Know Your Responsibilities:

Information for Tanning Salon Operators

What You Need to Know to Support Ontario’s Skin Cancer Prevention Act

This information material was created for tanning salon operators in consultation with the following organizations: • Canadian Dermatology Association• Central West Tobacco Control Area Network • Healthy Environments and Consumer Safety Branch

Environmental and Radiation Health Sciences Directorate E-mail: ccrpb-pcrpcc@hc-sc.gc.ca

• Niagara Region Public Health Youth Advisory Committee

This material is adapted with permission from Niagara Region Public Health and Hamilton Public Health Services

Thank You

This information material has been created for tanning salon staff to explain the Skin Cancer Prevention Act, Radiation Emitting Devices (RED) Act, and the health impacts of tanning bed use. This information material is designed to help you understand:• Your responsibilities under the RED Act• Your responsibilities under the Ontario Skin Cancer

Prevention Act• Health inspections• Causes and types of skin cancer• UV exposure reactions• Assessing skin type

Overview

• Youth under 18 years of age should not use tanning beds

• Overexposure to ultraviolet rays (UVR) can cause skin cancer

• Skin cancer are growths on the skin that can spread to other parts of the body. It can be caused by spending a lot of time in the sun or from using tanning beds. Most skin cancer is preventable.

Tanning Beds and Skin Cancer

• The Skin Cancer Prevention Act and the RED Act are in place to prevent skin cancer and protect people’s exposure to unsafe radiation

Tanning Beds and Skin Cancer

In Canada, the Radiation Emitting Devices (RED) Act protects against unsafe radiation emitting devices.

The Act governs:• Sale (including re-sale)• Lease • Importation of radiation emitting devices • Regulations associated with the Act

Radiation Emitting Devices Act RED Act

Information and Standards

Must be on every piece of tanning equipment in both English and French

• Instructions for use (including directions for determining exposure positions, maximum exposure time, and manufacturer recommendations on minimum time between exposures)

• Instructions on replacement and repair

• UV radiation warning labels

Radiation Emitting Devices Act RED Act

Construction Standards

Every tanning bed must include the following safety features

• Shut-off control

• Timer

• Plexiglass barrier between the lamps and user to prevent contact

Radiation Emitting Devices Act RED Act

All Pieces of Tanning Equipment Must:

• Meet RED Act standards

• Use lamps that meet standards

• Have an accurate timer (that allows for preset times and does not exceed maximum exposure recommendation times)

• Be used with acceptable eyewear

Radiation Emitting Devices Act RED Act

Labelling StandardsThis label must be on each piece of tanning equipment at the time of sale, lease or import. It must be provided in French and English.

http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2013/2013-27bk-eng.php

Radiation Emitting Devices Act RED Act

The following information must always be affixed to the outside surface of the tanning bed, where it can be easily viewed and read by a user before tanning:• Manufacturer’s name and address

• Model, serial number, and month/year of manufacture

• Detailed directions for determining the exposure positions and a warning that the use of any other position may result in overexposure

Radiation Emitting Devices Act RED Act

• Recommended exposure time in minutes

• Minimum interval between exposure

• Maximum number of minutes of exposure per year (as recommended by the manufacturer)

• Model for each type of lamp used in equipment

• Ultraviolet radiation warning labels

Radiation Emitting Devices Act RED Act

As of May 1, 2014, the Skin Cancer Prevention Act bans the sale, advertising, marketing and/or provision of tanning bed services to youth under 18 of years in Ontario.

Skin Cancer Prevention Act

What are Your Responsibilities?

• Register your salon with your local public health unit

• Check identification (ID) of customers every time they use a tanning bed

• Refuse tanning bed services to youth under 18 years of age

• Make sure all tanning bed users have adequate eye protection

• Cooperate with Public Health Inspectors

• Do not direct marketing or advertising to youth under 18 years of age

Skin Cancer Prevention Act

Under the Act, you CANNOT market or advertise tanning bed services to youth under 18 years of age

• Examples of unacceptable marketing or advertising include: targeting materials to youth under 18 years of age, marketing in or at locations frequented by youth (including schools), or using images targeted at youth under 18 years of age

Marketing and Advertising

Inspection:

• Public Health Unit will inspect your premises to ensure compliance

• Looking for signage, cleanliness and proper procedures

Fines:

• Up to $25,000 for a corporation and/or $5,000 for an individual

• Individual staff members can be fined even if the corporation is not fined

Enforcement and Fines

The Skin Cancer Prevention Act and RED Act regulations outline what signs you need to post, what labels are required on tanning equipment, and where they need to go. If these become damaged or missing, please contact your public health unit for assistance getting replacements.

