Hurstville City Council Skin Penetration Premises Inspection Report

• Business Name

• Conducted On:

  Date

• Prepared by

• Trim container #

Business Details (Public Health Regs 2012 Cl 32)

• Trading Name

• Address of Premises:
  Address

• Contact Name

• Business Phone Number

• Mobile Number

• Company / Sole Trader's Name

• ABN /ACN

• Residential Address of Business Operator

• E-mail address

Inspection Details

• Inspection start

  Date

• Inspection finish

  Date

• Inspection type:

  Select Routine Inspection Re-inspection Complaint Pre-purchase Inspection Final Inspection

  • Routine Inspection
  • Re-inspection
  • Complaint
  • Pre-purchase Inspection
  • Final Inspection

Procedures Conducted on Premises

• Type of procedure(s) undertaken at premises?

  Select Beauty Body Modification Body Piercing Colonic Lavage Cosmetic Tattooing Dry Needling Electrolysis Tattooing Waxing Medicure Pedicure Others

  • Beauty
  • Body Modification
  • Body Piercing
  • Colonic Lavage
  • Cosmetic Tattooing
  • Dry Needling
  • Electrolysis
  • Tattooing
  • Waxing
  • Medicure
  • Pedicure
  • Others

• If other, please describe?

Premises Design and Hygiene - Public Health Regs 2013 Cl 23

• Premises is clean and hygienic.

  Yes

  No

  N/A

• Waste disposal bin provided.

  Yes

  No

  N/A

• Hand wash basin with clean, warm portable water provided.

  Yes

  No

  N/A

• Separate sink with clean, warm, portable water provided.

  Yes

  No

  N/A

• Liquid soap or alcohol base hand cleaner provided.

  Yes

  No

  N/A

• Single use towels or an automatic hand dryer available.

  Yes

  No

  N/A

• Disposable gloves provided.

  Yes

  No

  N/A

• Clean linen provided.

  Yes

  No

  N/A

• Gowns or aprons provided for staff.

  Yes

  No

  N/A

• Equipment are in good working order, cleaned and dried after use and kept in clean and dry condition.

  Yes

  No

  N/A

Colonic Lavage Procedures only - Public Health Regs Cl 24

• Toilet available for use by clients only.

  Yes

  No

  N/A

• Closed system - toilet located in close proximity to procedure room.

  Yes

  No

  N/A

• Open system - toilet located in the immediate vicinity of the procedure room

  Yes

  No

  N/A

Sharps and Disposable Needles - Public Health Regs Cl 25

• Appropriate sharps containers provided (in accordance with - AS/NZS4261:1994 Reusable containers for the collection of sharp items used in human and animal medical application).

  Yes

  No

  N/A

• Non Re-useable sharp containers provided (in accordance with AS4031:1992 - Non-reusable containers for the collection of sharp medical items used in health care areas).

  Yes

  No

  N/A

Sterilisation of Re-useable Articles - Public Health Regs Cl 26

• Sterilisation Practice

  On-site sterilisation

  Off-site sterilisation

• Bench top autoclave used.

  Yes

  No

  N/A

• Autoclave operator trained

  Yes

  No

  N/A

• Sterilisation carried out in accordance with AS/NZS4815:2006 Office-base health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment.

  Yes

  No

  N/A

• On-site sterilisation - minimum 12 months record kept on:

• Time and date article was sterilised.

  Yes

  No

  N/A

• Length of time that the article was autoclaved and temperature and pressure level of the autoclave.

  Yes

  No

  N/A

• Off-site sterilisation - minimum of 12 months record kept on:

  Yes

  No

  N/A

• Date of when article was sent off-site for sterilisation.

  Yes

  No

  N/A

• Name and address of person who sterilised the article.

  Yes

  No

  N/A

Use of Needles, Sharps and Other Articles - Public Health Regs Cl 27

• Needles are not re-used.

  Yes

  No

  N/A

• All used needles disposed of in appropriate sharp container after use.

  Yes

  No

  N/A

• Single use only articles or non-reusable sharp are disposed of immediately after procedure is completed.

  Yes

  No

  N/A

• Articles used to penetrate skin are clean and sterile and kept in sterile condition.

  Yes

  No

  N/A

Protective Equipment - Public Health Reg Cl 28

• Never been used before gloves are worn during skin penetration procedure.

  Yes

  No

  N/A

• Gloves are disposed of immediately after procedure is completed.

  Yes

  No

  N/A

• Gown or apron worn during skin penetration procedure. (Waxing for the purpose of hair removal is exempted).

  Yes

  No

  N/A

• Gown made of impervious material worn for colonic Lavage procedure.

  Yes

  No

  N/A

Inks and Pigment - Public Health Regs Cl 29

• Ink and liquid used are decanted into single use container and applicator for each person undergoing procedure.

  Yes

  No

  N/A

Wax For Hair Removal - Public Health Regs Cl 30

• Wax and Instrument (such as a spatula) is disposed of immediately after procedure is completed.

  Yes

  No

  N/A

Additional notes

Further action

• Further action required:

  Yes

  No

  N/A

• Re-inspection required within indicated days.

I HAVE READ THE REPORT AND UNDERSTAND THE CONTENTS

• Owner/employee signature

  Sign

Inspecting Officer

• Officer's signature

  Sign

• ENVIRONMENTAL HEALTH OFFICER - (02) 9330 6000

Hurstville City Council - contact details

• Address: Civic Centre, MacMahon Street, Hurstville NSW 2220. Post: PO BOX 205, HURSTVILLE BC NSW 1481. Website: www.hurstville.nsw.gov.au email: hccmail@hurstville.nsw.gov.au Telephone: (02) 9330 6222 Fax: (02) 9330 6223