Weld County Department of Public Health and Environment - Body Art Self-Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Body Artists

• Do you have documentation on site, of employee training on universal precautions, disinfection, sterilization techniques, and procedures for infection and exposure control?

  Yes

  No

  N/A

• Do you have documentation onsite, of employee vaccination against Hepatitis B (HBV) or declining vaccination?

  Yes

  No

  N/A

Body Art Establishments

• Are all employee records complete and available on site?

  Yes

  No

  N/A

• Do you have a documentation onsite, of a contract for waste disposal?

  Yes

  No

  N/A

• Do you conduct spore tests on-site and log results? Are these results available for review by inspector(s)?

  Yes

  No

  N/A

• Do you have documentation on site of the manufacturers' information on sterilization equipment?

  Yes

  No

  N/A

• Do you have written procedures on infection and exposure control available for review onsite?

  Yes

  No

  N/A

Reporting Procedures

• Are all owners/artists aware of 24 hour reporting requirement for infections, complications, or diseases resulting from body art procedures?

  Yes

  No

  N/A

Client Records

• Are all client records on the premise for a minimum of 3 years available for review onsite?

  Yes

  No

  N/A

• Does the client consent contain the following items? <br> Name, address, current phone number of client <br> Date of procedure<br> Type and location of the body art<br> Documentation that both written and verbal instructions regarding risks, outcome and aftercare were given to client<br> Name, address, phone number of establishment <br> Name of artist who performed procedure <br> Directions for when to consult a physician <br> Detailed instruction on care for the procedure site <br> Explanation that all body art is considered permanent <br> Possible side effects of procedure<br> Indication that facility is licensed by WCDPHE

  Yes

  No

  N/A

Facility and Operations

• Are all procedure and instument cleaning areas constructed of smooth, nonabsorbent and easily cleanable material?

  Yes

  No

  N/A

• Is the room in which body art is done not less than 100 square feet?

  Yes

  No

  N/A

• Are toilet facilities constructed of smooth, nonabsorbent and easily cleanable material? Are they provided for both patrons and employees?

  Yes

  No

  N/A

• Is the premises clean and in good repair?

  Yes

  No

  N/A

• Are 50 foot candles of artificial light provided at the level where body art procedures are performed and in cleaning and sterilization areas?

  Yes

  No

  N/A

• Are all procedure and instrument cleaning areas made of smooth, nonabsorbent material for easy cleaning and disinfection?

  Yes

  No

  N/A

• Are all hand sinks easily accessible to each procedure area and supplied with hot and cold water, soap, and disposable towels or a hand-drying device?

  Yes

  No

  N/A

• Are separate areas used for cleaning, wrapping/packaging equipment and for the handling and storage of sterilized equipment?

  Yes

  No

  N/A

• Are all sinks separate and used only for their designated purpose (cleaning, hand washing, utility)?

  Yes

  No

  N/A

• Is sewage and liquid wastes discharged to a sewage system constructed, operated, and maintained according to law?

  Yes

  No

  N/A

• Is the waiting area separate from the procedure, cleaning, sterilization and storage areas?

  Yes

  No

  N/A

• Are reusable cloths appropriately washed and stored?

  Yes

  No

  N/A

• Are animals prohibited in body art procedure areas?

  Yes

  No

  N/A

• Are all chemicals properly labeled, stored, and used according to label instructions?

  Yes

  No

  N/A

• Are all body art establishments completely separated from areas used for human habitation and food preparation?

  Yes

  No

  N/A

• Are all sharps and infections/regulated waste handled properly?

  Yes

  No

  N/A

Infection and Exposure Control

• Does the body art establishment have and comply with written procedure for infection and exposure control available for review onsite?

  Yes

  No

  N/A

Instruments and Sterilization

• Are all instruments that penetrate body tissue properly cleaned, disinfected, and sterilized after each use?

  Yes

  No

  N/A

• Are instruments packaged and wrapped according to rules and regulations for body art establishments?

  Yes

  No

  N/A

• Is the sterilizer cleaned and maintained according to manufacturer's specifications?

  Yes

  No

  N/A

• Are instruments stored in a dry, clean area reserved for storage of sterile instruments?

  Yes

  No

  N/A

• Are contaminated single use needles, razors, and other sharps disposed of immediately in approved sharps containers?

  Yes

  No

  N/A

Body Art Procedures

• Are all artists aware of the conditions that would be prohibitive for clients to have a body art procedure done?

  Yes

  No

  N/A

• Are all artists aware of the procedures, specific to tattooing and body piercing, that shall be practiced by all body artists as outlined in rules and regulations?

  Yes

  No

  N/A

Inspections

• Will agents of the WCDPHE be permitted to examine documents and make inspections of the body art establishment during business hours?

  Yes

  No

  N/A

Compliance

• Has body art establishment properly obtained an operating license from the WCDPHE?

  Yes

  No

  N/A