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Body Art InspectIt Report • Date: 12- ' <br /> San Joaquin County Environmental Health Department Program <br /> Q. <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S 20 0 WO 62 <br /> (209)468-3420 <br /> www.sjogv.org/ehd Program <br /> Element: Lf <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO543783 Ludda Her <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)n-Provide evidence of sterilization and invoices for the purchased blades. <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)-Provide a written agreement or contract <br /> with the mail-back system practitioner planning to utilize. <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. -Post bloodborne pathogen training certificate in a conspicuous place. <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-Medical questionnaire is missing the following statements: <br /> 1. history of herpes infection at the procedure site <br /> 2. History of allergic reactions to antibiotics <br /> 3. History of hemophilia or other bleeding disorders <br /> 4. History of cardiac valve disease <br /> 5. Requirements for antibiotics prior to surgery or dental procedures <br /> 6. Other risk factors for blood borne pathogens <br /> The client consent form is missing the following statement"notice that inks are not FDA approved and health <br /> consequences are unknown." <br /> 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312-Post the <br /> health permit in a conspicuous place. <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-Complete the IPCP <br /> and provide a copy to the EHD. <br /> Notes: <br /> 1. Provide a copy of the updated client consent form and medical questionnaire to the EHD. <br /> 2. Provide a copy of the sterilization certificate and invoces of purchased blades to the EHD. <br /> 3. Provide a copy of the written agreement or contract with a mail-back system. <br /> 4. Ensure that a copy of the clients identification cards are maintain with their records. <br /> 5. Provide a copy of the IPCP to the EHD. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />