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• <br />Body Art Inspection Report Date (MM/DD/YY) ti - 1 3 <br />y County of San Joaquin County, Environmental Health Department 4 <br />E. Hazelton Ave., Stockton Permit Number <br />1868 CA 95205 <br />•% (209) 468-3420 www.sigov.org/ehd <br />F'ot✓ Permit Type <br />Facility Name Address City Zip Code CT <br />Q (RI A, 5tc�,r". i,��ilft •rf LtU: 4t�aziG aCtet �tarztn .y/� �L'�ir�ti <br />Permit/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 />Ti�i DERNANTCQSMt:TCSM*ICHINE <br />�e, <br />CLEANING'AND STERILIZATION ;our <br />cos <br />SAFET�G�`AN S 1ATION . x �,; .�, .. , our - cos <br />In N/0 <br />1. Autoclave is approved and effective - passed <br />In NIO <br />18. Safe machine design <br />NIA <br />integrator test <br />NIA <br />In N/0 <br />2. Process of cleaning, labeling, packaging and <br />0 <br />0 <br />In N/0 <br />19. Machines cleaned and disinfected between <br />0 <br />0 <br />NIA <br />stediziing items correctly <br />NIA <br />clients <br />In N10 <br />3. Autoclave loaded correctly/packages allowed to <br />0 <br />0 <br />In N/0 <br />20. Parts replaced between clients - grommets, <br />0 <br />0 <br />NIA <br />dry <br />NIA I <br />elastic bands, etc. <br />In N10 <br />4. Integrators used/monthly spore test/log <br />PREVENTING CROSSrCONTAMINATION i <br />NIA <br />maintained <br />0 <br />0 <br />In N10 <br />5. Decontamination/sanitation area separate and <br />0 <br />0 <br />In N/0 <br />21. Workstation/procedure area decontaminated <br />0 <br />0 <br />N/A I <br />supplied ` <br />I <br />N/A <br />In N10 <br />6. Invoices and log kept for disposable, pre- <br />0 <br />0 <br />In N/0 <br />22. Chemical disinfectant used <br />0 <br />0 <br />N/A <br />sterilized equipment, backu supplies available ' <br />N/A <br />Chemical used: <br />In N/0 <br />7. Sharps containers supplied, labeled, used and <br />0 <br />0 <br />In N10 <br />23. Disinfectant used sufficient contact time Wet <br />0 <br />O <br />NIA <br />disposed of correct) " <br />N/A <br />contact timeprovided: <br />In N10 <br />8. Jewelry, tattoo and piercing equipment - storage <br />0 <br />0 <br />In N10 <br />24. Barriers available and used as part of <br />0 <br />0 <br />N/A <br />and use <br />N/A <br />procedure <br />In N/O <br />25. Products applied to skin are single <br />0 <br />0 <br />PRACTITIONER HEALTH AND HYGIENE <br />N/A <br />useldis ensed aseptically <br />In NIO <br />9. No eating, drinking or smoking - clean clothes <br />11 <br />0 <br />In N/0 <br />26. Storage of inks, pigments, needles, tubes, etc., <br />D <br />El <br />NIA <br />WA <br />In N10 <br />10. Hands washed effectively and timely <br />0 <br />0 <br />In N10 <br />27. Jewelry, Inks, Needles etc approved and used <br />0 <br />❑ <br />N/A <br />NIA <br />In N/0 <br />11. Handwashing facilities properly supplied and <br />0 <br />0 <br />In N/O <br />28. Cross -contamination avoided during all phases <br />0 <br />0 <br />N/A <br />accessible, warm potable water * <br />NIA <br />of procedure <br />In N/0 <br />12. Personal protective equipment available and <br />0 <br />0 <br />BEST BUSINESS PRACTICES <br />NIA <br />used, eyewash station available' <br />CIJSTOMERS[CLLIIENTS_,�t � <br />" <br />In NIO <br />29. Areas separated/no living or sleeping <br />0 <br />0 <br />,. _�.1.� <br />.� <br />NIA <br />uarterslnoanimals <br />In NIO <br />13. Branding is completed with no other customers in <br />0 <br />0 <br />In NIO <br />30. Floors and walls clean and in good repair, <br />0 <br />0 <br />N/A <br />procedure area <br />N/A <br />adequate light <br />In N10 <br />14. Customers eighteen (18) years of age or older <br />0 <br />0 <br />In N/0 <br />31. Workstation, surfaces, including chairs, , etc. in <br />0 <br />0 <br />NIA <br />N/A <br />good repair; trash removed frequently <br />In N/0 <br />15. Skin prepared for procedure. <br />0 <br />0 <br />In N/0 <br />32. Permit/registration and required signs posted " <br />0 <br />0 <br />N/A <br />NIA <br />In N/O <br />16. Client records available - Consent form & <br />0 <br />0 <br />In NIO <br />33. IPCP and employee training records and <br />0 <br />0 <br />NIA <br />questionnaire <br />NIA <br />He atitiis B vaccination status present <br />In N/0 <br />17. Aftercare instructions given to client <br />0 <br />0 <br />In N/O <br />34 Restrooms available, stocked <br />❑ <br />❑ <br />NIA <br />NIA <br />C <br />SCC- ice` <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (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. Reinspection Date (on or about) <br />Page 1 of <br />