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BODY ART ESTABLISHMENT REGISTRATION or TANNING FACILITY PERMIT APPLICATION
Date Received by IDPH
Illinois Department of Public Health
Division of Environmental Health
525 W Jefferson St.
Springfield IL 62761
Phone 217-785-2439 Fax 217-782-0943
TTY (hearing impaired) 800-547-0466
Email
dph.bodyart@illinois.gov
or
dph.tan@illinois.gov
Permit or Registration Number
________________________
FM#____________________________
Fee Paid $_____________________
Purpose of Application (check one)
New
Change of Ownership
Change of Location Effective:___________________________List Previous Address Here:__________________________________
_____________________________________________________________________________________________________________________________________
I am applying for the following registration/permit (check one). I understand fees are due with application submittal.
Check
Here
Registration or Permit Type
You Must Complete Section(s)
Fee
Body Art Permanent Business
1 & 2
Base $500 See *
Body Art Mobile Business
1 & 2
Base $500 See *
Body Art Temporary Event
3
Flat $250
Tanning Facility
1 & 4
Flat $250
IMPORTANT: The registration or permit fee is due at time of application submission. This is a non-refundable fee. Checks or
money orders should be made out to the Illinois Department of Public Health. The application and review process from when we
receive the application to when you should have the inspector contact you to set up the inspection is APPROXIMATELY 4 to 6
weeks. This is dependent upon the number of applications received for review, the completeness of your application, and the
schedule of the inspector responsible for your area.
* The Body Art permanent and mobile business registration fee is $500. This fee includes one work station. If you have more
than one workstation, an additional $50 per work station is required. For example, if you have a total of 3 work stations, your fee
will be $600 ($500 + 2 x $50 = $600).
To calculate your body art fee: $500 + (Total number of work stations after the first one x $50) = Fee Due
Mail this completed application and fee to: Illinois Department of Public Health
Division of Environmental Health
525 W. Jefferson Street (Floor 3)
Springfield, IL. 62761
SECTION 1
* Denotes Mandatory Information
Legal Name of Business*
Doing Business As (if applicable)
Physical Facility Address*
City*
State*
Business Phone No. (include area code)*
Emergency/Cell Phone No.
Facility Email Address (please print clearly)*
Web Address
Days and hours of Operation
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Revised 04/11/2018
Section 1 cont.
Owner and/or Operator of Business
Owner or Operator First and Last Name*
Age*
Owner or Operator Address*
City*
State*
Zip code (+ 4 if known)*
Owner Phone No. (include area code)*
Owner Email Address*
Ownership Type (
Check applicable box and complete information)
Sole Proprietor/Individual
List Name:
Partnership/Multiple Owners
List Name of Each Owner:
Government
Non-Profit
Cooperative
List exact full cooperate name:
Limited Liability Company (LLC)*
List complete name of LLC and FEIN:
Corporation
List Complete name of Corp and FEIN:
*If either a LLC or Corporation, list the registered agent on file with the Secretary of State here:
Mailing Address
Check here ________ if the mailing address is the same as the physical address (do not have to re-type below).
Check here ________ if the mailing address is the same as the owner’s address (do not have to re-type below).
Mailing Address
City
State
Zip code (+ 4 if known)
Certification Statement
This application must be signed by the owner, if an individual; by one of the partners, if a partnership; or by an officer
of the company or corporation.
I affirm that I am the owner, partner or officer of the firm name as shown on page one, that I am authorized on the
part of said applicant to verify and file with the Illinois Department of Public Health this application, and that I have
a full working knowledge of the matters set forth herein and that all of same are true in substance and fact.
Print Name: _____________________________________________________________________________________
Signature: _______________________________________________________________________________________
Title: ________________________________________________________________________ Date: ___________________________________________
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SECTION 2 Body Art Establishment
List Equipment used for tattoo and/or body piercing services such as sterilizers, tattoo machines, cleaning systems,
Autoclave, etc. Do not include disposable supplies.
Type
Year of manufacture if available
List Number of Work Stations located in business: _______________________
If mobile, list home base address of establishment: ___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
IMPORTANT ADDITIONAL REQUIREMENTS for BODY ART ESTABLISHMENTS
Along with this application, you MUST attach the four documents described below. See Appendix A for detailed
requirements/instructions.
• Operational Procedures
• Establishment Floor Plan
• Aftercare Instructions
• Parental Consent Form (applicable to piercing services only)
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SECTION 3 Body Art Temporary Event
Complete all information to avoid delay in registration.
