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n <br />�o�y'".. �o Body Art Inspection Report Date (MM/DD/YY) /0..-1 <br />County of San Joaquin County, Environmental Health Department <br />n i 1868 E. Hazelton Ave., Stockton CA 95205 Permit Number <br />i' <br />(209) 468-3420 www.sioov.org/ehd <br />�`� • Permit Type <br />Facility Name Address City Zip Code CT <br />%2I.J �3`7�xnl.C;fsCOn lAb__e, ok,"tk2 &16 � i02l cL <br />Permi Registration Holder Name Permit Exp. Date Total Time Inspection Type <br />RISK FACTORS AND INTERVENTIONS <br />Risk factors are improper practices or procedures identified <br />as contributing factors of cross -contamination. <br />Interventions are control measures to prevent cross -contamination <br />and transfer of pathogens from one person to another. <br />In = In Compliance Out = Not in Compliance N/O = Not <br />Observed <br />N/A = Not Applicable COS = Corrected On Site <br />TATTOO AND PERMANENT COSMETICS MACHINE <br />CLEANINGAND.STERILIZATION .:. OUT COS <br />SAI"ETY'AND SANITATION OUT cos <br />In N/0 <br />N/A <br />1. Autoclave is approved and effective- passed <br />integrator test <br />11 <br />0 <br />In N/O <br />N/A <br />18. Safe machine design <br />❑ <br />❑ <br />In /0 <br />N/ <br />2. Process of cleaning, labeling, packaging and <br />sterliziing items correct) <br />❑ <br />❑ <br />In 0 <br />N/A <br />19. Machines cleaned and disinfected between <br />clients <br />❑ <br />171 <br />In3. <br />61A <br />Autoclave loaded correctly/packages allowed to <br />dry <br />Ino <br />NIA I <br />20. Parts replaced between clients - grommets, <br />elastic bands, etc. <br />❑ <br />11 <br />In <br />/A <br />4. Integrators used/monthly spore test/log <br />maintained <br />0 <br />11 <br />PREVENTING CROSS -CONTAMINATION <br />In N/0 <br />/ <br />5. Decontamination/sanitation area separate and <br />supplied * <br />In / <br />/A <br />21, Workstation/procedure area decontaminated <br />0 <br />El <br />In NIO <br />N/A <br />6. Invoices and log kept for disposable, pre- <br />sterilized equipment, backu supplies available * <br />El <br />In NI0 <br />N/A <br />22. Chemical disinfectant used <br />Chemical used: <br />1 <br />In N/0 <br />N/A <br />7. Sharps containers supplied, labeled, used and <br />disposed of correct) * <br />In / <br />N/A <br />23. Disinfectant used sufficient contact time Wet <br />contact timeprovided: <br />0 <br />El <br />In N/O <br />N/A <br />8. Jewelry, tattoo and piercing equipment - storage <br />and use <br />n N/O <br />N/A <br />24. Barriers available and used as part of <br />procedure <br />0 <br />= � PRACTITIONER HEALTH AN6HYGIENE� <br />n N/0 <br />N/A <br />25. Products applied to skin are single <br />use/dispensed aseptically <br />0 <br />In N/0 <br />N/A <br />9. No eating, drinking or smoking - clean clothes <br />E] <br />N/0 <br />N/A <br />26. Storage of inks, pigments, needles, tubes, etc., <br />In N/O <br />N/A <br />10. Hands washed effectively and timely <br />❑ <br />0 <br />N/0 <br />NIA <br />27, Jewelry, Inks, Needles etc approved and used <br />In N/0 <br />N/A <br />11. Handwashing facilities properly supplied and <br />accessible, warm potable water * <br />In &` <br />N/A <br />28. Cross -contamination avoided during all phases <br />of procedure <br />El <br />11 <br />1n N/0 <br />N/A <br />12. Personal protective equipment available and <br />used, a ewash station available <br />BEST BUSINESS PRACTICES" v <br />�P Tg <br />CUSTOMERSICLIENTS <br />In N/O <br />N/A <br />29. Areas separated/no living or sleeping <br />uarters/no animals <br />In N/O <br />GO <br />13. Branding is completed with no other customers in <br />procedure area <br />0 <br />❑ <br />In N/0 <br />(A <br />30. Floors and walls clean and in good repair, <br />adequate light * <br />In N/0 <br />N/A <br />14. Customers eighteen (18) years of age or older <br />0 <br />n N/0 <br />NIA <br />31. Workstation, surfaces, including chairs, , etc. in <br />good repair; trash removed frequently <br />0 <br />0 <br />In 1 <br />N/A <br />15. Skin prepared for procedure, <br />In N/0 <br />N/A <br />32. Permit/registration and required signs posted <br />r <br />In N/0 <br />N/A <br />16. Client records available - Consent form & <br />questionnaire <br />"4 <br />In N/O <br />N/A <br />33. IPCP and employee training records and <br />He atitiis B vaccination status present <br />❑ <br />In N/0 <br />N/A <br />17. Aftercare instructions given to client <br />In N/0 <br />N/A <br />34 Restrooms available, stocked * <br />❑ <br />Received by (Print)' Received by (Signature): Phone: <br />❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. <br />Page_Lof U <br />Phone: a70q -Y6 Y' <br />Reinspection Date (on or about) <br />