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b� Body Art Inslation Report Date: t �.�1.40 San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO 5'1� 0 O (209)468-3420 Program www.siogv.org/ehd q!�0 Element: MWWW'M Sao= PRO544051 Hynek Washington PR0537587 Jose Diaz(BBP exp. 1/17/20 PRO544052 Ericson Nadlan BBP exp. 10-3-20 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)—The record of purchase and sterilization certificate were not available for tattoo express supply needles (lot#10-05) used by Jose and Ericson. Provide the EHD with a record of purchase and sterilization certificate for the instruments used. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol 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)—A written agreement/contract was not available for a sharps waste hauler or an approved mail back system. Three of the sharps container was full. Provide documentation to the EHD of an approved sharps waste hauler or mail back system that will be utilized for sharps waste disposal. Ensure sharps container is disposed of prior to it becoming full. 9. No food, drink, tobacco product, or personal effects are permitted in the procedure area. HSC 119309—A fountain drink was observed in the procedure room. Ensure food and drinks are not permitted in the procedure room. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307.—Hynek Washington did not have a current Bloodborne Pathogen Training certificate.Jose's and Ericson's BBP certificate was not posted. Submit a current Bloodborne Pathogen Training Certificate to the EHD for Hynek. Post BBP certificate in a conspicuous place, provide evidence to the EHD. 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—A client consent form and medical questionnaire did not include all the information listed in Form B. Ensure all the information from Form B is included on the client consent form and medical questionnaire. Keep client records at the site. Submit a copy to the EHD. Include in the consent form: - A description of the client should expect after the procedure. Include in the medical questionnaire: - History of herpes infection at the procedure site. - History of hemophilia or other bleeding disorders. - Other risk factors for blood borne pathogens. 28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if condition is compromised. HSC 119315—Inks were observed stored on a shelf in the procedure area. Ensure inks are stored in a container or cabinet to prevent contamination. Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17