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loDertment In-Service Sign In SA ADMIN — <br /> Doctors Hospital �� <br /> °f'vtA"'c`a All fields must be filled in – PLEASE PRINT <br /> CLASS TITLE <br /> Hazardous Waste Management <br /> DATE May 1*st _ 10th. got1 <br /> CIRCLE ONE Mandatory Non-mandatory <br /> START TIME <br /> TOTAL HOURS <br /> C.E.U. APPROVED HOURS <br /> LOCATION Unit Rounding <br /> INSTRUCTORS Department Directors, Clinical Managers, Shift Managers <br /> TARGET AUDIENCE All clinical staff <br /> TEACHING METHODS: Lecture Self study Discuss io emonstration Video <br /> Circle all that apply Resource Binder <br /> DEPARTMENTS ICU, MS, MSS, Perinatal, OR, E <br /> LEARNING OBJECTIVES I. Proper identification of hazardous waste <br /> 2. Proper identification of waste disposal conta <br /> (clearly state) 3. Verbalize understanding of laws and regulations pertaining to waste disposal <br /> 4. Discussion of improper changing of containers and cost related to inappropriate use <br /> REASON: Circle all that Individual staff needs Patient population/Age specific <br /> apply Equip rnent Technology New/Revised Policy Procedure <br /> PARTICIPANT Post test Return demo Competency Re-monitor <br /> EVALUATION METHOD QI Chan2e in clinical practice OTHER <br /> F7— PRINT NAME (first & Last) D��'T EMP Contract/ ADMIN <br /> x c lau,.� t <br /> 2 'tL A <br /> y) S o v)-e K_ <br /> 4 LA <br /> 'S <br /> 6 n LOL 6 V/ <br /> 7 � <br /> 8 / <br /> 9 b <br /> ex f rem <br /> 11 ) � lam•. l�� <br /> 12 a <br /> 13 <br /> HAIn Service Sign-In shects.doc <br />