of contamination of clothing by blood or OPIM. (2) Masks in combination with eye protection devices, such as goggles or glasses with solid side shield, or chin length face shield, shall be worn whenever splashes, spray, splatter, or droplets of blood or OPIM may be generated and eye, nose, or mouth contamination can be reasonably anticipated. (3) Disposable gloves, such as surgical or examination type, shall be worn during the tattooing or body piercing process. Gloves shall be changed and properly disposed of each time there is an interruption in the application of the tattoo or body piercing, when the gloves become torn or punctured, or whenever the ability to function as a barrier is compromised. Disposable gloves s hall not be reused. (4) Gloves shall be worn when decontaminating environmental surfaces and equipment.

• Clean protective clothing is worn performing the following tasks: ______• ____ Disposable gloves are surgical or examination type and are worn during tattooing or body piercing. They are always changed whenever there is an interruption in the tattoo or body piercing process and when torn. • ____ Disposable gloves are not reused. • ____ Gloves are worn when decontaminating surfaces. • List any other personal protective equipment used in the facility for tattooing: ______• List any other personal protective equipment used in the facility for piercing: ______

410 IAC 1-5-32 Tattooing equipment

Sec. 32. (a) Only single-use razors shall be used to shave the area to be tattooed. (b) All stencils shall be properly disposed of after a single use. (c) If the design is drawn directly onto the skin, it shall be applied with a single-use article only.

• Razors, stencils, and articles, such as pens used to place designs on the skin, are single use. List how the facility disposes of these items: ______

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 6

410 IAC 1-5-33 Needles

Sec. 33. (a) Needles shall be individually packaged and sterilized prior to use. (b) Needles shall be single-use only. (c) Needles shall be discarded in sharps containers immediately after use. (d) Contaminated needles shall not be bent or broken or otherwise manipulated by hand.

• ____ Needles are only used on one patron and discarded immediately into a “sharps” container. • The needles used on all patrons are sterile and packaged in (list type of packaging): ______• ____ Contaminated needles are never bent, broken, or manipulated by hand. • List any other practices that your facility has concerning needles: ______

410 IAC 1-5-34 Reusable equipment

Sec. 34. (a) Heating procedures capable of sterilization must be used when heat stable, nondisposable equipment is sterilized. (b) Equipment that is to be sterilized shall be put in single-use packaging. (c) Records must be maintained to document the following: (1) Duration of sterilization technique. (2) Determination of effective sterility, such as use of a biological indicator, is performed monthly. (3) Equipment is maintained as recommended by the owner's manual, and proof is available that the owner's manual recommendations are reviewed monthly. (d) Reusable contaminated equipment shall not be stored or processed in a manner that requires any person to reach by hand into the containers where these sharp items have been placed. (e) Reusable contaminated equipment shall be: (1) placed in puncture-resistant containers; (2) labeled with the biohazard symbol; (3) leakproof on both sides and bottom; and (4) stored in a manner that does not require reaching by hand into the container where the equipment is stored until cleaning prior to sterilization. (f) Reusable contaminated equipment shall be effectively cleaned prior to sterilization or disinfection. (g) Any reusable contaminated equipment that comes into direct contact, or is likely to come into direct contact, with an instrument that penetrates the skin other than a piercing gun shall be effectively cleaned and sterilized prior to use. (h) All sterilized equipment shall not be removed from wrappers or sterilizer packaging until immediately prior to use. (i) Any reusable equipment that comes into contact with mucus [sic., mucous] membranes shall be effectively cleaned and sterilized prior to use. (j) Piercing guns shall be cleaned and undergo, at a minimum, high level disinfection after each use and whenever visibly contaminated. (k) All reusable equipment that has contact with intact skin shall undergo, at a minimum, intermediate level disinfection. (l) All other equipment used during the tattooing or body piercing procedure shall be single use, including corks. (m) All body piercers and tattoo artists shall comply with all other equipment manufacturer's recommendations.

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 7

• This facility uses ______to sterilize equipment. The equipment cleaning sterilization procedure used at this facility is as follows: ______

In Section 1 of the table below, list all equipment used in the facility during tattooing or body piercing. In Section 2, check whether it is single use or reusable (only one check mark in Section 2), In Section 3, check the method used for sterilization of reusable equipment. Check ONLY ONE, the highest level of disinfection/ sterilization (i.e. for equipment that is soaked in a disinfectant before you sterilize, check sterilize). Note that Section 3 is not completed for equipment that is single use.

Section 1 Section 2 Section 3 Name of Equipment Single Use Reusable Reused: Reused: Reused: heat high-level Intermediate sterilized disinfection -level Disinfection

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 8

Section 1 Section 2 Section 3 Name of Equipment Single Use Reusable Reused: Reused: Reused: heat high-level Intermediate sterilized disinfection -level Disinfection

• ____ Single use packaging is used for equipment being sterilized and the equipment is not taken out of the packaging until immediately prior to use. • ____ All manufacturers’ recommendations are followed. • List each step used in sterilizing equipment (includes cleaning before sterilizing):

Step 1: ______Step 2: ______Step 3: ______Step 4: ______Step 5: ______Step 6: ______Step 7: ______Step 8: ______Step 9: ______Step 10: ______

• List any other policies relating to reusable equipment (procedure for high-level and intermediate level disinfection, if applicable): ______

410 IAC 1-5-35 Dyes or pigments or other objects placed under the skin

Sec. 35. (a) All dyes or pigments used in tattooing shall be from professional suppliers specifically providing dyes or pigments for the tattooing of human skin. (b) In preparing dyes or pigments to be used by tattoo artists, only nontoxic, sterile materials shall be used. Single-use or individual portions of dyes or pigments in clean, single-use containers shall be used for each patron. (c) After tattooing, the remaining unused dye or pigment in single-use or individual containers shall be discarded along with the container. (d) Any object placed under the skin shall be sterile.

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 9

• Dyes or pigments at this facility are purchased from the following: ______• ____ Single use containers are used for dyes and unused dyes or pigments are discarded use. • Any object (such as sand) placed under the skin must be sterile. List items placed under the skin in this facility: ______

410 IAC 1-5-36 Work environment

Sec. 36. (a) No tattooing or body piercing shall be conducted in any room used as living quarters or in any room that opens directly into living or sleeping quarters. (b) Live animals shall be excluded from areas where tattooing or body piercing is being conducted. This exclusion does not apply to the following: (1) Patrol dogs accompanying security or police officers. (2) Guide dogs accompanying the following: (A) Blind persons. (B) Partially blind persons. (C) Physically disabled persons. (D) Guide dog trainers. (E) Persons with impaired hearing. (c) Eating, drinking, smoking, applying cosmetics, or handling contact lenses shall not be allowed in work areas where there is a likelihood of exposure to blood or OPIM. (d) Food and drink shall not be kept in areas where there is a reasonably anticipated risk of exposure to blood or OPIM. (e) All equipment and environmental surfaces shall be cleaned and disinfected after contact with blood or OPIM. (f) Environmental surfaces and equipment not requiring sterilization that have been contaminated by blood shall be cleaned and disinfected. (g) All work surfaces shall be: (1) nonabsorbent; (2) easily cleanable; (3) smooth; and (4) free of: (A) breaks; (B) open seams; (C) cracks; (D) chips; (E) pits; and (F) similar imperfections. (h) Disinfectant solutions shall be: (1) a hospital grade, tuberculocidal Environmental Protection Agency (EPA) registered disinfectant; or (2) sodium hypochlorite, five-tenths percent (0.5%) concentration, by volume (common household bleach in ten percent (10%) concentration in water); the solution shall be dated and shall not be used if it is more than twenty-four (24) hours old.

• ____ Tattooing or body piercing is not performed in living quarters or in areas that open up to living areas. • ____ The only live animals that can come into the facility are patrol dogs and guide dogs. • ____ Eating, drinking, smoking, applying cosmetics, or handling contact lenses is not allowed in the work area. • ____ Work surfaces are non-absorbent, easily cleaned, smooth and free of breaks, open seams, cracks, pits, and similar imperfections. • Environmental surfaces in the work area and equipment contaminated with blood must be cleaned and disinfected. The disinfectant used in this facility is as follows: ______