Event Name
Reason for event: Educational, Trade Show, Product Demonstration
Address
City
Zip
County
Date(s) of Events
Number of Workstations
Business or Booth Name
List all artists working in Booth (attach additional sheet if needed)
_Name_________________________________________Age____________
__________________________________________________________________
_________________________________________________________________
__________________________________________________________________
_________________________________________________________________
__________________________________________________________________
Contact Name
Telephone Number
(_________)____________-_______________
Contact Email
SIGNATURE OF APPLICANT
Permanent Business Contact Information
Name
Address
City
State
Zip
Telephone
(__________) _____________-_________________
IMPORTANT REQUIREMENTS FOR BODY ART TEMPORARY EVENT
Proof of OSHA compliant blood borne pathogen training MUST be available for all artists upon inspection on the
opening day of event.
Each individual business/booth must apply separately.
The operator must identify the location of hand sinks accessible to the artists (not located within a bathroom).
See Appendix B for Temporary Establishment Registration Information.
If there are any questions or concerns, please call 217/785-2439 or email dph.bodyart@illinois.gov
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SECTION 4 Tanning Facility Application
Primary Operation of Facility (check box and complete description if “Other”)
Tanning Facility
Health Club
Hotel/Motel
Beauty Salon
Barber Shop
Residence
Other; Describe Here:
Please provide complete information for each piece of tanning equipment in this facility. Types of equipment may
include bed canopy, bed bench, stand-up booth, free-standing facial unit, etc.
Room
ID
Manufacturer
Model
Serial Numbers
Year of
Manufacturer
Equipment
Type
Attach Additional Sheet(s) if more equipment information is to be provided.
IMPORTANT ADDITIONAL REQUIREMENTS for TANNING FACILITIES
Along with this application, you MUST attach the facility generated OPERATING PROCEDURES using the outline
provided in Appendix C (Note: all points on the provided outline must be addressed to be considered complete.)
If there are any questions or concerns, please call 217/785-2439 or email dph.tan@illinois.gov
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APPENDIX A, B and C
Appendix A; Body Art Operational Procedures/Floor Plan/Aftercare Instructions
Appendix B; Temporary Establishment Registration Information
Appendix C; Tanning Facility Written Operating Procedures
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Appendix A
The Body Art Establishment Registration application requires applicants to submit copies of
Operational Procedures, Establishment Floor Plan, Aftercare Instructions and a parental consent form
(only in cases where piercing is available for minors).
Attachment 1: Operational Procedures
Please describe the following procedures for your Body Art facility in the provided space and
then return this form with your application. If you do not have enough room feel free to attach
additional information.
Sterilization methods used for all reusable Items (State 100% disposable if applicable).
Testing methods used to ensure all sterilized items remain sterilized. Include spore testing
company and frequency if applicable.
Methods used for maintaining records for all procedures performed, ie: name, date, photos,
etc.
Methods used to ensure client is 18 years of age, ie: make copy of state issued ID.
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Methods for collection of parental consent if client is a minor requesting piercing procedure
(please also attach parental consent form) or mark N/A if no piercing available.
Methods used for preparing site where tattoo going to be located.
Methods for aftercare procedure and client instructions.
Workstation cleanup methods after procedure is completed, including product used to
sterilize surfaces.
Methods used to deal with a possible emergency (example - call 911).
For Reference: Body Art Code 797.800, 797.900, 797.1000
Attachment 2: Floor Plan of Establishment
Please attach a floor plan of your establishment that includes the following elements:
• Aerial view of facility
• Entrance and Exits
• Location of workstations
• Location of hand sinks (1 per 6 stations), must be separate from restrooms.
• Sterilization area (If applicable)
• Washroom
• Storage Room
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The attachment does not require an architectural drawing or blue print and can include
additional features if desired.
For Reference: Body Art Code: 797.1100 B, G, H
Attachment 3: Aftercare Instructions
Please provide the aftercare instructions given to a client after their procedure. The instructions
should include directions on using any washes, salves or creams, the rinse schedule and the
actions that need to be taken if problems arise as a result of the procedure.
Attachment 4: Parental Consent
Please include a copy of the consent form used to obtain the parental consent for minors when
Body Piercing procedures are made available. If this service is not available, a consent form
shall not be required.
All questions should be sent to dph.bodyart@illinois.gov
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APPENDIX B
Section 797.1400 Temporary Establishment Registration I
nformation
A temporary certificate of registration may be issued by the Department for educational, trade show or
product demonstration purposes that include body art procedures. The temporary certificate of registration
shall be valid for a maximum of 14 calendar days. (Section 20 of Act)
Refer to the Body Art Legal Base for complete list of r
equirements.
1. A body art establishment who wishes to obtain a temporary certificate of registration shall
submit a temporary certificate of registration application for review to the Department at least
30 days prior to the event.
2. A temporary certificate of registration non-refundable fee of $250 shall be paid for each booth
at each event. All body artist shall be 18 years of age and over.
