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

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Nottinghamshires Hygiene Accreditation Scheme Re-rating Application Form (Mansfield District Council)

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Nottinghamshire’s Hygiene
Accreditation Scheme
Re-rating Application Form
Before submitting this form, the proprietor should review the information provided following
the most recent inspection and consider what action has been taken to rectify any
shortcomings.
Please note that only one application for a re-rating shall be accepted within any 12 month
period.
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:
Date of Latest Inspection:
Rating Achieved:
Please provide details of the actions and/or measures taken to justify a re-score:
(Please refer to findings of previous inspections where necessary)
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 Re-rating Application Form (Mansfield District Council)

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Completed 19 December 2020

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