Body Art Incident Report Form
Document incidents related to body art services, including tattoos, piercings, and cosmetic body modifications.
Full Name of Person Involved
*
First Name
Last Name
Role of Person Involved
*
Client
Staff/Practitioner
Visitor
Other
Date and Time of Incident
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (e.g., procedure room, waiting area)
*
Type of Body Art Service Involved
*
Please Select
Tattoo
Piercing
Cosmetic Body Modification
Permanent Makeup
Other
Detailed Description of the Incident
*
Observed Effects or Injuries
*
Bleeding
Swelling
Infection (suspected)
Allergic Reaction
Pain/Discomfort
None Observed
Other
Immediate Actions Taken
*
Were there any witnesses?
*
Yes
No
Supporting Documentation (photos, reports, etc.)
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