3. The Department shall not issue the temporary certificate of registration if the holder of a
temporary certificate of registration fails to comply with all requirements of the Body Art Legal
Base.
4. An inspection of the location identified on the temporary certificate of registration application
shall be required prior to the performance of any body art procedures. The inspector will
contact the responsible party listed on the application prior to the event to set up the required
inspection time.
5. The establishment shall be contained in a completely enclosed location.
6. The temporary certificate of registration shall be prominently posted along with the warning
statement provided by the Department (see Section 797.600(c)).
7. Copies of documentation of proof of Blood borne pathogen training for all artists are required
to be available for review during inspection.
8. Conveniently located hand-washing facilities with liquid soap, paper towels and hot and cold
water under adequate pressure shall be provided. Drainage in accordance with local plumbing
codes is to be provided. Alcohol-based single-use hand wipes shall be available in each work
station to augment the hand-washing requirements of this Section.
9. The establishment shall provide instrument sterilizing equipment in compliance with this Part,
on which a spore test has been performed 30 or fewer days prior to the date of the event, or
only single-use prepackaged sterilized equipment shall be allowed.
10. In performing body art procedures, the body artist/apprentice shall wear single-use medical
grade gloves. Gloves shall be changed if they become contaminated by contact with any non-
clean surfaces or objects or by contact with a third person. The gloves shall be discarded, at a
minimum, after the completion of each procedure on an individual client, and hands shall be
washed before the next pair of gloves is donned.
11. Sharps ready for disposal shall be disposed of in approved sharps disposal containers. Storage
of regulated waste on site shall comply with the regulations in 29 CFR 1910.1030
12. No person shall perform any tattoo procedure upon a person under the age of 18 years that is
prohibited by Sections 12-10 through 12-10.2(c) of the Criminal Code of 1961. Age verification
shall be obtained by government issued identification containing a birth date and photograph
13. In other procedures, such as piercing, the parent or legal guardian shall sign a consent form.
14. Any body artist can refuse service to any individual, at any time, and for any reason.
15. Contact Body Art Program staff at dph.bodyart@illinois.gov with questions. Revised 02/18
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Appendix C
All Tanning facilities are required to submit a written copy of their operating procedures to be used in
the facility as well as an attachment to the facility’s application for a permit. Please include the
following form with your answers attached to the application for permit.
Operational Procedures
Please describe the following procedures for your Tanning facility in the provided space and then
return with this form with your application. If you do not have enough room feel free to attach
additional information.
The procedure for an operator to ensure that all clients are at least annually offered a written copy of
the warning
The procedure for proving and documenting whether the client is 18 years of age or over and able to
tan.
The procedure the facility follows to handle the presence of children that accompany a client.
The procedure the operator must follow to obtain client information on prescription and
nonprescription medications, consumed or used prior to the start of each tanning session, and the
procedure for informing clients about photosensitizing substances.
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The facility procedure for dealing with pregnant women who wish to tan.
The operators’ method for ensuring and documenting that clients have not used services of any tanning
facility in the preceding twenty-four hours.
The system for maintain complete and accurate records on clients’ use of tanning Facility. Details on
what information is collected and in what format. If electronic, procedures should describe data storage
and back-up methods.
The operator’s procedures for instructing clients on how to use the training equipment.
The procedure for determine and recording the client’s appropriate skin type, using the IDPH provided
skin type chart.
The procedure for thoroughly documenting and promptly reporting tanning injuries as specified in
Tanning Facilities Code, Section 795.200
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The procedures for conducting regularly scheduled maintenance of the tanning equipment, particularly
as required by the manufacturer of each tanning unit.
Procedures for the accurate preparation of the facility’s sanitizing solution and a description of how it
is to be tested and stored in properly labeled containers. Are step by step procedures provided to the
operator
A thorough procedure of equipment cleaning procedures by facility operators. Operators are
responsible for cleaning and sanitizing tanning equipment after each use. No clients are responsible for
cleaning.
A thorough description of eyewear sanitizing procedures (if the facility provides reusable eyewear for
its clients. Are step by step procedures provided to the operator?
The procedure for cleaning and sanitizing the restroom which must be cleaned and sanitized at least
once a day. The specific tasks described and who is responsible for each task must also be included.
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The procedures for the operator to preform while assisting the inspector during an Inspection. The
operator must have access to all information required by the inspector including the client records, the
operators’ training records, and the compatibility documentation for lamp replacement.
A thorough description of the training method (the “What” and “How”) to be used for each operator,
covering the ten areas described in tanning facilities code. Operators may not be left unattended until
training is complete.
For Reference: Tanning Facilities Code: 795.180, 795.150(a), 795.200