Fillable Nottinghamshires Hygiene Accreditation Scheme Application Form (Mansfield District Council)

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Nottinghamshires Hygiene Accreditation Scheme Application Form (Mansfield District Council)

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Nottinghamshire’s Hygiene
Accreditation Scheme
Application Form
In accordance with the scheme rules, proprietors have the opportunity to request assistance
from the Local Authority before the initial inspection to facilitate compliance with the rating
schedule.
Proprietors are encouraged to seek assistance from Local Authorities and implement
practices required by the schedules in advance of the initial inspection.
For this reason, proprietors should allow sufficient time before submitting the application to
the Local Authority.
PREMISES DETAILS
Name of Premises:
Address:
Postcode:
Telephone Number:
Email:
Activities:
(Please tick all appropriate
boxes)
Tattooing
Semi-Permanent Make-up
Cosmetic Piercing
PROPRIETOR/APPLICANT DETAILS
Name of Proprietor:
Position in the Business:
DECLARATION
I confirm that the information contained within this application is true and has been
completed by the Proprietor.
I confirm that I have read and understand the rules of the Hygiene Accreditation Scheme
(including the condition of entry, membership requirements, process for re-rating and the
process for withdrawal etc).
I acknowledge that the certificate/window sticker and any similar materials remain the
property of the Local Authority and must be returned upon demand.
I consent to the Local Authority retaining this application and details on its database(s).
SIGNED:
DATE:
Please return this form by email to EnvironmentalHealth@Mansfield.gov.uk or to:
Environmental Health, Mansfield District Council, Civic Centre, Chesterfield Road
South, Mansfield, NG19 7BH
Upon receipt of this form, an officer will contact you to arrange for the payment of the
fee.
To view Mansfield District Council's Privacy Notice, please visit our website at
www.mansfield.gov.uk/privacy
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Nottinghamshires Hygiene Accreditation Scheme Application Form (Mansfield District Council)

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Completed 19 December 2020

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