COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

ou�n Date(MM/DD/YY) = 2_-) Body Art Inspection Report y County of San Joaquin County,Environmental Health Department K:f , Permit Number 15?,�� A.t .1 1868 E.Hazelton Ave.,Stockton CA 95205 (209)468-3420 www.siciov.oraiehd c Permit Type 41ULL '-�t�1 Facility Name Address City Zip Code CT i"L,,vr MA -3act, &Jx- ?-5'IVB mei^.An,,!!% ermit/Registration Holder Name Permit Exp.Date Total Time Inspection lype Cr3c,-13 � RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected On Site CLEANING A '�; ^ r .�k T.„. .� T COSMCHIN _ , ry x AND STERILiZATI cos SAS NO'SA N _x .our c In N/O 1. Autoclave is approved and effective-passed In zNIO 18. Safe machine design IA integrator test ❑ N/A ❑ ❑ V1AA /0 2. Process of cleaning,labeling,packaging and El ❑ N/0 19. Machines cleaned and disinfected between ❑ ❑sterliziing items correctly NIA clients n N/0 3. Autoclave loaded correctly/packages allowed to E3 ❑ N/O 20. Parts replaced between clients-grommets, ❑ ❑ /Ad NIA elastic bands,etc. n N/0 4. Integrators used/monthly spore test/log ❑ ❑ PREVENTING CROSS CONTAMINATION maintained n 10 5. Decontamination/sanitation area separate and ❑ ❑ In 10 21. Workstation/procedure'area decontaminated ❑ ❑ /A supplied* N/A tNIO 6. Invoices and log kept for disposable,pre- ❑ In N/0 22. Chemical disinfectant used ❑ a /A sterilized equipment,backu supplies available` N/A Chemical used: Un N/0 7. Sharps containers supplied,labeled,used and ❑ ❑ /10 23. Disinfectant used sufficient contact time Wet ❑ ❑ WA disposed of correctly `-�/A contact timeprovided: t. AONIO 8. Jewelry,tattoo and piercing equipment-storage ❑ ❑ n NIO 24. Barriers available and used as part of 0 ❑ N/A and use procedure ' rIrl N/0 25. Products applied to skin are single ❑ ❑ r PRACTITIONER HEALTH AND HYGIENE N/A use/dispensed aseptically /0N 9. No eating,drinking or smoking-clean clothes ❑ ❑ �NAIO 26. Storage of inks,pigments,needles,tubes,etc., 11 1:1 26, In10. Hands washed effectively and timely ❑ ❑ (nNIO 27. Jewelry,Inks,Needles etc approved and used 11 13N10 NIA In N/0 11, Handwashing facilities properly supplied and ❑ In N/0 28. Cross-contamination avoided during all phases ❑ 13NIA accessible,warm table water' N/A of procedure & N/O 12. Personal protective equipment available and ❑ ❑ TN/O i�� P CTICES " . NIA used,eyewash station available' - .. _ - mt . CUSTONIE' 13 EIT � Areas separated/no living or sleeping ❑ ❑ 4 • � 4uarters/no animals 013. Branding is completed with no other customers in ❑ ❑ Floors and walls clean and in good repair, ❑ ❑ ! procedure area /A adequate light In 10 14. Customers eighteen(18)years of age or older 0 0 n N/0 31. Workstation,surfaces,including chairs,,etc.in ❑ ❑ /A N/A good repair;trash removed frequently In N/0 15. Skin prepared for procedure. ❑ ❑ In N/0 32. Permit/registration and required signs posted' ❑ ❑ NIA /A n N/0 16. Client records available-Consent form& ❑ n N/0 33. IPCP and employee training records and ❑ ❑ NIA questionnaire A He atitiis B vaccination status resent In NIO 17. Aftercare instructions given to client ❑ In N/O 34 Restrooms available,stocked` ❑ ❑ N/A NIA Received by(Print): Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: ❑ This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee maybe charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page is I