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HomeMy WebLinkAboutInkredible Body Art - Inspection - 350 WINTHROP AVENUE 8/23/2023 IV North Andover Wealth Department Community and Economic Development Division Body Art I;stablishnzent lnspecticrrr Forrn Establishment Name. �_... :_ " Establishunent .Arlclress: i .. ......___ .... .. ......_ __.. ..... . _ .....a..m............. Owner(s) of Establishiner�it. _.,. � .. ._ ...... .. .. m ,w ......_..... �� (: wner(s) (;'crntact lrrf`cr:� _- ..._ ....... 4..� . ,..Lvn-...... .� .._ .� ...... .� a..::. .... � Nurnbcr- of pr-oceclure rooms: C 1 CAO t., �.. Licensed Boll), Ai-t Practiticrrrcr�• Licensed ltcrcly ArtPi-actiticrner•Address: Licensed Body .Art Practitioner Phone: J. . .. ..:.. .. ......'. Estalalishrnent 'Type......._J'at oo/llody Art Piercing, � 1'��rt�tcrrr/13r�����ly Art &- Piercing Inspection Type: Pre-4 p rrtirrrl VA1111rr�rl Corrrlalairi�tdr1iUl-� Rr..port Inspector: /J/ �,. ),)1 1)M ,.. Violation Re-inspection Reg Date n,aatiaan Violation Columents ..... ...._____w Cori-ected.. ___...._j�hys,ical Facility.— ......_µ�µ. .. ....�.._... ..... .. . _...:..... . ........ _..... .. . ::.. .... ....._._ Walls, floors and ceilin s are �"n :;araocrth and c:leart l Ist,ablishment space is separate trctlaa non-establishment or ha.ltataaltic s ace _ _ ..__ . _.. _ ..... ..-- . ..... ... C"licrit waiting arcaa is separate from lac+cly atrtrrctcedura area N(v .i aanitnals are al.lcawed in estalalislaaatent cxccl)t: 0 `yet-vice aniinals © l'isla aaqu ariurn in Nton- lalc>c,cdcaral areas No insect and/or rodent infestation Ade( LI,Itu ventilation rlclec agate fighting . . � ._._ _..__.. ... ..._._.w�...._.._ l 2(l foot candles : Cut caf.f. f floor Toilet. room (ininiaaaa.aan cal l): 0 Toilet & hand sinks are clean and working ❑ Hand silty with fiat/cold. water gander pressure C "Yoilet, toilet paper, liclaaid soap & paler towels in fixed dispensers 0 Covered & foot operated waste receptacle Solid Waste 0 Covered, leak prncal', rodent resistant containers Cl Ern plied weekly. _. .... Caaaaitcariaal Sink CI Adeclaaate size ❑ Hot/cold water under pressure llastraaanent cleaning area has 6V autoclave area located aat lc aast .aft Ophlklqs inches from ultrasonic clearlaaag aalllt � Instrument storage area. ® Stared in clean, dry location in covered containers ❑ Area is secaarcd, and stores iaastralj nents only _. _ . f oors are non-larninate 1ec:aarstic cc,ilirap, tiles not used _ _ .. _..... _.__..._.. ._ _........... _..... __._.._. .. _._._ _.__........ ...._.-_.............. Physical Facility— Procedure Area: -- ._e... Procedure srarfiaccs are smooth, easy to clean & sanitize _. ............... _........., . s or ze e.�llearatarracfas�araiti hcraclae°s are easy to - _. . . _ ... _.,_.__ _. __ ----- . F'ach practitioner has ra rninimurn of v� 4 scfuarr e..'c'et. . ..... .............. Work stations have a form ot`divider betwecn therm _. .. . ._, ............ franca sink stations rraclude: ❑ I loticolcl water under pressure ❑ l_,iyrrid soap & disposable paper towels in fired disp.ensers _.....__...._..........--__ Lighting provides 100 foot candles where l.rody wart procedra.re is performed/where instrUment.s and sharps are rassenahled, and in any _ r c cn areas Sharps at aincr provided in each pr�r trticaracr room and cleaanni; area Waste receptacle that is toot � ol7craatcd grad ern tied each day Practitioner does not smoke, eat or � - -i'ri rn�arocedurr. area 1'ostar � PoSti igs are pr(�rrninently displayed p... Disclosure statements posted Coils aicuous] Board of lfealt:h inlorrn.ation (name., °' address, and phone number) pasted conspicuousty ..... ---- , „ ...._. .... I.,naergenc:y plan wailealale incicrdinp : ❑ Police, tire:; or I,,MS contact phone numbers 0 A working telephone; at; c-stablishrnerrt . ..........k _ _ .. , . _.. A current oc.cUpar,ac,�._pgrmrt .,.. . ... .... - - ..... _....... A current e_nt estat)lishnrcrat pe r rnit A current practrtrc.rn,c ) rrnit r I�-,b Us Items l'he fiallowing, Products applied to � skin are single use and disposed of: � 0 1 lcrllokv bore, needles with ca nula. 1l `stencils, gauze, razors etc. 0 Ink, stye, pigments and individual cc:>ntainrs _.... . ..... . ... _..... . __.._. _.. l Sharps �rrc clrs-rcrsccd into appreavecd s s ccrnrrnS Sanitation andSterilization: Ultrasonic cleaning unit present and � �vctirkrn , Autoclave present and working (if" � non-cdrs rosabtc rrrstrunnnts rrsedl,. _ - �.._ AutOCI,rve INNS (daily log forsanilizin , slrrtcrc l rvc tern ,eratrrr�c .. _.._l lcleefA r ❑ is clean Q7 re F1 l siacatccl away from _ ns c 7ublic arck�s ,....'