Placenta Process Record – Placenta Tincture (step 1)

PRN Member email address (your form will be sent to this address) *

Client's name *

Any allergies noted on Booking Form? *

Yes, please noteYes, please note

Meconium present (double check on Placenta Release Form) *

Yes

Any other physical contaminants present? *

Yes, complete 'corrective action taken' box below

Date of processing tincture *

Time of processing tincture *

Temperature of placenta prior to processing (if not under 8°c then note in corrective actions taken box below) *

Location remedy is being processed at *

Hands washed & Personal Protection Equipment worn (7.5) *

Yes

No, why?No, why?

Work space set up correctly (cleaned, disinfected, protected & supplies prepared) (7.1/7.12) *

Yes

No, why?No, why?

Equipment is clean, disinfected and in good working order prior to use (7.1) *

Yes

No, why?No, why?

Placenta tincture process (P6) followed *

Yes

No, why?No, why?

Alcohol used is minimum 40% ABV *

Yes

No, corrective action taken?No, corrective action taken?

Clean down & disinfect completed (7.1) *

Yes

No, why?No, why?

Waste management steps followed (7.11/A6) *

Yes

No, why?No, why?

The Client has been made aware of the following (please tick)

Tincture will be kept with you for 6 weeks until ready to be strained (complete step 2 after 6 weeks)

Tincture will be sent to client with instructions on steeping & straining after 6 weeks

My clients are left with instructions/labels on how to look after and consume their remedy safely

Any other stipulations?Any other stipulations?

Corrective action taken

Notes