Signage

http://www.health.gov.on.ca/en/public/programs/tanning/docs/uvr_sign_pos.pdf

Point of Sale Warning Sign:

• Main warning sign

• Lists dangers associated with tanning bed use, requirement to wear protective eyewear and notes restriction of youth under 18 years of age using tanning beds

• Must be clearly displayed within 1 metre of each cash register

Signage

http://www.health.gov.on.ca/en/public/programs/tanning/docs/uvr_sign_pos.pdf

Signage

Health Warning Sign

• Must be displayed in rooms where tanning beds are located

• Warns potential users of the dangers associated with tanning bed use

• Also advises of the requirement to use protective eyewear

http://www.health.gov.on.ca/en/public/programs/tanning/docs/uvr_sign_health.pdf

Age Restriction and Identification Decal

• Must pose decal on all entrance doors to tanning facility

• Sticker indicates anyone under 18 years of age is banned from using tanning beds AND anyone under 25 years of age must show identification

http://www.health.gov.on.ca/en/public/programs/tanning/docs/uvr_sign_door.pdf

Signage

Employee Reminder Decal

• Decal must be stuck to countertop at cash register or service desk

• Decal must face employee

• Reminds employees that anyone under 18 years of age is restricted from using a tanning bed AND anyone under 25 years of age must show identification

http://www.health.gov.on.ca/en/public/programs/tanning/docs/uvr_sign_employee.pdf

Signage

Ask for ID from anyone who looks 25 years of age or younger.

You must ID every time

Acceptable ID must be:• Government-issued

• Have a photo

• Include date of birth

Ontario photo health cards are acceptable, but you may NOT request one

Acceptable ID

Ontario Driver’s License is an acceptable form of identification

Should match year of birth

Should match month of birth for a male person(month + 50 for female)

Should match day of birth

Year, month, and day of birth Identifies when

cardholder will turn 19

Should match person in front of you

Ontario Driver’s Licence

Year, month, and day of birth

Tells you (M)ale or (F)emale

Ontario Photo Health Card

Ontario Health Cards with a photo may be accepted, but you may NOT ask for one

What is the health concern?

• Tanning beds may become tainted with blood or body fluids such as Hepatitis B, Hepatitis C or HIV

• Tanning beds must be cleaned and disinfected after each use

• You do not have to see blood or body fluids for an infection to occur

Protect yourself!

• Wash your hands thoroughly

• Use gloves or other proper personal protection when required

• Follow manufacturers instructions when cleaning and disinfecting tanning beds or booths

Keep it Clean

• Clients’ skin should be free of cuts, wounds, irritations and rashes

• Protective eyewear is required. Single use eyewear is recommended

• If using reusable protective eye wear, ensure it is properly cleaned and then disinfected after each client

• Cleaning and disinfecting chemicals should be properly labeled

Protect Your Clients’ Health

• Garbage receptacles should be provided in each tanning room

• Used towels, robes and linens must be laundered after each client

• Washrooms must be maintained in clean condition and supplied with liquid soap and single use towels

Protect Your Clients’ Health

Health Inspections1. Side of Bed: all required labels should be on beds

and throughout tanning salon

2. Tanning Beds: Must be cleaned/disinfected after each client to prevent infections such as HIV and hepatitis

3. Pillow Area: All pillows/towels should be made of easily washable surface and cleaned or laundered after each use

4. Floor: Should be made of easily washable surface, cleaned daily, and be in good repair

5. Chairs: Any surface that bare skin may have touched should be cleaned and disinfected

6. Garbage: Should be provided in each tanning room

7. Squirt Bottle: Cleaning/disinfecting chemicals provided for client use should be properly labeled with the name of product & directions for use

8. Towel Dispensers: Single-use towels recommended for cleaning and disinfecting purposes

• Over exposure to Ultraviolet Rays (UVR) can cause skin cancer

• Most skin cancer is preventable

Ultraviolet Rays (UVR) and Skin Cancer

UVR and Skin

http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/Tanning/ucm116425.htm

UVB Rays: • Penetrate outer skin layer• Main cause of sunburn• Any tan or change in skin colour is

sign of skin damage (“there is no such thing as a healthy tan”)

UVA Rays:• Go deeper into skin• Can cause permanent damage to

skin’s collagen and elastin• This type of damage causes aging

skin (including wrinkles, saggy skin and sun spots)

• May cause skin cancer (three most common types are: melanoma, basal cell skin cancer and squamous cell skin cancer

• Rates of melanoma are increasing in Ontario

• Can be cured if found early

• Can spread to other parts of the body and cause death

• Fourth most common form of cancer in Canadians 15 to 49 years of age

Melanoma

Canadian Dermatology Association (2014). Modified with permission

Melanoma

Basal cell skin cancer is the most common form of skin cancer in Canada. It is also the least dangerous, but must be treated or it will continue to grow.Early warning signs:• Reddish bump with a pearly border• Bleeds, crusts over and then comes back• Does not heal within four weeks • Often on the upper body or legs, feet, arms, and hands

Basal Cell Skin Cancer

http://www.dermatology.ca/media/skin-cancer-photos/

Fair-skinned people with blond hair or red hair and skin that usually sunburns are most at risk from this form of skin cancer.

