Body Art Studio Permit Application

Body Art Studio Permit Application Information

Important - Please Read Thoroughly!
General Information
- It is required to submit this completed application at least 14 days prior to the start of construction.
- Fees: The Body Art Studio Plan Review fee is $275 (one time). The Body Art Studio Permit Fee is $425 (annually). Information on paying these fees will be emailed 3-5 business days after application is submitted.
Before Beginning the Application
- Review the Body Art Studio Plan Checklist. This checklist shows what details the Environmental Health Specialist will be looking for regarding:
  - Policies & Procedures (also know as Standards Operating Procedures)
  - Client Files
  - Client Evalutation form
  - Informed Consent form
  - Written Aftercare instructions
  - Body Art Studio Minimum design standards
  - Cleaning/Sterilization Room (required if studio is not 100% single-use/disposable)
- There are templates for the required Standard Operatings Procedures (SOPs) available on our website, under the "For body art studios" section: https://dekalbpublichealth.com/environmental-health/body-art/
When Filling Out the Application
- This application is divided into 7 pages (this is page 1). You will not be able to view page 4 until the next page (page 2) is completed.
- You may save this application and continue working on it at a later time using the "Save" button at the bottom of the page.
- All required fields (notated with: *) must be completed before this application can be submitted.
- Ensure all information is accurate. Any incomplete or incorrect information may delay the plan review process.
- Once submitted, you will not be able to edit the application.
After Submitting the Application
- You will receive two emails within a few mintues of submitting:
  1. Important Next Steps - Body Art Studio Permit Application
  2. Your Copy of the Body Art Studio's Permit Application
- Within 3-5 business days of submitting, you will recieve an invoice for the fees noted above. Please note the application review process will not begin until the payment for both fees have been received and processed.
- Once fees are paid, the application will be assigned to an Environmental Health Specialist (EHS) for review. Please allow 7-10 business days for the initial review.
If you have questions, please email the DeKalb Body Art Program at: dekalb.bodyart@gets.onmicrosoft.com

APPLICATION FOR BODY ART STUDIO PERMIT
Name of Body Art Studio*
County that Body Art Studio is located in*
NOTE: This application is only for studios located in DeKalb County.
Address of Body Art Studio*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Body Art Studio Telephone #*
Body Art Studio Email*
example@example.com
Body art procedures to be performed (Check all that apply):*

TattooingPiercingMicroblading
Business Model (Select one):*

100% Disposable/Single Use Items OnlyAutoclave and Ultrasonic Unit Utilized
Water Supply (Select one):*

PublicPrivate Well
Water System Name*
Sewage Disposal (Select one)*

Onsite SystemPublic
Number of Artist Workstations*
Studio Owner's Name*

First NameMiddle InitialLast NameSuffix (Sr, Jr, III)
Type of Government Issued Identification*
Expiration Date of Government Issued Identification*

MonthDayYear
Date
File Upload: Copy of Government Issued Identification *

Cancelof
Owner's Mailing Address*

Street

Street Address Line 2

CityState

Zip Code
Billing Mailing Address*

Street

Street Address Line 2

CityState

Zip Code
Owner's Primary Phone #*
Owner's Secondary Phone #
Primary Point of Contact Email*

Confirmation EmailIMPORTANT: This is the email address that the important next steps & application confirmation emails will be sent to!

Body Art Studio Design & Floor Plan
Please ensure the following information is clear on the floor plan. You may upload additional documents with the floor plan as needed.

Design Requirements:
- All work areas are separate from observers or visitors.
- Work areas are able to provide privacy, if desired by a client, by means of a
  nonabsorbent curtain or similar approved partition.
- Hand washing sink provided within 30 feet of each workstation in an unobstructed pathway.
- At least one service sink (also known as mop sink) or one curbed cleaning facility equipped with a floor drain.
- At least one restroom containing a toilet, handwashing sink, and self closing door.
- Shelving, cabinets, or closed, sealable containers provided for the storage of equipment and supplies.
- Location of sharps containers for disposing of needles.
- Separate containers for biomedical waste and general solid waste
- If body art procedures are conducted in an environment where air particulates are of concern, such as a hair salon or nail studio, floor to ceiling partitions are provided.
- *Cleaning room to be used exclusively for the cleaning, disinfection, and sterilization of instruments. Must include a stainless-steel instrument sink, ultrasonic cleaning unit, and autoclave, each be separated by a minimum distance of forty-eight inches unless using a splashguard approved by the Health Authority. (*Required when "Autoclave and Ultrasonic Unit Utilized" business model is selected.)
File Upload: Floor Plan - shall be an 8 ½” x 11” or larger detailed, to-scale floor plan of the body art studio. *