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 10

410 IAC 1-5-37 Infectious waste containment

Sec. 37. (a) Contaminated disposable needles or instruments shall be: (1) stored in: (A) leak-resistant; and (B) puncture-resistant;containers; (2) tightly sealed to prevent expulsion; (3) labeled with the biohazard symbol; and (4) effectively treated in accordance with this rule prior to being stored in an unsecured area and sent for final disposal. (b) Infectious wastes that are not contaminated sharps or objects that could potentially become contaminated sharps shall be placed in containers that meet the following requirements: (1) Impervious to moisture. (2) Sufficient strength and thickness to prevent expulsion. (3) Secured to prevent leakage expulsion. (4) Labeled with the biohazard symbol. (5) Effectively treated in accordance with this rule prior to being placed in an unsecured area and sent for final disposal. (c) If infectious waste is stored prior to final disposal, all persons subject to this rule shall store infectious waste in a secure area that: (1) is locked or otherwise secured to eliminate access by or exposure to the general public; (2) affords protection from adverse environmental conditions and vermin; and (3) has a prominently displayed biohazard symbol. (d) Infectious waste shall be stored in a manner that preserves the integrity of the container and is not conducive to rapid microbial growth and putrefaction. (e) Disinfect reusable containers for infectious waste each time that they are emptied unless the surfaces of the reusable containers have been protected from contamination by disposable liners, bags, or other devices that are removed with the infectious waste.

• List infectious waste items that are placed in leak-resistant, puncture-resistant containers immediately after use: ______

• List other infectious waste items (i.e. gauze soaked with blood) and state disposal method for those items: ______

• After infectious waste containers are appropriately filled, the containers are stored in the following location in the facility: ______• _____The storage area meets these requirements: the area is secure (either locked or has no public access), protected from adverse environmental conditions, and displays the biohazard symbol. • If reusable containers are used (i.e. plastic liners used in the container), list how they are disinfected if Contaminated with blood: ______

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 11

410 IAC 1-5-38 Treatment and transport of infectious waste

Sec. 38. (a) All operators shall ensure that infectious waste is either treated on-site in accordance with this rule or transported off-site for treatment in accordance with this rule. (b) A treatment is effective if it reduces the pathogenic qualities of infectious waste for safe handling, is designed for the specific waste involved, and is carried out in a manner consistent with this rule. Effective treatment may include: (1) incineration in an incinerator designed to accommodate infectious waste; (2) steam sterilization; (3) chemical disinfection under circumstances where safe handling of the waste is assured; (4) thermal inactivation; (5) irradiation; or (6) discharge in a sanitary sewer or septic system that is properly installed and operating in accordance with state and local laws. (c) All persons subject to this rule shall: (1) transport infectious waste in a manner that reasonably protects waste haulers and the public from contracting a dangerous communicable disease; and (2) effectively treat infectious waste in accordance with this rule before it is compacted. (d) The operator shall ensure that infectious waste, effectively treated or not is transported off-site in compliance with 410 IAC 1-3.

• ____ This facility does not compact untreated infectious waste. • If infectious waste is treated in the facility, state the method of treatment: ______• If transported off-site for treatment, state treatment facility: ______• ____ When infectious waste is treated, either at the facility or somewhere other than the facility (usually a commercial vendor), a form is generated that has the following information: name, address, and telephone number of the tattoo/body piercing facility and the treatment facility if the infectious waste is being sent to a treatment facility, a brief description of the infectious waste (i.e. used tattoo needles), the method of effective treatment, and the signature of a responsible person at the tattoo/body piercing facility.

IOSHA Standards/ Policies for Tattoo/Body Piercing Facilities 7-76 Food & Consumer Protection AMA Rev. 1-10-20 MRW-MRH 11 Allen County Dept. of Health 12

Food Protection Division  200 E. Berry Street, Suite 360  Fort Wayne, IN 46802

Phone: (260) 449-7126  Fax: (260) 449-3010  www.allencountyhealth.com

UNIVERSAL PRECAUTIONS (Patron Information)

Tattoo and body piercing studios providing services in which there is a risk of skin, eye, mucous membrane, or parenteral contact to human blood or other potentially infectious materials must practice universal precautions. Universal Precautions are the prevention of disease transmission through the use of infection control practices with all patients.

This studio shall comply with infection control practices required by ISDH which were adopted by Indiana law, Indiana Occupational Safety and Health Administration (IOSHA) standards, and the Centers for Disease Control and Prevention (CDC) recommendations. The following infection control practices include, but are not limited to, those required by the Universal Precautions Rule and are used to prevent transmission of blood borne pathogens to patients and treating staff:

• Appropriate use of protective barriers, including gloves for hand contact, masks, gowns, laboratory coats, and protective eyewear or face shields which are used for procedures having the potential of creating a spray or splatter of blood or other potentially infectious materials.

• Gloves are changed and hands are washed whenever contamination occurs.

• Heat stable, non-disposable instruments requiring sterilization that are contaminated with blood or other potentially infectious materials are heat sterilized after treatment of each patient.

• Precautions are taken to prevent injuries caused by needles, syringes, and other contaminated sharp objects are discarded in puncture-resistant containers.

