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DATA GUIDELINES
<br />Hazardous Materials. Infectious and Medical Wastes
<br />A. GENERAL INFORMATION
<br />1. Name and Address of Facility
<br />2. Owner, Administrator, Manager Name
<br />3. Contact Individual Name and Telephone Number
<br />4. Infection Control Committee Chairperson and Alternate, ar.d Telephone Number
<br />5. Principal product or service, and description of Departmental -type services
<br />provided (e.g., convalescent/critical/acute/chronic care, Pathological lab-
<br />oratory, radiation therapy, or, "complete hospital acute care" etc).
<br />B. WASTES DESCRIPTION
<br />1. List the types, known or estimated quantity per day/wk/month, and sources of
<br />wastes generated from, or delivered to, your facility; e.g., sharps, laboratory
<br />cultures, surgical and pathological specimens, anatomical parts, reusable and
<br />disposable blood and tissular -contaminated materials; disposable instruments,
<br />utensils, and fomites, isolation room produced wastes, etc.
<br />2. As stated in B. 1. above, also list wastes or mixtures of wastes (if possible
<br />by name) which have any of the following properties: carcinogenic, corrosive,
<br />explosive, nontoxic, flammable, irritant/strong sensitizer, toxic, radioactive;
<br />C. WASTES HANDLING
<br />1. Explicitly describe the procedures in practice for handling wastes listed in
<br />B. above, both in-house; and out -of -house prior to ultimate removal, for
<br />wastes listed in B. above,
<br />2. describe sanitation/sterilization techniques and frequencies of removal for
<br />directly and indirectly contacted items, such as double bagging, labeling,
<br />equipment used in cartage, separation of wastes by type, etc.
<br />3. How many individuals (and their titles) are responsible for direct collection
<br />and cartage of accumulated wastes listed in B. above, and what degree of
<br />training are such individuals afforded?
<br />4. Describe how wastes listed in B. above, are stored prior to disposal/trans-
<br />portation, including security measures inside and outside the facility, e.g.,
<br />separated or combined wastes in barrels (list whether steel or not), ponds,
<br />tanks, warehouse, pressure or leaded containers, plastic encased, large con-
<br />tainer such as a covered or uncovered dumpster; open yard, link fenced,
<br />locked lids, etc.
<br />D. WASTES DISPOSAL
<br />1. If incineration is used, provide the Air Pollution Control District Permit
<br />Number, and describe the procedures and individuals involved with incineration,
<br />listing frequency of operation, and methods of disposal of ash/residue disposal,
<br />including the volume of material disposed of.
<br />2. What entity removes wastes from the facility, with what frequency and in what
<br />manner?
<br />NOTE: IF WASTES ARE GENERATED WHICH FALL INTO CATEGORIES LISTED IN ITEM B. 1. and/or 2.
<br />ABOVE, PLEASE COMPLETE THE PERMIT APPLICATION/BILLING FORM ATTACHED TO THESE
<br />GUIDELINES, AND RETURN THE APPLICATION FOR OUR PROCESSING WITH THE DATA LISTED
<br />ABOVE.
<br />EH 00-38 b 3/80 200
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