Plans shall show the accurate placement of each of the following: windows, doors, chairs, tables, sinks, restrooms, waiting area, and all equipment placement whether affixed or not for clients or staff, and shall include room measurements.
Cancelof
Floor, Wall, Ceiling Material Requirements
- Floors and floor coverings of all work areas, dressing rooms, locker rooms, toilet rooms and vestibules shall be constructed of smooth, nonabsorbent, hard durable material and maintained in good repair.
- The floor and cove base/joint shall be properly sealed.
- Walls and ceilings, including doors, windows, skylight, and similar closures shall be constructed of durable, easily cleanable material and be maintained clean and in good repair.
List the floor, ceiling and wall finishes/materials for the work room(s). Inspector may request more information upon review.
- Floor Material(s): (list here)*
- Ceiling Material(s):(list here)*
- Wall Material(s):(list here)*

Required Documents & Specification Sheets
File Upload: Verification of Residency Document **MUST BE NOTARIZED***

Document available here (copy/paste link into web browser): https://dph.georgia.gov/document/document/envhealth-ba-verification-residencypdf/download
Cancelof
File Upload: Employee Drug & Alcohol Use Agreement*

At minimum, it should state that "Body artists shall not be under the influence of alcohol or drugs that cause drowsiness or other impairment while performing body art procedures". Each employee must sign a copy; all signed copies must be kept on file.
Cancelof
File Upload: Standard Operating Procedures (SOP)*

Templates available on our website (copy/paste link into web browser): https://dekalbpublichealth.com/environmental-health/body-art/
Cancelof
File Upload: Aftercare Instructions **Needed for each procedure performed***

Must Include all of the following: 1. What to do, what to avoid, suggested care solutions/balms cleaning instructions, and what to look for during healing process 2. Advise client to consult a healthcare provider at first sign of infection 3. Name, address, and phone number of both studio and Local Health Department (DeKalb Public Health ; 445 Winn Way, Decatur, GA 30030 ; 404-508-7900)
Cancelof
File Upload: Client Evaluation Form*

Must meet all requirements. See "511-3-8-.08 Client Files" section of Body Art Rules for requirements (starts on page 22 of the document) (copy/paste link into web browser): https://dph.georgia.gov/document/document/bodyartrulesfinalpdf/download
Cancelof
File Upload: Autoclave Specification Sheet*

Required when "Autoclave and Ultrasonic Unit Utilized" Business Model is selected
Cancelof
File Upload: Ultrasonic Cleaner Specification Sheet*

Required when "Autoclave and Ultrasonic Unit Utilized" Business Model is selected
Cancelof
File Upload: Tattoo Machine/Pen Specification Sheet*

Cancelof
File Upload: Tubes for Tattoo Machine/Pen (if applicable)

Cancelof
File Upload: Needle Cartridge(s) Specification Sheets*

Cancelof
File Upload: Safety Data Sheets (SDS) for inks*

The Safety Data Sheets of all inks must be available for client review to assess any possible allergic reaction to ingredients.
Cancelof
File Upload: Mill Certificates for Jewelry

Jewelry used in piercing shall meet the requirements of DPH Rule 511-3-8-.04(45)(a) - (k) and consist of a material rated by the ASTM or the ISO as being suitable for permanent surgical implant, such as stainless steel, titanium, niobium, solid platinum, or a dense low porosity plastic such as Tygon or PTFE. Solid 14 karat or higher, white, or yellow nickel-free gold may also be used. NOTE: If you do not have mill certificates yet, these will be discussed during the plan review phase.
Cancelof
File Upload: Forceps Specification Sheet*

Cancelof
File Upload: Piercing Needle(s) Specification Sheet*

Cancelof
File Upload: Sharps Disposable Pickup Company/Contract

If you already have a Sharps Disposable Pickup Company selected, please upload here. If not, this will be discussed plan review.
Cancelof

BODY ART STUDIO EMPLOYEE LIST
**Important information on the DPH (GA Department of Public Health) Body Artist Certification:**
- No person shall practice body art procedures without first obtaining a Body Artist Certification from the Department of Public Health.
- You may obtain a certification in Tattooing, Piercing and/or Microblading.
If you are certifying for the first time, please refer to this Body Artist Certification Guidance Document for more information.
- To register for the exam(s) offered in DeKalb County, use this Registration Form.
If you need to renew your certification, please refer to this Body Artist Certification Renewal Guidance Document.
- Note, you do not need to re-take the exam(s) to renew your certification.
Number of Employees (including yourself if you will perform body art procedures at this studio):*
NOTE: If you select "11+" you will provide information for the first 10 employees now and the rest during the plan review phase.
Employee #1 Name*
List employee's First and Last Name
Employee #1 Date of Birth*

MonthDayYear
Date
File Upload: Employee #1 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #1 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #1 Telephone #*
Employee #1 Email*
example@example.com
Employee #1 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #1 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #2 Name*
List employee's First and Last Name
Employee #2 Date of Birth*

MonthDayYear
Date
File Upload: Employee #2 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #2 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #2 Telephone #*
Employee #2 Email*
example@example.com
Employee #2 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #2 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #3 Name*
List employee's First and Last Name
Employee #3 Date of Birth*

MonthDayYear
Date
File Upload: Employee #3 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #3 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #3 Telephone #*
Employee #3 Email*
example@example.com
Employee #3 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #3 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #4 Name*
List employee's First and Last Name
Employee #4 Date of Birth*

MonthDayYear
Date
Employee #4 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #4 Telephone #*
Employee #4 Email*
example@example.com
Employee #4 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #4 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #5 Name*
List employee's First and Last Name
Employee #5 Date of Birth*

MonthDayYear
Date
File Upload: Employee #5 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #5 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #5 Telephone #*
Employee #5 Email*
example@example.com
Employee #5 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #5 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #6 Name*
List employee's First and Last Name
Employee #6 Date of Birth*

MonthDayYear
Date
File Upload: Employee #6 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #6 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #6 Telephone #*
Employee #6 Email*
example@example.com
Employee #6 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #6 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #7 Name*
List employee's First and Last Name
Employee #7 Date of Birth*

MonthDayYear
Date
File Upload: Employee #7 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #7 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #7 Telephone #*
Employee #7 Email*
example@example.com
Employee #7 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #7 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #8 Name*
List employee's First and Last Name
Employee #8 Date of Birth*

MonthDayYear
Date
File Upload: Employee #8 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #8 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #8 Telephone #*
Employee #8 Email*
example@example.com
Employee #8 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #8 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #9 Name*
List employee's First and Last Name
Employee #9 Date of Birth*

MonthDayYear
Date
File Upload: Employee #9 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #9 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #9 Telephone #*
Employee #9 Email*
example@example.com
Employee #9 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #9 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof
Employee #10 Name*
List employee's First and Last Name
Employee #10 Date of Birth*

MonthDayYear
Date
File Upload: Employee #10 Valid Drivers License or Government issued I.D.*

Cancelof
Employee #10 Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Employee #10 Telephone #*
Employee #10 Email*
example@example.com
Employee #10 DPH Body Artist Certification #
Found on the upper-left section of the Body Artist Certificate
File Upload: Employee #10 Department Issued Body Artist Certification

NOTE: If in process of renewing, upload expired certificate. If in process of obtaining for the first time, we will request this during the plan review phase.
Cancelof

BODY ART STUDIO OWNERSHIP ADDENDUM
Mark which type of entity the business is owned by and please provide the contact information below*

CorporationPartnershipLLCAssociationOther Legal Entity
Business Name*
Business name registered with the Georgia Secretary of State (typically ends in LLC, INC, etc.)
Business Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Business Telephone #*
Business Email*
example@example.com
Owner #1 Name*
First & Last Name
Owner #1 Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Owner #1 Telephone #*
Owner #1 Email*
example@example.com
Owner #2 Name
First & Last Name
Owner #2 Mailing Address

Mailing Address

Street Address Line 2

CityState

Zip Code
Owner #2 Telephone #
Owner #2 Email
example@example.com
Authorized Agent’s Name
First & Last Name
Authorized Agent’s Address

Mailing Address

Street Address Line 2

CityState

Zip Code
Authorized Agent’s Telephone #
Authorized Agent’s Email
example@example.com
File Upload: Business's Georgia Secretary of State documentation*

Cancelof

I,(Applicant's Legal Name)* , affirm all the information provided in this application (including the Verification of Residency and all supporting documents) is true to the best of my knowledge. I understand that any misrepresentation, omission or concealment of material facts is grounds for denial or revocation of my Body Art Studio Permit. I have read and agree to abide by the Department of Public Health, Rules and Regulation for Body Art, Chapter 511-3-8.

Applicant Signature* Date*
Should be Empty:

Body Art Studio Permit Application Information

APPLICATION FOR BODY ART STUDIO PERMIT

Body Art Studio Design & Floor Plan

Required Documents & Specification Sheets

BODY ART STUDIO EMPLOYEE LIST

BODY ART STUDIO OWNERSHIP ADDENDUM