Basal cell skin cancer is most common in:• Men over 50 years of age

• People who have already had one basal cell skin cancer

• Organ transplant patients whose immune systems are weak

Basal Cell Skin Cancer

Squamous cell skin cancer is the second most common form of skin cancer in Canada. It can grow quickly over a period of a few weeks, and can spread to other areas of the body. It often appears on the head, neck, arms, and the back of the hands and legs.

Early warning signs:

• Thick, red, scaly bumps or growths

• Open sore or crusted skin

• Grows quickly

Squamous Cell Skin Cancer

Photoaging happens when the skin begins to show early signs of aging due to UV exposure.

Photoaging signs include:

• Wrinkles

• Frown lines

• Spider veins

• Freckles, age spots or uneven skin colour

• Stretched lips

• Skin that looks like leather

• Skin that sags

Photoaging

Skin reactions include ‘phototoxicity’ and ‘photoallergy.’

These can be caused by a pre-existing allergy to UV rays reacting with:• Medications• Foods• Skin care products• Lotions

Skin Reactions

UV rays can trigger a photosensitivity reaction such as an itchy rash or hives.

Photosensitivity

Hives:• Are large, itchy welts or red bumps

• Can start after only a few minutes of being exposed to UV rays

• Can last for minutes or hours

• Sometimes, people who have a severe reaction may:– Get headaches

– Have trouble breathing

– Feel dizzy and weak or be sick to their stomach

Photosensitivity

A phototoxic reaction can appear a few hours after UV exposure.

Phototoxic reactions can:• Cause pain, redness and swelling

• Are similar to a sunburn

• Only happen when the person has taken certain drugs

People with these reactions may also have a brown or blue-gray mark in areas of the skin that have been exposed to UV rays.

Phototoxic Reactions

This is an allergic reaction that causes the skin to become red when exposed to UV rays.

Photoallergic Reactions

This type of reaction happens due to a pre-existing allergy, or when a person has or has used:• Skin care products

• Antibiotics

• New tattoos

• Certain foods, including artificial sweeteners

Erythema is a medical term to describe redness and swelling of the skin.

Sunburns are caused by UV rays (mostly UVB rays) and symptoms may develop hours after exposure.

Erythema (sunburn)

At the start of each new tanning session, it’s a good idea to remind clients:• About the risk of a reaction to UV rays

• To check the drug labels or speak to a pharmacist when using a new product

If a client complains of rashes or itching during or after a tanning session, tell them

to see a doctor.

Preventing UV Reactions

Genetics and reaction to sun exposure determine skin type.

Determining a client’s skin type will help you understand their risk for skin damage.

Skin Types

1

3

2

4

6

5

TYPE 1: Very pale skin, blond or red hair, blue or green eyes. Burns and never tans. May have many freckles or moles.

TYPE 2: Fair skin, blond or red hair, light coloured eyes. Usually burns, seldom tans.

TYPE 3: Medium-skinned Caucasians who sometimes burns, sometimes tans.

TYPE 4: Darker-skinned Caucasians or Mediterraneans. Tans easily, rarely burns.

TYPE 5: Middle eastern skin tone. Tans easily, seldom burns.

TYPE 6: Dark brown/black skin. Doesn’t burn, but can still suffer from skin and eye damage from exposure to the sun.

Part I: Genetics 

Your eye colour is:0. Light blue, light gray or light green1. Blue, gray or green2. Hazel or light brown3. Dark brown4. Brownish black

Your natural hair colour is:0. Red or light blonde5. Blonde6. Dark blonde or light brown7. Dark brown8. Black Your natural skin colour (before sun exposure) is:0. Ivory white9. Fair or pale10. Fair to beige, with golden undertone11. Olive or light brown12. Dark brown or black  How many freckles do you have on unexposed areas of your skin?0. Many13. Several14. A few15. Very few16. None  Total score for genetic disposition: _______

Part II: Reaction to Extended Sun Exposure  How does your skin respond to the sun?0. Always burns, blisters and peels1. Often burns, blisters and peels2. Burns moderately3. Burns rarely, if at all4. Never burns  Does your skin tan?0. Never -- I always burn5. Seldom 6. Sometimes7. Often8. Always How deeply do you tan?0. Not at all or very little 9. Lightly10. Moderately11. Deeply12. My skin is naturally dark How sensitive is your face to the sun? 0. Very sensitive 13. Sensitive14. Normal15. Resistant16. Very resistant/Never had a problem Total score for reaction to sun exposure: _______ Your Fitzpatrick Skin Type __________________

Determine Your Skin Type

Combine total score from Parts 1 and 2 to determine

your Skin Type Score:

0-7: Type 18-16: Type 217-25: Type 326-30: Type 430+: Type 5-6

Haliburton, Kawartha,

Pine Ridge District Health Unit

Call toll-free at 1-866-888-4577Visit www.hkpr.on.ca

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