Healthy Nail Salon Recognition Program: Registration Form
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1Alameda County Department of Environmental Health
Application #____________
Date _____________
1131 Harbor Bay Parkway Alameda CA 94502
(510) 567-6770
FAX (510) 337-9135
Healthy Nail Salon Recognition Program: Registration Form
Instructions: Please complete the registration form and submit in person, via email () or mail to:
Pamela Evans, Alameda County Environmental Health, 1131 Harbor Bay Parkway, Alameda CA 94502
Description and Eligibility Criteria
In order to qualify for the Healthy Nail Salon Recognition Program, salons must be in compliance with the Board of Barbering and Cosmetology’s
professional code, must choose safer nail products and must implement safer practices as established by Alameda County’s Healthy Nail Salon
Recognition Program.
1.
Choose nail polishes that do not contain the toxic trio (dibutyl phthalate (DBP), toluene, and formaldehyde).
2.
Use safer nail polish removers, including but not limited to acetone.
3.
Avoid using nail polish thinners unless absolutely necessary. When using thinners do not use those containing toluene and methyl ethyl
ketone (MEK).
4.
Ensure that all nail salon staff wear nitrile gloves when using nail products.
5.
Ventilate the salon to improve air quality in the salon. Designate a specific area for artificial nail services and properly ventilate the area.
6.
Install mechanical ventilation unit(s) within one year of entering recognition program, if one does not already exist.
7.
Train all nail salon staff onsite (on payroll and on contract) and owners on safer practices using SFE’s guide if one does not already exist.
8.
Allow Alameda County program staff to monitor air quality within the salon.
9.
Be committed to trying and adopting safer artificial nail products.
10. Do not allow customers to bring in products unless they meet program criteria.
Safer products and practices will be determined by Alameda County program staff on a case by case basis in consultation with nail salons.
Section I - Contact Information
Legal Name of Business
Name Of Owner(s)
Name of Manager
Business Address
Secondary Contact
Telephone
Mobile
Primary Language Spoken
(
)
-
(
)
-
Web Address (URL)
Email
Section II – General Business Information
Years in Business
Number of Staff
Do Any Nail-Technicians Rent Chairs?
________Full Time
________Part Time
YES
_____ (how many?)
NO
Section III – Salon Practices
Do you display or have on file MSDS (Material Safety Data Sheets) for all products?
YES
NO
ONLY SOME MSDS
Do you purchase your supplies through a beauty supply store?
Which beauty supply stores?
YES
NO
Do you purchase your supplies through a distributor?
Which distributors?
YES
NO
Do you have a ventilation system in your salon?
What type of ventilation system?
YES
NO
By submitting this form, I agree to:
Participate in the Healthy Nail Salon Recognition Program
Meet eligibility criteria
Allow Alameda County program staff to conduct surveys
Allow Alameda County program staff to conduct air monitoring to evaluate program progress
By submitting this enrollment form, I confirm that the information being submitted is accurate and complete, to the
best of my knowledge.
X
________________________________
SIGNATURE OF OWNER
DATE
/
/ 20
IF YOU HAVE ANY QUESTIONS REGARDING THIS FORM, PLEASE CONTACT PAMELA EVANS AT 510-567-6770 OR
Concept and design by San Francisco Dept. of the Environment
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Parent category: Life