Infectious Disease Prevention

Personal Service Settings Sterilization Records

Download this template to use for collecting records related to maintaining sterilization.

Ontario Regulation 136/18 Personal Service Settings states that owners/operators of personal service settings who use sterilizers for re-usable critical equipment MUST keep sterilization records. All fields must be filled out completely.

Records must be kept onsite for at least 1 year, and in a secure location for 2 years afterwards.

DATE/TIME

STERILIZER

EQUIPMENT

MAINTENANCE

BIOLOGICAL INDICATOR TEST

Date/Time of sterilizer use:

E.g. July 1st, 2019, 9:00AM

Name of sterilizer

E.g. Prestige Pro Medical Tattoo Autoclave

Equipment reprocessed

E.g. Hildbrandt Standard Tattoo Needles

Maintenance or repairs

E.g. Calibration or re-testing

Tests or checks

E.g. Bi-weekly spore test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Service Settings Disinfectant Records

Download this template to use for collecting records related to Disinfectant in Personal Service Settings.

Ontario Regulation 136/18 Personal Service Settings states that owners/operators of personal service settings must document ALL high level disinfectant solutions used for equipment reprocessing. All fields must be filled out completely.

Records must be kept onsite for at least 1 year, and in a secure location for 2 years afterwards.

PRODUCT NAME

PRODUCT CONCENTRATION

DATE PREPARED

DATE DISCARDED

Name of product and chemical:

E.g. CS20 – Hydrogen Peroxide

Concentration of chemical mixture

E.g. 7.0%

Date solution was prepared (manufacturer’s instructions)

E.g. July 1 2019

Date solution was discarded (manufacturer’s instructions)

E.g. August 1 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Service Settings Blood Exposure Records

Download this template to use for collecting records related to blood exposure in a Personal Service Setting.

Ontario Regulation 136/18 Personal Service Settings states that owners/operators of personal service settings must document ALL accidental blood and/or body fluid exposures that happen during a procedure for both clients AND operators. All fields must be filled out completely.

Records must be kept onsite for at least 1 year, and in a secure location for 2 years afterwards.

DATE/TIME

SERVICE

INJURY 

SERVICE PROVIDER

PERSON EXPOSED

ACTIONS TAKEN

Date/Time of service:

E.g. July 1st, 2019, 9:00AM

Type of personal service:

E.g. Manicure

Body part exposed:

E.g. Right hand, pinky finger cuticle  

First and last name with contact information

E.g. Jane Smith (manicurist)

519-123-4567

First and last name with contact information

E.g. Mary Jones

519-555-1234

E.g. Told client to wash their hands and see a doctor. Washed and disinfected scissors with bleach.