• Document No.

  • Licence number

  • Audit Title

  • Premise/trading name

  • Conducted on

  • Prepared by

  • Location
  • Personnel interviewed

Premises details

  • Trading name

  • Licence number

  • Address

  • Proprietor

  • Person interviewed

  • Inspection type

  • Inspection time & date

  • Business details notified

  • Inspection Invoice to be issued?


  • Cutting

  • Colouring

  • Razoring

  • Waxing

  • Ear piercing

  • Other



  • Premises is clean and hygienic

  • Premises is structurally suitable

  • Adequate washing, drainage, ventilation and lighting facilities provided

  • Suitable floor coverings, shelves, fittings and furniture

  • Shelves fittings and furniture are durable, smooth, impervious to moisture and capable of being easily cleaned

  • Hand wash basin provided

  • Hand wash basin is provided with clean, potable, warm water through a common spout

  • Hand basin situated against a wall with a durable, smooth, impervious to moisture and capable of being easily clean [LGR11(2)]

  • Single use towels or other suitable hand drying equipment provided

  • Liquid soap provided

  • Separate sink for the cleaning of equipment

  • Cleaning sink provided with clean, warm water


  • Equipment is in good working order

  • Equipment is stored in a clean and dry environment

  • Clean linen available

  • Clean and dirty linen stored in separate receptacles

  • All articles used to penetrate the skin (including both reusable articles and single use items) are clean and sterile [PHR27


  • Waste disposal bin provided

  • Sharps container appropriately disposed of by a licensed contractor [POEO]

  • Sharps / needles disposed into a sharps container immediately after use [PHR27(2)&(4)]

  • Single use items are appropriately disposed of immediately after use

  • Clinical waste bin provided?


  • Hands washed prior to and after conducting procedure

  • If skin penetration performed:

  • Clean gowns or aprons available and worn during skin pen procedure [PHR23(e)(iii)&28(2)&(3)]

  • Single use disposable gloves are provided and worn during skin penetration procedures [PHR23(e)(iii)&28(1a)]

  • If waxing is performed:

  • Skin prepared with suitable antiseptic (pre-wax solution)

  • Wax not reused and thrown out after use [PHR30]

  • The spatula used to apply the wax is thrown out after use - no double dipping [PHR30]

  • Single use applicator used [PHR29(1)]

  • Roll on wax: canister / applicator not reused [PHR30]


  • All equipment is cleaned and dried after use

  • Hospital grade disinfectant is being used

  • All sterilised articles kept in a sterilised environment [PHR27(5)]

  • Add media

  • Comments

  • Inspection result

  • Action

  • Reinspection required

  • Date of reinspection

  • I have read and understood the contents of this inspection report and will forward the report,mid applicable, onto the proprietor / owner or applicable person.

  • Time inspection completed


Inspection results

  • Satisfactory - All aspects of the premises comply with relevant legislative requirements.

  • Unsatisfactory - one or more relevant legislative requirements have not been met and have resulted in unsatisfactory workplace practices. A re-inspection will be required and legal action may be considered should the matter not be rectified prior to the reinspection.

General information

  • The Factsheets published by NSW Health outline the industries best practice standards. Council advises all premises to comply with the relevant documents for best practice purposes.

  • Fact sheets can be found on the NSW Health website Fact sheets are available in English, Vietnamese, Chinese, Arabic and other languages.

  • Information on submission requirements for Development Applications, registration forms and fact sheets may be found on Council's website.

Council's Contact Details

  • Ballina Shire Council Telephone: (02) 6686 1210 Email:

  • 40 Cherry St Fax (02) 6681 1375. Web:

  • BALLINA NSW 2478

  • PO Box 450 Ballina NSW 2478

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.