. „. lslcrr -clr,l <r;�rt�lr.r . 1. _ ..._._... wcrr strrtrr rstrurnnts are: Mi N� �w� 0 ('leaned and processed in 04 rrltrr�rsernic, rrrrit ❑ lndivictrrally packed in steriIif,er l:rack.s ❑ Sterilized via stearn t aucrctave _.. _.... _.._ .. .. `sterilizer packs have: 7 l'erriperatcrre/steril irer. indicator V' ❑ Ll'xpiration date which doesn't exceed 6 months 0 Packs are, intact without fears or breach _ .. .... ........... �_..... Disposable me dical gloves available Practitioners wear gloves while handling instruments _.. .. _....... ..... . _.. _ __........ Used linens/c;lottrs stored in covered �. containers, and stored in (dry and clean area until used ... d,inrs/cloths are washed in accordance with erlal-rdreal�le hospital/radical care facility standards _ .... .. _._ ... __ _......._,. _._ ........_._ _.__.r .._... Standards of Practice for review with Pr�acAtitioner) _._ _ _ _ __ __­_ °.... ......_­_._._. .__._...._ _._..... . ... ..-_- All body art procedures Marc. � performed according to CDC Universal Precaautious -- --- .... .... . .. Practitioners: D Maintaairi personal ✓ cleanliness and wear cleaara clothes El l)ora't operatc when having skin rash, infection, etc. 0 Dora"t operate when having crarnrraanaicahle disease C l Don't diagnose/treat cora.muicablc disease or condition El It'diagnosed with/suspected ot'liaving immunodeficiency conditional lep B, must observe and tfiallow all current CI DC standards _. .......... _._..._ —_....__... Service is r•cl`used when: 0 C`lients are under the influence ol`alcohol/drugs, or show signs cif`recent. intraavencsaas drug use El `1`aattooirig, branding or- sc.a.rihcat.iou of`cherats under l l years of gag Har piercing systems used on ear lobes only. f lands are washed with heat water and soap prior to glove ap lrcation and procedure _.. __ - ... Practitioners wear sinfl.e usc gloves during, procedure, and change gloves once coratarninated cr torn . ._----- _......... __ .......... lnstrurneuts coutaarninated during proced.yi•:- arc arnrnc,dratc,ly r eplac ed__ C"lient skin is cleaned and free of visible infection _ ..... _... - - .......__ Practitioners use inks, dyes, ligaments, needles, all other ecluipi neat. 0 Manufactured for body art procedures onl:.y.. _.. _ _....... .- __..._. .. -._...... .. _....._ ..........__.....,.... El ,According to na.., �� aaraaaliactnaer's instructions Aftercare instraactions are provided � to client Practitioner has received as copy, of` the North Analcaw Body Aa..�,...�.�. s.._....... _. ....... _ Recc►rdk��enI n : Records must hc kclat fiar a:a mininaurn of3 years and be laccessible,tally,lantcr�tliaafiranaticarara rccfaast. '''.. 0 Name, address & hours of` operation El Name &, address (&Owner Body art procedures c.af'f'ereaf 0 Inventory list of'all jewelry, body art equipment& instruments, inks, manu acturer inf6rrnat:ion, etc. ❑ Material safety data slacet 0 A copy of`tlae Noah Andover l OIJ body art re nla l,iaaras 0 Spore testing copies © Waste hauling manifests inc.,ident reports ,_.... ........ ----- Employee info nation inChAding; a Name, horne address, D013, and telephone naamber Cl 1. act employee ditties 171 prra.ctitioner"s fl:ep B info © Photo 11:) ❑ Dates of'erriployment. El Training records (Anatomy Physiology ecaaarse, hloodborne pathogen, l" .Aid CPR, ccrti Iicate of" 100 hours instruction tinac firona. ,American ,Academy of` Micrcapigrnentation or Society of Permanent Cosmetic Professionals) 0 ,Apprentice records (all Training records, plus as copy of`letter from Trainer, tia.ainin�; I<a��„, aaacl 4aaaracaalaaraa) _...... _ Client rnl'orrnaation including: C] Name, address and DOB El Date, description of location ()F prcruccftire, practitioner performing procedure 0 Health history consent. 1 c>r•r11 0 (:"Opy 01'guarrclidn ll) if`crlient. is under 1 _. ..... _......_ .... _ A ulcrc,laave nraanufarcturcr s rn lr[uctrc ns (rf rcic.varr l ` Monthly autoclave slrcrrc cic°str-arc:licrrl tests fr`rr lcv�ura.t Completed Exposure (.'trrjtrcrl Plan is available on site k . .. .. .. _ . .... . , Additional it:iona comments: r _. _. _.... ._ M.. .......... _.__._------ Signature raf`iraslaector•._...�...�. ` igntur c.rrf`1 crsc,rra in Charge:_........... ... . f)artc;_ � R insPcc,ticrrr; Yes N o If`es, chute rrf`reinspectrun._......__._ ,..._...... ..._.___. ��m