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SKIN TYPE ASSESSMENT FORM SOLARIA The following form is based on the Fitzpatrick Skin Photo Type Classification System. It was taken from information on the Victorian Department of Human Services Guide to Requirements for Solaria in Victoria February 2009 at http //www. health. vic*gov*au/environment/downloads/radiation/ctuguidelines. pdf This form is an example of how skin type can be assessed by asking a client a series of questions. It is indicative only. Score Genetic Predisposition Light Blue Blue Grey or Blue Dark Brown Brownish Black What is the colour of your eyes Grey or Green Sandy/Red Do you turn brown within several hours after sun exposure How does your face react to the sun Tanning Habits When did you last expose your body to sun/solarium/tanning cream Did you expose the area to be treated to the sun Skin Type Score Painful redness blistering peeling Blistering followed by peeling Light colour tan Seldom Burns sometimes Rare burns Reasonable Tan very easily Sometimes Often Never had burns Very sensitive To what degree do you turn brown Several Chestnut/ Dark Blonde Pale with/ Beige Tint Few Hardly or not at all Never Reaction to Sun Exposure What happens when you stay in the sun too long Very Pale Many areas Do you have freckles on unexposed areas Green Blonde Reddish What is the natural colour of your hair Sensitive Normal Very resistant Never had a problem Total More than 3 months ago 2-3 Hardly ever Less than a weeks ago Always Black Light Brown Incidental None Turn dark brown quickly Fitzpatrick Skin Type Over 30 I II III IV V VI 5-6 Skin Type 1 means skin which always burns and never tans pale white skin Name of client. Total Skin type Score. Note the total score above is to be treated as a guide only in determining a person s skin type. Result of Skin Type Assessment Skin Type 1 if a person is assessed as Skin Type 1 the solarium must not allow that person to use a tanning unit Skin Type skin type number to be circled Assessment conducted by. health. vic*gov*au/environment/downloads/radiation/ctuguidelines. pdf This form is an example of how skin type can be assessed by asking a client a series of questions. It is indicative only. Score Genetic Predisposition Light Blue Blue Grey or Blue Dark Brown Brownish Black What is the colour of your eyes Grey or Green Sandy/Red Do you turn brown within several hours after sun exposure How does your face react to the sun Tanning Habits When did you last expose your body to sun/solarium/tanning cream Did you expose the area to be treated to the sun Skin Type Score Painful redness blistering peeling Blistering followed by peeling Light colour tan Seldom Burns sometimes Rare burns Reasonable Tan very easily Sometimes Often Never had burns Very sensitive To what degree do you turn brown Several Chestnut/ Dark Blonde Pale with/ Beige Tint Few Hardly or not at all Never Reaction to Sun Exposure What happens when you stay in the sun too long Very Pale Many areas Do you have freckles on unexposed areas Green Blonde Reddish What is the natural colour of your hair Sensitive Normal Very resistant Never had a problem Total More than 3 months ago 2-3 Hardly ever Less than a weeks ago Always Black Light Brown Incidental None Turn dark brown quickly Fitzpatrick Skin Type Over 30 I II III IV V VI 5-6 Skin Type 1 means skin which always burns and never tans pale white skin Name of client. .

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