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Body Art Inspeon Report Date: 100(71 b8 2 ? San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 4)03 Izos>as8-sato � 3 •• •., ; . Program www.siogv.org/ehd » Element: SP,Go PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME Observations and Corrective Actions: 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. The record of purchase,evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f)-Provide sterilization certificates for blades to verify equipment is pre- sterilized. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste"or with the biohazard symbc and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e)-Provide contract/written statement with mail back system to document proper disposal of sharps. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307.-Post bloodborne pathogen training certificate in a conspicuous place. 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding_ Body piercing, unless performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302-Include in Room#1 consent form: Client is at least 18 years of age. Include in client records driver's licenselcopy of identification to verify client age. 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303-Include in Room#1 consent form: Client is at least 18 years of age. Include in Room#1 medical questionnaire: history of herpes infection at the procedure site,and other risk factors for bloodborne pathogens. Include in Room#2 medical questionnaire: history of herpes infection at the procedure site, history of allergic reactions to latex, history of allergic reactions to antibiotics, history of cardiac valve disease, and requirements for antibiotics prior to surgery or dental procedures. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed it Form B. HSC 119308(b)-Include in Room#2 postprocedure instructions: signs and symptoms of infection,and indications when to seek medical care. 20. The machine used to insert pigments into the skin shall be designed with removable tip parts between the tip and motor housing. The machine must be designed in a manner that will prevent backflow into enclosed parts of the motor housing. HSC 119311(i) 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC 119311(a)-Utilize single use products to apply to skin prior to tattooing. Either single use markers/pencils, or ink and a toothpick would suffice. Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of i EH-11/17