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,R "' i�i Body Art InspectReport Date: 13 11-7 <br /> 41 San Joaquin County Environmental Health Department Program <br /> .� <br /> .. <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> \*\ (209)468-3420 Program <br /> www.siogv.org/ehd Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Savoeun(Tiffany)Prok <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and <br /> client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f) <br /> 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste"or with the biohazard symbol <br /> and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br /> Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303 <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b) <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP)shall be maintained, followed and updated. HSC 119313 <br /> 36. Design plans shall be submitted to EHD for approval prior to constructing or remodeling body art facility. HSC 119312 <br /> All violations noted above must be corrected prior to final consultation <br /> Notes: <br /> 1.) Prior to final consultation. <br /> a. Correct all items listed above. <br /> b. Pay for facility and practitioner permit at EHD. <br /> C. Contact EHD to schedule final consultation. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />