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Home My WebLink AboutBen Marchant 610108 07 01 11SC.pdfN'c - NPSrbXWXa. of a d Nitmal N't SMX'.*' Score: N/A Dinsim of nwrMuw1wa HtA.1h Inspection of Tattoo Establishment v7spection Date Health Department Current Facility To Old Facility ID I K11 U-041 Water Carnmunity transient Non -Community 3 H Non -Trap sienlNon-Community Non- c V 4 PubliV ate r Supply Water sample taken todaytoday"?[EInspection Des [j] N o [:]Re-inspection [:]Name Change EYerification of Clusure Wastewater Systern: [j]Community [flinn-site System Disit Elstalus change 'Estah0shment Name BEN J MARCHANT Name Of BEN J MARCHANT Tattoo Artist Location Address: RAMBLIN ROSE TATTOO Mailing Addr, City: HICKORY scat NC zip 28602 City: stateNC zip RECORDS: (.3206;.3208) Comments: I Records maintained for each patron include name, address, phone number, SEE COMMENT SHEET ATTACHED — date of birth, and signature ............. ................ ...... ......... 2 Monthly records of b acteri al en dosp ore destruction tests m ai ntain ed for each autoclave TATTOO ROOM: (3205; .3207; .3208; .3210) 3, Separate and apart from areas used for other purposes ........... ... ........ 4. Separate workstations for each artist ............ ....... ....................... ....... 5, Room clean and good repair ... ....... ........ ...... __ ...... ....... 6, Furniture easily cleanable, kept clean .......... ... _ ................... ............. 7. Instruments, dyes, carbons, Stencils kept in clean closed containers, case or storage cabinet ........ _ ............. ... : ........................................ 8, Sterile in s "in ents packaged to sterile containers _. . ... ., ...... 9. Magid soli d waste container with piasti c liner ................... I ......... I O. No animals or use of tobacco in tattoo room .... ..... ... _ ..... ... __ ............ 11, No eating or drinking by artists in tattoo room ........... ....... LAVATORY: (.3203;,3204;.3207;.3208) 12, Accessible to tattoo room ,.... 13, Use restricted to tattoo artists ....... ............ ................ 14, Clean and good repair, kept free of storage, . ................. ....... 15, Hot and cold water un der pressure, mixing faucet ...... 16 Antiseptic soap and germicidal solution provided ...... ....... 17, Individual scrub brushes an ol fingern ai I files or of ange sticks provided for each ark st ... 18. Individual disposable hand towels provided,,... ... .......... 19, Approved water supply and sewage disposal .......... ....... .......... TATTOOING PROCEDURES: (.3208; .3209) 20, Hands washed thoroughly before each patron,, ........ 21, Clean disposable latex gloves wom, ... 22. Clean gown or lap cloth used ......................... ...................... ......... 23, Sterile instruments handled by aseptic technique ........ 24, Ink di spensed into disposable ink caps . 25. San examined and only healthy skin tattooed .................. ............ 26, New disposable or sterile razor used ........ .......... ........ 27, Germicidal solution applied to Skin 28. C)nly new sterile needles used ................ ...... ................ .................. 29. Tattoo cleaned and sterile dressing applied ......... ....... PRECAUTIONS: (.3207; .3208; .3209) 30, Blood and body fluidprecautions taken ........... ........... .................. 31, Protective coverings &lap cloths removed & disposedof orlaundered, 32 Contaminated Equipment cleaned and disinfected .................................. 33, Contaminated instniments properly stored, cleaned, and autoclaved ... Comment Sheet Attached? 34. Needles removed and placedin sharps container, ....... ...... MISCELLANEOUS: (.3205; .3207; .3210) []Yes No 35 Poisons in covered, labeled containers,,.,,..,., .......... 36. Premises free of vermin flies or mosquito breeding places..._. .......... 37, Outdoor solid waste in watertight containers with tight lids, properly Rept secured ...... __ .......... Received by:Q 38. Litter and solid waste not allowed to accumul ate .......... # 1711 - Carpenter, Scott Inspecti on by: FHS I-D. Pailiese: Qleretal Statute 130A-2n3requizesthe CoLqion Zr Health Stivices to adolA rules gavenlinglattook, 15A NCAC' 18A,3200apcifies five, Thisfbnuix dn-elopedtobe rased inmak*ins petiollsoftanoo, health qxcia6-tsshoU coin*,te the forixinetyfinrthpycol4uctanilospection- Isaaellon observations wit itfos atroit ad1 y11a to artbl,place a cl*,ckmark best deesclreatrrt to h its compliance veifliffie applirebkn�s' pleFale snorts aid oil, copyfor Longilaltoba k,fl iOthtatho artist, 2,Collyforthe k-callvalthdepainuerd, SWific definerries axe uncktaw& If additional explamfionis zaededusc awOerslwet Disposit6= Plewereferto Recoisle Retpntion mid Disposition Schedille S.M., for CountyDistrict Heath Depaltments whch is publishedbythe 14oithCat hnaDi,,wionofPzcbi"s&History Additioral forms maybe oslell-dfyom: 16321VI3ilSerAce Cet*rRallug),4NC27609-I632, (CouderP_01-00) DnM4014 (R�.,47M) low, m=e4alHeAn, Saw e6 So, CjmkPwxw, IM)