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.vtN , yip <br /> Body Art Inspecticaeport 40 Date: 2. <br /> San Joaquin County Environmental Health Department Program PRQ s-1 I q S� <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3t20 <br /> wwwsiogv.org/ehd ProgramLl I <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO541951 Taylor Mulroone <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)—Maintain record of purchase of blades at the facility at all time. <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- Provide a copy of the client ID and write down the lot number of the blade uses on <br /> the client on the consent form. <br /> On the medical questionnaire, provide a statement on"history of hemophilia or other bleeding disorders"and other <br /> risk factors for blood borne pathogens." <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)—Provide a statement regarding when to seek medical care. <br /> 28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from <br /> dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if <br /> condition is compromised. HSC 119315—Make sure to store inks in a container or cabinet away from dust and moisture. <br /> 33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br /> repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, <br /> durable, and nonabsorbent finish. HSC 119314 <br /> Note: <br /> 1. If you have any question, please contact me at (209) 468-3284 or mvue@sjcehd.com <br /> 2. Provide a copy of the updated consent form to the EHD. <br /> 3. Provide a copy of the updated medical questionnaire to the EHD. <br /> 4. Provide a coy of the updated postprocedure instructions to the EHD. <br /> Unless otherwise noted, correct all violations before February 18, 2019 <br /> C--- <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />