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The following documents can be copied and pasted into your word processor and easily modified to meet your specific needs. They should be used as a guide and modified to meet your company policies and procedures, including the laws in your state or country. If you feel uncomfortable making modifications to these documents and forms, please seek the advice of an attorney or accountant.
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Sun Tanning Bed - Potential Hazards
Drugs Verses Ultraviolet Rays
PLEASE NOTE: THIS LIST IS NOT EXHAUSTIVE, AND INDIVIDUALS TAKING MEDICATION SHOULD CONSULT WITH THEIR PHYSICIAN PRIOR TO PROLONGED EXPOSURE TO ULTRAVIOLET RAYS.
Note: If you are using a medication in any of these classes, you should take precautions even if your particular medication is not listed.
Astemizole Azatadine Brompheniramine
Buclizine Carbinoxamine Chlorpheniramine
Clemastine Cyclizine Cyproheptadine
Dexchlorpheniramine Dimenhydrinate Diphenhydramine
Diphenylpyraline Doxylamine Hydroxyzine
Meclizine Methapyrilene Methdilazine
Orphenadrine Pheniramine Promethazine
Pyrilamine Terfenadine Trimeprazine
Coal Tar and Derivatives
Alphosyl Aquatar Denorex Medicated Shampoo
DHS Tar Gel Shampoo DOAK Shampoo Estar
Ionil T. Plus LAVATAR Medotar
T/Derm Tar Emollient Tegrin Shampoo T/GelTherapeutic Shampoo
Contraceptives, Oral & Estrogens (birth control pills, female sex hormones)
Chlorotrianisene Diethylstilbestrol Estradiol
Estrogens, conjugated Estrogens, esterified Estopipate
Ethinyl estradiol Medroxyprogesterone Megestrol
Norethindrone Norgestrel Quinestrol
NSAID: Non-Steroidal Anti-Inflammatory Drugs (antiarthritics)
Diclofenac Diflunisal Fenoprofen
Flurbiprofen Ibuprofen Ketoprofen
Meclofenamate Naproxen Phenylbutazone
Piroxicam Sulindac Suprofen
Phenothiazines (major tranquilizers, anti-emetics)
Acetophenazine Butaperazine Carphenazine
Chlorpromazine Ethoproprazine Fluphenazine
Mesoridazine Methdilazine Methotrimeprazine
Perphenazine Piperacetazine Prochlororperazine
Promazine Promethazine Propiomazine
Thiethylperazine Thioridazine Trifluoperazine
Sulfonamides ("sulfa" drugs, antimicrobials, anti-infectives)
Acetazolamide Sulfacytine Sulfadiazine
Sulfadoxine Sulfamethizole Sulfamethoxazole
Sulfasalazine Sulfapyrazone Sulfisoxazole
Sulfonylureas (oral anti-diabetics, hypoglycemics)
Acetohexamide Chlorpropamide Glipizide
Glyburide Tolazamide Tolbutamide
Thiazide Diuretics ("water-pills")
Bendroflumethiazide Benzthiazide Chlorothiazide
Chlorothalidone Cyclothiazide Hydrochlorothiazide
Hydroflumethiazide Methyclothiazide Ploythiazide
Tetracyclines (antibiotics, anti-infectives)
Chlortetracycline Demeclocycline Doxycycline
Methacycline Minocycline Oxytetracycline
Amitriptyline Amoxapine Desipramine
Doxepin Imipramine Nortriptyline
SOURCES OF DATA 1. Medications that Increase Sensitivity to Light: A listing, prepared by Jerome I. Levine, M.S., R.Ph., 12/90, US Dept of Health & Human Services, FDA 91-8280.
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Rules and Regulations
1. Members who are more than 5 minutes late will forfeit their time.
2. Members may schedule only one appointment up to 4 days in advance.
3. Members may make appointments only for themselves.
4. Reservations can be made only if you have already purchased a discount packet or single ticket.
5. For reservations at the Antioch club, call 555-1234.
6. Members who do not show up for their reservation or call to cancel their reservation for the same day lose their phone reservation privileges for 30 days.
7. If 5 appointments are missed, the member will be restricted from using the tanning bed for 30 days.
8. Eye goggles are required and are available; your keys must be left at the front desk as security.
9. Please do not wear any oils or lotions while using the tanning bed.
There will be no refunds on tickets purchased or lost. If you have any questions about potential hazards from drugs caused by ultraviolet rays, please ask one of the staff for an informative handout.
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WAIVER AND RELEASE
I agree that I am voluntarily using this tanning bed. I am fully responsible for the amount of time I have chosen for exposure, both in the time per visit and the number of visits for tanning. I agree to use protective eyewear at all times. Before using the tanning bed, I will acquaint myself with the effect of UVA tanning and will obtain my doctor’s permission to tan if I am undergoing any treatment or taking any medication. I agree to hold [Company Name] and all of its employees, owners, directors, and officers harmless and free of any liability from my use of the tanning bed.
Print Name____________________________ Phone Number____________________
1. If you burn easily in the sun, you will burn easily while using the tanning bed.
2. If you cannot achieve a tan from the sun, you probably won’t be able to tan by using a [Company Name] tanning bed.
3. If you are taking any restrictive-photosensitive medication or if you are prone to reactions from ultraviolet light, you should not use the tanning bed.
4. Be especially careful of body areas that see little or no sunlight.
5. Take it easy. Do not try to get a great tan in one or two visits.
6. Monitor your tanning results by using a small sticker to monitor results.
7. Remember, overexposure to sunlight and/or UVA sun lamps can cause permanent damage to your skin and may cause skin cancer.
If you have any questions about the effects of tanning, be sure to consult your doctor.
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