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1JOCLors nospltai ue artment in-z�)erVice wn in z neer ADM/N <br /> Or mantcca <br /> All f s must'be.fil>ed in — PLEASEJORINT <br /> CLASS TITLE <br /> Hazardous Waste Management <br /> DATE May 1 st — 10th. Q _ <br /> CIRCLE ONE Mandator 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 Discussio �— em stration Video <br /> Circle all that apply Resource Binder <br /> DEPARTMENTS ICU, MS, MSS, Perinatal, OR, E ' eta <br /> LEARNING OBJECTIVES 1. Proper identification of hazardous waste <br /> 2. Proper identification of waste disposal cont ers <br /> (clearly state) 3. Verbalize understanding of laws and regulali ert ' io 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 /> appI Equipment Technolo New/Revised Policy Procedure <br /> PARTICIPANT Post test Return demo Competency Re-monitor <br /> EVALUATION METHOD QI Change in clinical practice OTHER <br /> PRINT NAME (First,& Last) DEPT EMP NontEmp ADMIN <br /> 1 t <br /> 3 `• � t/ <br /> l l "kdL- <br /> 4 a <br /> v\ <br /> 5 HIM <br /> Ni(xjy 5a. rkS 0 L7 T_ _✓ <br /> 6 CkC0p <br /> � Ze <br /> s <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> HAln Service Sign-In sheets.doc I - <br />