Proprietor / Owner
Proprietor/Owner Residential Address
Proprietor/Owner Phone No.
Address of Premises
Person interviewed during inspection
- Mobile Hairdresser
- Mobile Beautician
- Colonic Lavage/Irrigation
- Nail Treatments
- Dry Needling (Micro-dermabrasion)
Is the premises Clean and Hygienic?
Does the premises have a Waste Disposal Bin?
Does the premises have a Hand Basin that has a supply of Clean, Warm, Potable Water?
Does the premises have a separate sink that has a supply of Clean, Warm Water for cleaning equipment? (Required if the equipment used in skin penetration procedures at the premise and is cleaned at the premises)
Does the premises have liquid soap for the persons carrying out the skin penetration procedure?
Does the premises have single-use towels or an automatic hand dryer for the persons carrying out the skin penetration procedure?
Does the premises have disposal gloves for the persons carrying out the skin penetration procedure?
Does the premises have clean linen for the persons carrying out the skin penetration procedure?
Does the premises have gowns or aprons for the persons carrying out the skin penetration procedure?
Is the equipment in good working order, cleaned and dried after use?
Does the premises have a Toilet? (only available for use by the clients and not by the general public)
Is the toilet in the case of a closed system located in close proximity to the room?
Is the toilet in the case of a open system located in the immediate vicinity of the room in which the procedure is being carried out?
Is there an appropriate sharps container? (appropriate sharps container is AS/NZS 4261:1994 for reusable containers and AS/NZS 4031:1994 for non reusable containers)
Is there a an adequate supply of sterile disposable needles?
Are all reusable articles used to penetrate a persons skin sterilised? (at the premises or off site)
Is the bench top autoclave? (maintained in accordance with AS 2182-1998 sterilisers-steam-bench top)
Is there at least 1 person present at the time the autoclave is used who is trained in the operation?
Is the sterilisation carried out in accordance with AS/NZS 4815:2006? (Office based health care facilities)
Does the occupier of the premises have records for the past 12 months?
Is the time and date when each article is sterilised shown in the records?
Is the length of time the article was autoclaved and temperature and pressure levels of the autoclave shown in the records?
Do the records show the date on which the article was sent off-site for sterilisation?
Do the records show the name and address of the person who sterilised the article?
All needles must be single use?
Is there non-reusable appropriate sharps container (AS 4031-1992) in use and used immediately after procedure?
Any other article used in the procedure must be disposed of immediately after the procedure?
Any other non-reusable used in the procedure must be disposed of immediately after the procedure?
A person must not use any article that may penetrate the skin unless it is clean and sterilised and in a sterilised environment?
Does the person that carries out a skin penetration procedure wear single use gloves? Are the gloves on the premises? Are the gloves disposed of immediately?
Does the person that carries out a skin penetration procedure wear (other than colonic lavage) a clean gown or apron durning the procedure? (This question does not apply to a person carrying out a skin penetration procedure that involves wax for the purpose of hair removal, unless the person reasonably suspects they will be in contact with human bodily substances)
Does the person that carries out a colonic lavage procedure wear a clean gown made from impermeable material?
Are skin inks and pigments or other liquid decanted into a single use container? Use a single use applicator for each person undergoing the procedure? (this does not apply to skin penetration procedures involving the use of wax for the purposes of hair removal)
Is the wax disposed of and any instrument used to apply the wax (such as a spatula), immediately after completing the procedure?
Has the premises / business provided Council notice in writing that skin penetration procedures are being carried out?
Has the premises / business notified council within 7 days of any change in particulars?
Has notification been provided to Council (In the case of a mobile skin penetration business) where the occupier resides?
Has the occupier of the premises been served with a prohibition order?
Is the order displayed in a conspicuous place or at each entrance of the premises concerned?