• Surfaces and equipment contaminated with blood or other potentially infectious materials that need not be sterilized are cleaned and disinfected after treatment of each patient. Disposable coverings may be used on some surfaces to prevent contamination.

• Infectious waste is placed in containers labeled with the biohazard symbol, impervious to moisture and of sufficient strength to prevent expulsion.

• Containers of infectious waste are stored in a secure area prior to treatment and final disposal.

• Patron care staff receive training on infection control.

These infection control procedures listed above and all other practiced protect you from disease transmission. Indiana law requires that tattoo and body piercing studios be committed to the appropriate use of Universal Precautions. Any deviation from these practices observed should be brought to the attention of the Allen County Department of Health. If you are not satisfied with the explanation of Universal Precautions provided by this facility or have concerns, you may file an official complaint with the Allen County Department of Health by calling (260) 449-7126 or by writing to the following address:

Allen County Dept. of Health 200 E. Berry, Ste. 360 Ft. Wayne, IN 46802

Universal Precautions 7-75 Food & Consumer Protection Division AMA/MW 9/17/12 Rev. 1-10-20 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

Information you should know before getting a tattoo

PATRON RIGHTS Each patron has a right to expect that:  Clean disposable gloves are worn at all times during tattooing or body piercing.

 Hands are washed for 15 to 20 seconds with soap and running water immediately before putting on clean gloves and immediately after removing gloves. Hands are to be dried with single-use towels.

 The area to be tattooed should be shaved and the razor disposed of after use.

 All needles for tattooing and body piercing are to be sterile and disposable.

 All reusable equipment is cleaned, placed in single-use packaging, and sterilized.

 Single-use containers are used for each dye.

 A tattoo or body piercing can not be given in living areas or in a room next to a living area.

 No animals, except for service and patrol dogs, are allowed in the work area.

 Eating, drinking, smoking or using make-up are not allowed in work area.

 Work areas and equipment are to be cleaned with an approved cleaner after each patron.

 The person who is giving the tattoo or body piercing should not be sick. Tattoo and body piercing artists with diarrhea, vomiting, fever over 100 degrees, rash, coughing, jaundice (yellow skin), or drainage from an open wound may not perform tattooing or body piercing.

If you would like to register a complaint, call the Allen County Department of Health at (260) 449-7126.

Patron Rights 7-74 Food & Consumer Protection Division AMAMW 9/17/12 Rev. 1-10-20 MRW-MRH 9 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

TATTOO & BODY PIERCING ORDINANCE Frequently Asked Questions

In response to the training given by the Allen County Department of Health on October 18, 2011, we have compiled this list of frequently asked questions to aid in a better understanding of the changes in the Tattoo and Body Piercing Ordinance (Allen County Code Title 10, Article 7).

I have not received a Hepatitis B vaccination. What options do I have to meet that requirement? Upon renewal of the Tattoo/Body Piercing Artist permit, it will be required for applicants to submit documentation of one of the following: ∗ Completion of the Hepatitis B vaccination series by submitting a shot record or verification of the date(s) the vaccination was received ∗ Declination of the Hepatitis B vaccine by submitting a declination form ∗ Proof that at least the first of the series of the Hepatitis B vaccination has been received and agree to show proof of completion within six (6) months of issue of the permit.

Does the Department of Health offer the Hepatitis B vaccine? Yes. We offer the vaccination at the Medical Annex located at 4813 New Haven Ave, Fort Wayne, IN. Appointments are required. Call (260) 449-7514 to make an appointment. Vaccinations are offered on Tuesdays, Wednesdays, and Fridays. The cost to receive the vaccine is $44.00 for each shot of the series. The total amount for a series of three is $132.00. (It is possible that these costs may fluctuate based on actual vaccine costs.)

I received the Hepatitis B vaccine years ago, but I do not have a copy of my shot record. How can I prove I am immune? If the vaccination was received at a local health department, you can contact the health department in the county where you received your vaccination and obtain a record of this vaccination. If your family physician does not have record of your vaccination, you can ask for the appropriate blood work to be done to prove immunity.

If I want to decline to have the Hepatitis B vaccine, does the Health Department have a form that I can fill out? Yes. We have provided a copy of our Declination of Hepatitis B Vaccine Form along with this guidance to all of our licensed tattoo facilities. We also have forms available at our main office located at 200 E Berry Street, Suite 360, Fort Wayne, IN (Citizens Square Building) and on our website. If filling out the declination form and submitting it via mail, please pay particular attention to the directions on the form to avoid any issues that would lead to re-submitting a new form.

