| Name of Facility | : | |
| Address | : | |
| Owner/Operator | : | Number of Operators: |
| Number of chairs | : | Number of Tables: |
| 1 | 3. |
| 2 | 4. |
| | Remarks |
| FLOORS | |
| I | (a) Easily cleanable construction, smooth, good repair. | |
| 1 | (b) Clean. | |
| 1 | (c) Receptacles covered. | |
| 3 | Separate label receptacles for sharps and biomedical waste. | |
| II | WALLS AND CEILINGS | |
| 1 | All Clean, light coloured. | |
| 1 | Good repair. | |
| 3 | Patrons provided privacy during procedure | |
| III | VENTILATION AND LIGHTING | |
| 1 | (a) Well lighted 100-foot candles. | |
| 1 | (b) Well ventilated. | |
| 1 | (c) Free from odors and condensation. | |
| IV | CHAIRS AND EQUIPMENT | |
| 2 | (a) Easily cleaned and disinfected. | |
| 1 | (b) No open seams or tears. | |
| 1 | (c) Cases, shelves, tables, mirrors etc. clean and free of dust and power. | |
| 1 | (d) In good repair. | |
| V | LAVATORY (SINKS) FACILITIES | |
| 1 | (a) Adequate in number and convenient for use. | |
| 1 | (b) Clean. | |
| 1 | (c) Soap or detergent, hand-drying device provided at each station. | |
| 1 | (d) Free of soiled linen. | |
| VI | WATER SUPPLY | |
| 2 | (a) Adequate supply of portable hot and cold running water. | |
| VII | TOILET FACILITIES | |
| 1 | Number, convenient, accessible, designed. | |
| 2 | Enclosed, self-closing doors. Fixtures in good repair, clean, hand drying devices and waste receptacle provided. | |
| 2 | Ventilation adequate. | |
| 2 | Separate washrooms for both sexes. | |
| VIII | LINEN | |
| 1 | (a) Adequate supply of clean linen/disposable table sheets. | |
| 1 | (b) Clean linen stored in closed cabinet. | |
| 1 | (c) Towels or washcloths used only on one patron. | |
| 1 | (d) Soiled linen stored in covered containers. | |
| 1 | (e) Protection placed around neck to prevent haircloth from contacting patron's skin. | |
| 1 | (f) All linen free from holes tears and stains. | |
| 1 | (g) Separate sterile compartment for the storage of cotton, gauzes etc. | |
| IX | SANITATION | |
| 2 | Facility in residence or business separated by a partition from floor to ceiling, | |
| 4 | Waste containers kept clean and sanitary. | |
| X | PERSONAL APPEARANCE AND CLEANLINESS | |
| 2 | Neat and clean. | |
| 5 | Valid health certificate. | |
| 2 | Clean outer garments and used only for work. | |
| 2 | Hands and fingernails clean. | |
| XI | HEADREST | |
| 2 | (a) Properly stored when not in use. | |
| 2 | (b) Protected with fresh clean paper. | |
| XII | TOOLS AND EQUIPMENT | |
| 5 | (a) All tools and equipment free of bodily fluids. | |
| 2 | (b) Adequate supply to endure proper sterilization (Minimum of two sets). | |
| 2 | (c) Adequate supply of personal protective equipment (PPE). | |
| XIII | STERILIZATION | |
| 5 | (a) All tools and instruments are sterilized before reuse on another patron. | |
| 5 | (b) Sterilization cabinets and wet sterilized contain adequate fresh disinfectant. | |
| 5 | (c) Tools kept in sterilizers at all times when not in use. | |
| 2 | (d) Tools not kept in pocket of uniform. | |
| 3 | (e) Sterilizing cabinet airtight and free from letters, papers and articles not to be sterilized. | |
| 5 | (f) Adequate equipment and supplies for sterilization. | |
| XIV | LICENCE | |
| 5 | (a) Valid public health licence to operate. | |
| 1 | (b) Posted in a conspicuous location to view. | |
| Total Score: |
| Other Remarks/Recommendations: |
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| An inspection of the body art facility was made on by |
| (Name of the signing environmental health officer). All items marked, indicates an unsatisfactory condition which must be corrected to comply with the Public Health Regulations. |
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| ENVIRONMENTAL HEALTH OFFICER |