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List all chemicals(e.g. NON-EPA registered solutions) used in this facility: N/A All chemicals <br /> To be used in this facility must be approved and meet EPA standards. <br /> YES X NO <br /> Are all chemical bottles labeled? <br /> The Material Safety Data Sheet (MSDS) sheets for all chemicals are located in: Kept in a <br /> binder located at register area. <br /> How are sterile instrument packs evaluated prior to use? <br /> Each pack is inspected individually to make sure that the indicator shows proper sterilization. <br /> Bags will be checked to make sure that they are intact and free from any holes, tears, <br /> punctures, discoloration, wetness or moisture contamination. Each pack will also be inspected <br /> to make sure they were properly sealed and labeled. <br /> Are sterile instrument packs opened in front of the customer prior to the procedure? <br /> YES X NO <br /> Clean instruments to be sterilized shall first be sealed in peel packs that contain either a <br /> sterilizer indicator or internal temperature indicator.The outside of the pack shall be labeled <br /> with the name of the instruments,the date sterilized, and the initials of the person operating <br /> the sterilizing equipment. <br /> Sterilizers shall be loaded, operated, decontaminated, and maintained according to the <br /> manufacturer's directions. <br /> Describe the location of your decontamination area/clean room and sterilization equipment in <br /> the facility: The room is located at the back of the building at the furthest most point from <br /> the procedure and customer areas. Room is clearly labeled as bio hazardous and employees <br /> only. <br /> Is the decontamination room more than 5 feet from the procedure area or separated by a solid, <br /> cleanable barrier? YES X NO <br /> Is an ultrasonic machine used for washing and cleaning instruments? YES X NO <br /> Page 4 of 24 <br />