Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Business Details

  • Trading Name

  • Proprietor(s)

  • ABN

  • Phone number

  • Email

  • Person in charge at time of inspeciton

Inspection Details

  • Inspection type:

  • Inspection delivered via:

Procedures Conducted on Premises

  • Type of procedure(s) undertaken at premises

  • If other, please describe

Cleanliness and Structure

  • Premises is clean and hygienic

  • A dedicated hand wash basin is provided with warm running water via a common spout

  • A separate sink is provided for the cleaning of equipment

  • Floors and walls are constructed with a material that is durable smooth, impervious to moisture and capable of being easily ccleaneed

  • Walls behind and wash basins, sinks and shampoo troughs have impervious sheeting or tiled splash back which extend from floor level to a height of 450mm above unit and 150mm on either side of unit

  • Construction of premises is free from open joints, gaps, cracks, crevices and generally kept in good repair

  • Premises is provided with adequate ventilation

  • Shelves, fittings, fixtures and furniture are covered with a material that is durable, smooth, impervious to moisture and capable of being easily cleaned


  • Equipment is clean and stored in a clean, dry and dust free environment before reuse

  • Hospital grade disinfectant is used to clean equipment and is within the expiry date

  • Clean linen, garments and towels are used on each client

  • Soiled and clean equipment is store separately

  • Cleaning equipment is maintained in a clean condition and in good repair

  • Chemicals are stored in a cool, dry and well ventilated area

  • Waste disposal bin(s) are provided

  • Sharps bin(s) are provided for the disposal of sharps

  • Are sharps disposed of via a licensed contractor and receipts available

Personal Hygiene

  • Soap and single use towels are provided at hand wash basin(s)

  • Hands are washed immediately before and after attending to a client and before attending to the next client, or if the procedure is interrupted

  • Operators are not eating or drinking while attending to clients

  • Animals are not in rooms where procedures are carried out

  • No smoking in public access areas

  • Cuts and abrasions are covered by clean waterproof dressing

  • Up to date first aid kit is available

  • Clean clothing is worn at all times

  • Personal protective clothing is worn when necessary

  • Equipment (non penetrating) is cleaned after each use with detergent, warm water and physical action and dried before use.

Skin Penetration Procedures

  • Steriliser is provided to sterilise re-usable equipment i.e. Autoclave / Dry heat steriliser only

  • If autoclave used, is current certificate of calibration available

  • Records are kept for each sterilisation cycle and maintained (time, date, length of time, temperature and pressure of autoclaving)

  • Pre-packaged sterile items are stored in clean and dry area to avoid contamination

  • Articles used to penetrate the skin are sterile before each use

  • Articles used to penetrate skin are sterilised before re-use or disposed of immediately

  • Single-use disposable items are disposed of immediately after use

  • New sterile gloves are worn for direct contact with sterile items and during procedures

  • Ear piercing guns are solely used for the purpose of ear piercing

  • Approved skin antiseptic is used to prepare skin and is within expiry date

Waxing Procedures

  • Single use disposable gloves are worn during procedure and disposed of immediately

  • Wax is disposed of immediately after procedure

  • Single use spatulas are used once only and are not re-dipped

  • Re-usable equipment is cleaned appropriately between each use

  • Single use items are disposed of immediately after use

Additional Notes

Further Action

  • Further action required:

  • Reinspection required

Sign off

  • Business Owner/ Operator

  • Authorised Officer

  • Authorised Officer signature

  • Mark Complete

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.