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~ Body Art Inspect Report z` San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 (209) 468-3420 www.siogv.org/ehd PR Number PRACTITIONER/ARTIST NAME Observations and Corrective Actions: PR N Date: Program Record: Program Element: 115 /7-01-5 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) 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 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in Form B. HSC 119308(b) 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312 37. A body art facility shall not conduct business without a valid health permit. A person shall not perform body art without a valid registration and a permitted facility. A body art facility shall notify the LEA in writing within 30 days of resignation, termination of a practitioner. Anew hire or apprentice must be registered the EHD prior to performing body art at the facility. HSC 119312 & 119306 Unless other wise noted, violations listed above must be corrected within 34 days. Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 2 of 2 EH -04/2014