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Page I of <br />,o C' <br />Body Art Inspection Report <br />Date (MM/DD/YY} f� Z 1 <br />2 <br />y <br />County of San Joaquin County, Environmental Health Department <br />Permit Number �PTdD 23 S <br />e <br />< <br />1868 E. Hazefton Ave., Stockton CA 95205 <br />(209) 468-3420 www.sioov.oro/ehd <br />Permit Type alter <br />Facility Name <br />Address <br />City <br />Zip Code CT <br />a le i?�S <br />lq <br />t� Cz%t�►r"OW__A1 <br />',A , <'(5a_41 V ScA n J <br />, .,Y► <br />Permit/Registration Holder Name <br />Permit Exp. Date <br />Total Time Inspection Type LY <br />6 vena <br />.:30- <br />R. <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 <br />N/O = Not <br />Observed <br />N/A = Not Applicable COS = Corrected On Site <br />* <br />rT. _ 0 D E ENTCOSMETICS MACHINE <br />GLEANING <br />AND STERILIZATION. , ��, <br />ours : cos <br />��5 A aSAN TION <br />our_ cos' <br />In NQ <br />1. Autoclave is approved and effective - passed <br />0 <br />0 <br />n 0 <br />18. Safe machine design <br />❑ <br />0 <br />/ <br />integratortest <br />A <br />In N/O <br />2. Process of cleaning, labeling, packaging and <br />11 <br />13 <br />n N/0 <br />19. Machines cleaned and disinfected between <br />11 <br />0 <br />JA <br />stediziin items correct) <br />NIA <br />clients <br />In 0 <br />3. Autoclave loaded correctly/packages allowed to <br />El <br />n N/0 <br />20. Parts replaced between clients - grommets, <br />El <br />El <br />! <br />d <br />NIA <br />elastic bands, etc. <br />In 10 <br />4. Integrators used/monthly spore testllog <br />11 <br />PREVENTING CROSS=CONTAMINATION <br />A <br />maintained <br />10 <br />5. Decontaminatiordsanitation area separate and <br />0 <br />� <br />n N/O <br />21. Workstation/procedure area decontaminated <br />0 <br />13 <br />/ <br />supplied * <br />NIA <br />!0 <br />6. Invoices and log kept for disposable, pre- <br />i N/0 <br />22. Chemical disinfectant used <br />NIA <br />sterilized equipment, backupsupplies available * <br />NIA <br />Chemical used: ck Vic % <br />(1h,)N/0 <br />7. Sharps containers supplied, labeled, used and <br />❑ <br />0 <br />In WO <br />23. Disinfectant used sufficient contact time Wet <br />/A <br />disposed of correct(* <br />/A <br />contact timeprovided: <br />WIn 0 <br />8. Jewelry, tattoo and piercing equipment - storage <br />❑ <br />N/0 <br />24. Barriers available and used as part of <br />11 <br />13 <br />A <br />and use <br />I /A <br />procedure <br />n N10 <br />25. Products applied to skin are single <br />13 <br />11 <br />PRACTITIONER HEALTH AND HYGIENE <br />N/A <br />useldis ensed aseptically <br />In /0 <br />9. No eating, drinking or smoking - clean clothes <br />[I <br />El <br />N/0 <br />5/A <br />26. Storage of inks, pigments, needles, tubes, etc., <br />0 <br />13 <br />N/A <br />In /0 <br />10. Hands washed effectively and timely <br />0 <br />11 <br />n /0 <br />27. Jewelry, Inks, Needles etc approved and used <br />N/A <br />/A <br />qN10 <br />11. Handwashing facilities properly supplied and <br />0 <br />0 <br />In NIO <br />28. Cross -contamination avoided during all phases <br />/A <br />accessible, warm potable water * <br />NIA <br />of procedure <br />/15_311/0 <br />12. Personal protective equipment available and <br />0 <br />❑ <br />BEST BUSINES.S;PRACTICES <br />N/A <br />used, eyewash station available <br />CUSTOMERSICLIENTS <br />In <br />29. Areas separated/no living or sleeping <br />0 <br />El <br />!A 'quarters/no <br />animals * <br />In N 0 <br />13. Branding is completed with no other customers in <br />0 <br />30. Floors and walls clean and in good repair, <br />!procedure <br />area <br />/A <br />adequate light <br />(In -710 <br />14. Customers eighteen (18) years of age or older <br />n N/0 <br />31. Workstation, surfaces, including chairs,, etc. in <br />13 <br />❑ <br />/A <br />N/A <br />good repair; trash removed frequently * <br />n NA10 <br />15. Skin prepared for procedure. <br />n <br />32, Permit/registration and required signs posted <br />11 <br />0 <br />IAO <br />In /0 <br />16. Client records available - Consent form & <br />In N/O <br />33. IPCP and employee training records and <br />NIAuestionnaire <br />N/A <br />He atitiis B vaccination status present <br />n /O <br />17. Aftercare instructions given to client <br />In N/0 <br />34 Restrooms available, stocked <br />!A <br />NIA <br />Received by <br />(Print): Received <br />by (Signature): Phone: <br />Specialist (Print): <br />Specialist (Signature): Phone: <br />F1This report is an Official Notice of Violation. Corrections must <br />be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this <br />report are not corrected <br />by the reinspection date. Reinspection Date (on or about) <br />Page I of <br />