CASE NO:_______________ INSPECTION TYPE: ___INITIAL ___PROBATIONARY INSPECTOR: __________________DATE: ___________ BUSINESS/REG #:_______________________________________ LICENSEE / OWNER / LICENSE #:_______________________________ ADDRESS:________________________________________________________________________________________________________ YES

NO

The business or licensees are utilizing clean and disinfected items while services are performed. 2A Multi-Use items are cleaned and disinfected immediately after each client. 2A-2B-2D-2E Hair Services Skin Services Nail Services Single use items and implements are discarded in the trash immediately after use. 2A-2B-2E Hair Services Skin Services Nail Services All electrical equipment is cleaned and disinfected immediately after each client. 2A(8) Lancets, disposable razors or sharp objects are properly disposed of in a puncture resistant container. 2A(9) Clean and disinfected implements and materials are stored in a clean dry container. 2A(10)

Y

N

1

Y

N

2

Y

N

3

Y

N

4

Y

N

5

Y

N

6

All products are used properly to avoid cross contamination. 2A(11)

Y

N

7

New or clean and laundered items are used or changed immediately after each client. 2B-2E

Y

N

8

The licensee is washing their hands and the hands/feet of the client prior to providing services. 2B-2E The business or licensees are cleaning and disinfecting the pedicure foot spa immediately after each client and immediately after the last client at the end of each day. 2C(1-3)

Y

N

9

Y

N

10

The business or licensees are making and keeping a record of cleaning and disinfecting all pedicure foot spas for 30 days. 2C(3)

Y

N

11

GENERAL REQUIREMENTS -- RULE 6A All persons and places of business are properly licensed/registered to perform Barber, Cosmetology, Esthetic, Hairstyling or Manicure services. (C.R.S. 12-8-120/C.R.S. 12-8-114.5) Shop is properly registered to perform Barber, Cosmetology, Esthetic, Hairstyling or Manicure services. 12-8-114.5 No products and supplies in possession or use have been banned by a state or federal agency.

YES

NO

Y

N

12

Y

N

13

Y

N

14

CLEANING AND DISINFECTION REQUIREMENTS – RULE 2

FINE

FINE

DETAILS

DETAILS

Y

N

YES

NO

Y

N

16

Y

N

17

All liquids, creams and other preparations are kept in properly labeled, clean and closed containers.

Y

N

18

Work area is kept clean and free from excessive accumulation of debris. Clean and disinfected implements/materials are stored in a clean manner and separate from soiled or dirty items at all times. Business owner/manager and licensees cooperated with the inspector and/or inspection. 12-8-132(1)(f)

Y

N

19

Y

N

20

Safety Data Sheets (SDS) for all products/supplies are available/accessible. SPECIFIC REQUIREMENTS -- RULE 6B All bottles and containers containing poisonous or caustic substances are distinctly and correctly labeled and stored in an area not open/accessible to the public. A first aid kit available.

15 FINE

DETAILS

Y

N

YES

NO

All services are being provided within the appropriate scope of practice for the license held. 6A

Y

N

22

Chemical exfoliation services are provided and proof of a 24-hour certificate is available. 3C(1)

Y

N

23

Microdermabrasion services are provided and proof of a 14-hour certificate is available. 3C(2)

Y

N

24

Electric file: In use? Appropriate? Proof of an 8-hour certificate is available. 9A(2-3)

Y

N

25

Manicure waxing services are provided and proof of a 6-hour certificate is available. 9C(3)

Y

N

26

Permanent makeup services are provided and proof of a 132-hour certificate is available. 11B(1)

Y

N

27

Other findings:

Y

N

28

SCOPE OF PRACTICE REQUIREMENTS

All findings have been explained to me and by signing this notice, I agree to the findings. This Violation Notice may be an offer to settle this matter only if a fine is assessed. I agree to this settlement as indicated by my signature. I agree to cease and desist from engaging in future violations. Settlement terms: Fines Assessed _____Probation term of year/s with unannounced inspections without a written complaint. _____Attend the cleaning and disinfection seminar within 6 months of probation term that begins on the date below. (See back of form for scheduling details) PRINTED NAME: ______________________________ TITLE: _______________________ SIGNATURE: _________________________________

21 FINE

Within 20 days

DETAILS

21 to 45 day

Due Date FINE + 15%

FINE + 15%

TOTAL

TOTAL

DATE: _______________________

Violation Notice Issued to_______________________________________________ License# /Registration #______________________ Return the yellow copy with payment. To the State of Colorado, DORA, Division of Professions and Occupations, 1560 Broadway, Suite 1350, Denver 80202 “Make Checks Payable to “The State of Colorado”