brennenstuhl BRX 5000, User Manual

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Reusable Instruments Level of Disinfection / Sterilization Disinfectant / Sterilizer Product Used
1.
2.
3.
4.
5.
Surfaces and Equipment Level of Disinfection / Sterilization Disinfectant / Sterilizer Product Used
1.
2.
Hand-washing Facilities for your Booth
Describe the hand-washing facilities (e.g., hot and cold water under pressure, liquid soap and paper towel
dispensers):
Printed Aftercare Instructions and Consent Forms
Please acknowledge that there will be printed copies of aftercare instructions and consent forms for each client
before invasive services are provided:

Yes, I will have printed copies.
Disposable Sharps Storage and Disposal
Indicate how disposable sharps generated onsite will be stored and disposed of:
Signature: Date:

PLEASE RETURN THIS FORM TO THE EVENT ORGANIZER AT LEAST 14 DAYS BEFORE THE EVENT.

EVENT ORGANIZER: PLEASE FORWARD A COPY OF FORMS FOR ALL PARTICIPANTS TO THE HEALTH
AUTHORITY 14 DAYS BEFORE THE EVENT.