HomeMy WebLinkAboutTanning Facilities Inspection Report ��� Y�
� �'� TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSE'fT5 02664
������'6,fc�"� Tel (508) 398-2231 — Fax(508)398-2365
BOARD OF HEALTH
�ARY IIZSPHCTIQ�I L�2M P'Qt TA1�lING FACILITffi
IN ACCORD�NCE �iiTH I�GGlll SHCTIaI� 207-214
�7PII, SOC9 A 1`II� SfA1E RHWLATIQ�.S ARS PRO�LQ�l1ED
NAME OF FACILITY: Z"S�Grr�O 7Gf/7
�xFss: a 3 'D �h��t s �rrr Peor�:(5681�`iy�-�-tYLi 7
PERSON IN CHARGE: ,y,�r�h /�oc.�va�aL, TITLE: OG.�n�
��a oF �� D���: (w 1
yes no
Ctistomers given a written statement of warning. . ... � ...
Notice posted in conspicuous in every area , /
that a tanning device is used...... .. ... ... .. .. .. .. v ...
Notice meets wording as required..... . .. . . . ... .. ... ✓ ...
Rnowledgeable operator present.... ........ ........ . V ...
Maximian temperature 100 F in tanning facility.. .._. � ...
Accisate timer +/- 10$ . ... . .. .. ... .. . . .... ... . ... . � ...
Customers use.protective eyewear. . . ... .. . . . . .... .. . �I ... No o^�
1 �
Written consent for patrons 74-17 years of age. ... . � ... V/1O'� _ ��„Q
f � � y��-
No patrons under 14 years of age without parent or �� -
guardian.. .. ....... .. ..... ........ .. . . ... .. . .. .�- �' {- �^"-K3`'e'
�
No material claimi.ng use of tanning device is safe �
andfree from risk.. . . .. .. . ... ...•.... . . . . .. .. . .... ...
Sanitize Agent available for disinfection. ... .. .. .. ✓ . ..
Comnents; �(` No P� __aa_/ _.�'n �n��a .. !-I✓�,a/•�-� -h'C�n �L/--. _ _--
_ �� � �,
�a � �o oZ0 �
C.c��) �.q SC!'�Pc4.�,�PC�,
You have sev n days after receipt of this notice to correct any violations noted
above. The �rd of Health may revoke the license of a tannirng facility which fails
to compTy after said seven days (MGL111 s208) or may impose a fine'of $200 to $2000.
If you are aggrieved by a determination of the Depart�nt of Public Health within
twenty days of said determination.
� � �
1 — I? —15 Gli�,2.k1rJ �Ii �G—�
Znspec Date Person in Charge �—
. �� Printed on
L�3 P��iea
2/92 �" 6�
T S �r��,a T�.v a'3 � wr+�r�s Pq rr+,
IMemberName
Address Ciry Zip
Phone(home) (work)
I
i A9e _M _F _ Occupation
I
; Through what metlia or person did you hear ebyut this salon? ,
�
I
I�� Please answer ihe foibwing quesbons to aid our consullenis in eslebNshing the best program for you. II
�' 1. Are you in eny way allergic M the sun? Y� No �
; �
2. Are you taking a�ry medicaCwn which would cause sensiMiity to sunlignt9
Yes _No (antibbtics)
IMPORTANT:If you start a�ry new me�catlai whi�e msmber,pleaae Inform us.
a
3. Complexion? Dark 4 Olive 3 Medium 2 Light 1
4. Skin type? Oiy 3 Normal 2 Dry 1
� 5. HaircobR Bladc 3 Brown 2 Blonde 1 Red 1
� 6. Do.you isn easily? Yes 2 No i
7. Do you burn? Yes 1 No 2
S. Do you freckle? Yes 1 No 2
9. Ne you active outdoore? Yes 2 No 1
10. Do you use moisturizer? Yes 1 Na 2
11. Do you plan to wear a bathing suit? Yes 2 No 1
� ConEact Lenses should be removed or sun goggles wom throughou[sun session.
� For added protection,it is advised ihat sun goggles be wom by ail petrons.
IMPORTAN�N071C�S:
If you are pregnaM at this time or if yau beeome pregrrent vW�ile yeu are a member,please Inform us: i
If you do not develop a tan in the sun,yw�are uMikely to t�from the use of the tanning devices at j
Mis tanning cerrtec �
We recommend thet you do not tan ou[doore on days you are Tanni�indoors,or that you do not tan
N you have a sunbum. �
Certain medicatlons,lotbns antl other produets mey eause your skln to be more sensiNve to UV
radiation.
Check fhe postetl list M tlrugs and products Imown to increase Me photosensiNviry W the skin.
Failure to wear protective eyewear mrey resuN in severe 6ums w Wng teim injury to ihe eyes.
I
We recommend that you remove wntaet lenses before Tanning. �
1 hereby give my consent for
who is my and is years o}ape W tan et this tanning ttMer.
Signed: pa�;
I understand ihat ihe use of fhe tacilities herein are used by me wi1M an explanation of Me processes herein
by the owner or an agent of the owner.I understaM tlie same and hereby release and waive arry claim of I
damage that I might have due to any use of the faci�ities hereW and I do so wRh no promises or guarentees
made by the owner or any agent of the arvnec I
i
Date Signature (
r
Name
PACKAGE
i
I 0 Sin le Visit Gog9les
�� 1 Introductory 4 Lotion
i
i 2 10 ViSits 5
3 25 Visits 6
7
Date Comments Time Date Commenis Time
1 24
�
� 2 25
3 26
� 4 27
5 28
6 29
7 30
8 31
9 32
10 33
11 34
12 35
13 36
14 37
15 38
16 39
77 40
18 41
19 42
20 43
21 44
22 45
I; 23 �
! Amount Due: Amount Paid: Balance:
I
� Amount Due: Amount Paid: Balance:
Amount Due: Amount Paid: Balance: