Health Premises Audit - Local

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Other Personnel

Operator Details

• Trading Name

• Licence Number

• Address of Premises
  Address

• Proprietor / Owner

• Person interviewed during inspection

• Telephone

• Other Information

• Add media

  Media

Type of Procedures

• Select Type of Audit

  Select Body Modification Beauty Colonic Lavage Waxing Electrolysis Cosmetic Tattooing Dry Needling Tattooing Body Piercing Hairdresser Barber Mobile Hairdresser

  • Body Modification
  • Beauty
  • Colonic Lavage
  • Waxing
  • Electrolysis
  • Cosmetic Tattooing
  • Dry Needling
  • Tattooing
  • Body Piercing
  • Hairdresser
  • Barber
  • Mobile Hairdresser

• Other

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  Media

Premises Must Be Properly Equipped

• Is the premises Clean and Hygienic?

  Yes

  No

  N/A

• Does the premises have a Waste Disposal Bin?

  Yes

  No

  N/A

• Does the premises have a Hand Basin that has a supply of Clean, Warm, Potable Water?

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• Does the premises have liquid soap for the persons carrying out the skin penetration procedure?

  Yes

  No

  N/A

• Does the premises have single-use towels or an automatic hand dryer for the persons carrying out the skin penetration procedure?

  Yes

  No

  N/A

• Does the premises have disposal gloves for the persons carrying out the skin penetration procedure?

  Yes

  No

  N/A

• Does the premises have clean linen for the persons carrying out the skin penetration procedure?

  Yes

  No

  N/A

• Does the premises have gowns or aprons for the persons carrying out the skin penetration procedure?

  Yes

  No

  N/A

• Is the equipment in good working order, cleaned and dried after use?

  Yes

  No

  N/A

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Additional requirements for Colonic Lavage Procedures

• Does the premises have a Toilet? (only available for use by the clients and not by the general public)

  Yes

  No

  N/A

• Is the toilet in the case of a closed system located in close proximity to the room?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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Premises must have sharps containers and supply of sterile disposal?

• 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)

  Yes

  No

  N/A

• Is there a an adequate supply of sterile disposable needles?

  Yes

  No

  N/A

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Reusable articles must be sterilised

• Are all reusable articles used to penetrate a persons skin sterilised? (at the premises or off site)

  Yes

  No

  N/A

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Reusable articles sterilised on the premises

• Is the bench top autoclave maintained in accordance with AS 2182-1998 sterilisers-steam-bench top?

  Yes

  No

  N/A

• Is there at least 1 person present at the time the autoclave is used who is trained in the operation?

  Yes

  No

  N/A

• Is the sterilisation carried out in accordance with AS/NZS 4815:2006? (Office based health care facilities)

  Yes

  No

  N/A

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Reusable articles sterilised at the premises

• Does the occupier of the premises have records for the past 12 months?

  Yes

  No

  N/A

• Is the time and date when each article is sterilised shown in the records?

  Yes

  No

  N/A

• Is the length of time the article was autoclaved and temperature and pressure levels of the autoclave shown in the records?

  Yes

  No

  N/A

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Reusable articles sterilised of site, the occupier must make and keep records for at least 12 months

• Do the records show the date on which the article was sent off-site for sterilisation?

  Yes

  No

  N/A

• Do the records show the name and address of the person who sterilised the article?

  Yes

  No

  N/A

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Requirements for carrying out skin penetration procedures

• All needles must be single use?

  Yes

  No

  N/A

• Is there non-reusable appropriate sharps container (AS 4031-1992) in use and used immediately after procedure?

  Yes

  No

  N/A

• Any other article used in the procedure must be disposed of immediately after the procedure?

  Yes

  No

  N/A

• Any other non-reusable used in the procedure must be disposed of immediately often the procedure?

  Yes

  No

  N/A

• A person must not use any article that may penetrate the skin unless it is clean and sterilised and in a sterilised environment?

  Yes

  No

  N/A

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Protective equipment to be worn

• 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?

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• Does the person that carries out a colonic lavage procedure wear a clean gown made from impermeable material?

  Yes

  No

  N/A

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Use of inks and pigments

• 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)

  Yes

  No

  N/A

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Use of wax for hair removal

• Is the wax disposed of and any instrument used to apply the wax (such as a spatula), immediately after completing the procedure?

  Yes

  No

  N/A

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Notification of skin penetration procedures

• Has the premises / business provided Council notice in writing that skin penetration procedures are being carried out?

  Yes

  No

  N/A

• Has the premises / business notified council within 7 days of any change in particulars?

  Yes

  No

  N/A

• Has notification been provided to Council (In the case of a mobile skin penetration business) where the occupier resides?

  Yes

  No

  N/A

Display of prohibition orders

• Has the occupier of the premises been served with a prohibition order?

  Yes

  No

  N/A

• Is the order displayed in a conspicuous place or at each entrance of the premises concerned?

  Yes

  No

  N/A

• Officer

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