Higher risk personal appearance
services – fixed or mobile premises
Licence application
Council of the City of Gold Coast
ABN 84 858 548 460
PO Box 5042 GCMC QLD 9729
P 07 5667 5987
F 07 5596 3653
E mail@cityofgoldcoast.com.au
W cityofgoldcoast.com.au
Public Health (Infection Control for Personal Appearance Services) Act 2003
Please use BLOCK LETTERS and complete all details in full.
Section 1 - Applicant
(must be a legal entity e.g. person/s or corporation)
Applicant/s name
ACN
Director
Registered office
address
names
Trading name
Postal address
Contact person
Phone
Mobile
Email
Section 2 - Premises details
Fixed premises
Building name
Floor level
Shop number
Street number
Street name
Suburb
RPD
Postcode
Lot
Plan
Mobile premises
Vehicle
description
Make and
model
Registration
number
State/territory of
registration
Inspection
address
Proposed start date of the operation
Form SKP01 – Personal Appearance # 45413455v3
15/7/2016
Page 1 of 4
Section 3 - Services types (tick all applicable)
Body piercing
Scarring or cutting
Implanting
Tattooing
Tattoo removal
Other (please detail):
Section 4 – Applicant suitability
1
2
Has the applicant been convicted (or found guilty) of any of the following offences :
 An indictable offence (drink driving and minor traffic offences are not indictable offences)
 An offence against the Public Health (Infection Control for Personal Appearance Services) Act 2003
3
or a corresponding law
 An offence against the Health Act 1937 or an Australian or foreign law regulating the same subject
matter as that Act
 An offence relating to the provision of personal appearance services against an Australian or
foreign law.
Yes – detail:
No
1
Has the applicant had a licence suspended or cancelled, or an application for licence refused under the
Public Health (Infection Control for Personal Appearance Services) Act 2003 or a licence or registration
under a corresponding law?
Yes – detail:
No
1
Has the applicant had a registration of an establishment suspended or cancelled, or an application for
registration of an establishment refused, under the Health Regulation 1996?
Yes – detail:
1
No
- If the applicant is a corporation, this includes an executive officer of the corporation
2
- You are not required to detail convictions for which the rehabilitation period under the Criminal Law (Rehabilitation of
Offenders) Act 1986 has expired and is not revived under Section 11 of the Act.
3
– A ‘corresponding law’ is an Australian or foreign law that provides, or provided, for the same matters as the Public Health
(Infection Control for Personal Appearance Services) Act 2003.
Section 5 - Infection control qualifications
Do all persons providing higher risk personal appearance services have a statement of attainment for one
of the following infection control competency standards?

HLTIN2A

HLTIN402A
Yes – attach copies of the Statement of
Attainments issued by an accredited training
provider for all persons providing this service

HLTIN402B

HLTIN402C
No – you will be required to provide copies of the
Statement of Attainments prior to the issue of the
licence certificate and commencement of the
activity.
Section 6 - Other approvals - check if any of these other Council approvals are required for fixed premises
Town planning approval
Trade/liquid waste approval
Building approval
Advertising signs
Plumbing approval
Phone 1300 GOLDCOAST (1300 465 326) for further information regarding these approvals.
Form SKP01 – Personal Appearance # 45413455v3
15/7/2016
Page 2 of 4
Section 7 - Applicant declaration
(must be completed by OR for each applicant)
I understand and acknowledge that:




