Horsham rural City Council Health Premises Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

GENERAL INFORMATION

• Date and Time audit began

  Date

• Premises Number

• Name of Premises

• Address of Premsies

• Phone Number

• Name of Proprietor or Staff in attendance

• Name of Officer

  Select Luke Mitton Helene Wortley

  • Luke Mitton
  • Helene Wortley

• Activities conducted

  Other

PREMISES DESIGN & WORKFLOW

• Workflow and designated zones<br><br><br>

  Yes

  No

  N/A

• Hand wash facilities

  Yes

  No

  N/A

• Equipment sink

  Yes

  No

  N/A

• Suitability/ maintenance floors/walls/ceiling

  Yes

  No

  N/A

• Fittings/fixtures/equipment

  Yes

  No

  N/A

• Lighting & ventilation

  Yes

  No

  N/A

CLEANING AND DISINFECTION

• Collection containers for soiled instruments

  Yes

  No

  N/A

• Manual cleaning procedures

  Yes

  No

  N/A

• Disinfection processes:- Bleach/Thermal/Chemical

  Yes

  No

  N/A

• Equipment for manual cleaning

  Yes

  No

  N/A

• Process for accidental contamination of instruments/needles

  Yes

  No

  N/A

• Cleanliness of premises

  Yes

  No

  N/A

• Work surfaces

  Yes

  No

  N/A

STORAGE & HANDLING OF EQUIPMENT & MATERIALS

• Clean/sterile instruments and stock

  Yes

  No

  N/A

• Dispensing of bulk cream

  Yes

  No

  N/A

• Staff personal items

  Yes

  No

  N/A

OPERATOR HYGIENE

• Appropriate hand washing practices

  Yes

  No

  N/A

• Use of gloves

  Yes

  No

  N/A

• Personal hygiene

  Yes

  No

  N/A

LINEN

• Storage of soiled linen

  Yes

  No

  N/A

• Laundering of soiled linen

  Yes

  No

  N/A

• Storage of clean linen

  Yes

  No

  N/A

OCCUPATION HEALTH & SAFETY

• Immunisation

  Yes

  No

  N/A

• Training

  Yes

  No

  N/A

• Procedure for dealing with accidental bleeding

  Yes

  No

  N/A

• Procedure relating to occupational exposure

  Yes

  No

  N/A

• Personal protective equipment

  Yes

  No

  N/A

• Chemicals:- use and storage

  Yes

  No

  N/A

WASTE

• Contaminated instruments/ needles

  Yes

  No

  N/A

• Clinical and related waste

  Yes

  No

  N/A

• Handling and Disposal of Sharps

  Yes

  No

  N/A

• Other waste

  Yes

  No

  N/A

WAXING

• Application of skin disinfectant

  Yes

  No

  N/A

• Waxing procedures/ reuse of wax

  Yes

  No

  N/A

• After care advice

  Yes

  No

  N/A

ELECTROLYSIS/ COSMETIC TATTOOING

• Per-sterile/single use disposable needles

  Yes

  No

  N/A

• Application of skin disinfectant

  Yes

  No

  N/A

MANICURE, PEDICURE AND NAIL TREATMENTS

• Nail fungus and infections

  Yes

  No

  N/A

• Chemicals- minimising exposure

  Yes

  No

  N/A

BODY / EAR PIERCING

• Application of skin disinfectants

  Yes

  No

  N/A

• Use sterilised and appropriate jewellery

  Yes

  No

  N/A

• No equipment sharing

  Yes

  No

  N/A

• Use of aseptic techniques

  Yes

  No

  N/A

TATTOOING

• Application of skin disinfectants and lubricants

  Yes

  No

  N/A

• Use of single use inks, water for rinsing and stencils on each client

  Yes

  No

  N/A

• No equipment techniques

  Yes

  No

  N/A

• Use of aseptic techniques

  Yes

  No

  N/A

• Use of wipes/ paper towels

  Yes

  No

  N/A

COLONIC IRRIGATION

• Equipment to have ARTG number

  Yes

  No

  N/A

• Temperature of water 34'C-40'C

  Yes

  No

  N/A

• Single-use lubricant, gloves and wipes provided

  Yes

  No

  N/A

• Clean gowns, robes, towels provided

  Yes

  No

  N/A

• Adequate toilet and shower facilities

  Yes

  No

  N/A

• Use of single-use and sterile catheters

  Yes

  No

  N/A

• Use of single-use tubing

  Yes

  No

  N/A

• Equipment not connected directly to potable water

  Yes

  No

  N/A

• Equipment does not allow backflow of faecal matter into clean water

  Yes

  No

  N/A

• Water system filters

  Yes

  No

  N/A

CLIENT CONSENT/ AFTER CARE (Piercing and tattoo only)

• Client consent obtained

  Yes

  No

  N/A

• Transmission of disease

  Yes

  No

  N/A

• After care advice

  Yes

  No

  N/A

ULTRASONIC CLEANERS

• Preparation/Operation/Maintenance

  Yes

  No

  N/A

OFF-SITE STERILISATION Reg. 24(b)(ii)

• Off-site sterilisation - cleaning and transport

  Yes

  No

  N/A

STERILISATION- PACKAGING & LOADING

• Materials- suitable packaging and sufficient stock

  Yes

  No

  N/A

• Labelling - packaging labeled appropriately

  Yes

  No

  N/A

• Sealing - packaging correctly sealed

  Yes

  No

  N/A

• Loading - correct loading of steriliser

  Yes

  No

  N/A

STERILISATION PROCESS

• Monitoring of sterilisation process

  Yes

  No

  N/A

• Unloading

  Yes

  No

  N/A

• Validation of steriliser loads

  Yes

  No

  N/A

• Maintenance of steriliser

  Yes

  No

  N/A

BEST PRACTICE RECORDS

• Guidelines on-site

  Yes

  No

  N/A

• Cleaning schedule

  Yes

  No

  N/A

• Incident Record

  Yes

  No

  N/A

• Chemical Disinfection Record

  Yes

  No

  N/A

• Staff Training and Qualifications

  Yes

  No

  N/A

• Staff Immunisations

  Yes

  No

  N/A

• Client Procedure Record

  Yes

  No

  N/A

• Wax Temperature Record (reusable hard wax only)<br>

  Yes

  No

  N/A

• Documentation of off-site sterilisation

  Yes

  No

  N/A

• Sterilisation Monitoring Record

  Yes

  No

  N/A

• Ultrasonic Cleaner Test Record

  Yes

  No

  N/A

• Heat Sealer Test Record

  Yes

  No

  N/A

• Equipment Maintenance Record

  Yes

  No

  N/A

• Validation of Steriliser/ Load Record

  Yes

  No

  N/A

FURTHER ACTION

• Further Action?

  Nil

  Letter

  Reinspection

  Order/Notice

REINSPECTION DATE

• Select date

  Date

SIGNATURE

• Signature of Officer

  Sign