Download this template to use for collecting records related to invasive procedures.
Ontario Regulation 136/18 Personal Service Settings states that owners/operators of personal service settings must document ALL services that are of an invasive nature. 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.
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DATE/TIME |
SERVICE |
BODY PART |
SERVICE PROVIDER |
CLIENT INFORMATION |
STERILE EQUIPMENT |
|---|---|---|---|---|---|
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Date/Time of service: E.g. July 1st, 2019, 9:00AM |
Type of invasive procedure E.g. Tattoo |
Body site services E.g. Inner left forearm |
First and last name with contact information E.g. Jane Smith (Tattoo artist) 519-123-4567 |
First and last name with contact information E.g. Mary Jones 519-555-1234 |
Lot number & expiry date of sterile needles/items. E.g. LOT #10001, EXP. APR 6 2022 |
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