It is an offence to knowingly provide false or misleading information
Approval of this application does not extend to the approval of any other statutory or local government
requirements relating to this premises or activity
Documentation must be provided if a power of attorney (POA) signs on behalf of a person
A person signing on behalf of a corporation or incorporated association must occupy a position that is
legally entitled to make an application on behalf of that corporation or incorporated association
Applicant one
(a person or organisation)
Name
Signature
Complete when signing on behalf of person or
organisation
Signatory name
Date
Position (eg. CEO)
Additional applicant – if required
Name
Signature
Complete when signing on behalf of person or
organisation
Signatory name
Date
Position (eg. CEO)
Section 8 – Attachments
The checklist below is required to be completed and the applicable documentation (including plans) MUST be
submitted with all applications (exemptions may apply for existing, approved and complying HRPAS premises).
Two copies of the floor plan detailing all work area zones, equipment, benches, storage cupboards,
sinks, hand wash basins, door/window openings, staff areas and chemical/cleaning equipment storage
areas. (Scale 1:100)
Two copies of cross sectional plans drawn through each work area zone and storage area. Details are to
include finishes to walls, floors and ceilings, lighting provisions, heights of fixtures, and junctions of walls
and floors. (Scale 1:50)
Two copies of the site plan detailing location of premises in regard to other premises, waste storage
areas and staff toilets (only for fixed premises).
Details of location and type of all sterilising equipment and laundry facilities for sanitising needles,
towels, wraps, etc.
Statement of Attainment for all persons providing higher risk personal appearance services
Evidence that you are eligible for nil fees – see Section 9
Form SKP01 – Personal Appearance # 45413455v3
15/7/2016
Page 3 of 4
Section 9 - Fees
Fixed premises
Nil fee – the fee is nil for this application. Upon approval, the term of the licence will be until 31 August next,
unless otherwise specified by the applicant or Council.
Mobile premises
The fee is nil if you (the applicant) can demonstrate you meet one of the eligibility conditions, being either:
• You own, rent or lease a rateable property within the City of Gold Coast; or
• You are a registered charity, voluntary sporting community, religious or incorporated not for profit
organisation.
Eligible for nil fees – One or more of the following items of evidence must be included with this
application:
proof of ownership – rates notice, address of property
signed tenancy/lease agreement (short-term/holiday accommodation not acceptable)
Australian Securities & Investments Commission (ASIC) documentation detailing ‘Principle place of business’
proof of residency – minimum of two bills less than six months old for utilities/phone/vehicle registration detailing
applicant name and property address
•
registration with Australian Charities and Not-for-profits Commission (ACNC)
Failure to provide adequate evidence may result in your application not being accepted.
•
•
•
•
Not eligible for nil fees - the following fees apply for this application:
Fee name
Account number
Fee amount
Application fee - for operational approval/accreditation/ licence/
registration/permit/environmental authority
RE 98403
$595.00
Licence fee – application lodged 1 Sept - 30 Nov (100% of full fee)
Licence fee – application lodged 1 Dec – end Feb (75% of full fee)
Licence fee – application lodged 1 Mar – 31 May (50% of full fee)
Licence fee – application lodged 1 Jun – 31 August (25% of full fee)
$595.00
RE 98404
$446.25
$297.50
$148.75
These fees are in accordance with the City of Gold Coast’s (City) regulatory fees and non-regulatory charges. A copy of our regulatory fees
and non-regulatory charges can be found on our website, cityofgoldcoast.com.au.
Payment options


Cash, cheque or credit card at any of the City’s branch offices. For branch office locations and operating hours, please refer to our website.
Cheque or money order – make payable to: Gold Coast City Council. Postal address at top right of first page.
Please ensure that you provide adequate reference details or attachments to allow the cheque to be appropriately receipted.
Note: Please be advised that payments by credit card will incur a surcharge of 0.60%.
Privacy statement
Council of the City of Gold Coast is collecting your personal information in accordance with Public Health (Infection Control for Personal
Appearance Services) Act 2003in order to assess your application. The information will only be used by authorised officers for the purpose of
administering licenses and approvals on the Gold Coast. Your information will not be given to any other person or agency unless you have
given us permission or we are required or allowed to by law.
Should approval be given to this application, such approval will not extend to approving any other statutory or Local Government
requirements relating to the property.
Office use only
Date received
Fee paid
Received by
Receipt number
Application approved
Account number
Form SKP01 – Personal Appearance # 45413455v3
15/7/2016
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