Is it allowable to keep our patron records electronically by scanning a photo ID and obtaining an electronic signature? Yes. It is extremely important to have a method for saving information (such as automatic back up or printing a paper copy) to ensure that all necessary records are kept for the minimum of two (2) years.

I don’t receive my spore test results until after the 15th of the month. Will I be charged a fine if I submit my spore tests after the 15th? Not necessarily. You can send the results of the previous month before the 15th. As long as we are receiving your spore tests on a monthly basis (in other words, the monthly spore tests that are completed and submitted to the Health Department show consistent monthly testing), no fine will be assessed.

Tattoo & Body Piercing Ordinance – FAQ 7-70 Food & Consumer Protection 1 AMA/MRW 1/9/2020 MRW-MRH 11 Allen County Dept. of Health

Can I send the Health Department my required documents electronically? Yes. Feel free to correspond with us via e-mail. You may send monthly spore tests, notifications of staff changes or any questions you may have to either Michelle Radosevich, Assistant Director, Food & Consumer Protection ([email protected]) or to Steve Schumm, Director, Food & Consumer Protection ([email protected]). You may also send notification via mail or fax it to our department at (260) 449-3010.

What happens if our autoclave shuts down (or is no longer in use) and I cannot provide my monthly spore test to the Health Department? If your autoclave shuts down or is no longer in use, call our department or send us an e-mail as soon as possible to let us know that it is not being used at the present time. Only single-use equipment may be used until you provide the Health Department with a spore test indicating that the autoclave has been repaired and meets all necessary requirements for sterilization.

Can I add a line to my patron records to indicate the type of material used for our jewelry? Yes. You may simply add a line to your records to document the material, such as stainless steel, platinum, etc.

Is there a minimum age for tattooing and/or piercing a minor? Currently, there is no minimum age for tattooing or piercing a minor in the State code, 410 IAC 1-5 (Sanitary Operation of Tattoo Parlors). However, it is up to the establishment to use their best judgment to protect themselves and their patrons.

Can we allow our patrons to have a person with them while they are receiving a tattoo or piercing? If your facility chooses to allow observers in the tattoo and body piercing area, the patron must sign a written consent allowing an observer to watch the procedure without space restrictions. The parent or guardian of a minor, however, must be present and does not need to sign the waiver.

Do we have to provide restrooms for the customers? No. Each establishment is only required to provide restrooms for their employees under Allen County Code, Title 10, Article 7. You may, however, want to check the regulations of the Allen County Building Department in this regard as their requirements may differ based on occupancy of use of the establishment.

Who is allowed to enter the “clean room” of our establishment? Only employees who have a current Bloodborne Pathogen Certification are allowed to enter the clean room.

What is the penalty for tattooing illegally? Tattooing illegally can result in a fine of up to $500 per day of violation and may result in further legal action (such as permanent permit revocation or other applicable penalties), depending on the case.

Can our establishment perform microdermal procedures if we do not use a dermal punch? A facility is allowed to perform microdermal procedures if a needle is used instead of a dermal punch and no portion of the skin is removed. However, due to the semi-permanence of the microdermal anchor, removal of the anchor is not permitted in your facilities.

Tattoo & Body Piercing Ordinance – FAQ 7-70 Food & Consumer Protection 2 AMA/MRW 1/9/2020 MRW-MRH 11 Allen County Dept. of Health

Food Protection Division  200 E. Berry Street, Suite 360  Fort Wayne, IN 46802

Phone: (260) 449-7562  Fax: (260) 449-3010  www.allencountyhealth.com

DECLINATION OF HEPATITIS B VACCINE

DATE: ______

I, ______, understand that due to my (Name of Artist) occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring hepatitis B virus (HBV) infection. I understand that according to the Centers of Disease Control and Prevention, approximately 25% of those who become chronically infected during childhood and 15% of those who become chronically infected after childhood die prematurely from cirrhosis or liver cancer, and the majority remain asymptomatic until the onset of cirrhosis or end- stage liver disease.1

I have been given the opportunity to be vaccinated with hepatitis B vaccine through my employer, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me through my employer.

______Signature of Artist Date

______Witness** Date

**This form must be signed in the presence of a Department of Health Employee, or in the presence of the owner/permit holder of the tattoo/body piercing facility.

1 http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#treatment

Declination of Hepatitis B Vaccine 7-77 Food & Consumer Protection AMA 10/25/11 Revised 1-10-2020 MRW/MRH 17 Allen County Dept. of Health