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r <br /> or fprS 1�05j7118i delaartmeilt In-7-Service Sign In Sheet ROMAN <br /> Uf Mantcea — <br /> � ��«, <br /> All fields must be filled in — PLEASE PRINT <br /> CLASS TITLE= ��" -�- <br /> ATE <br /> DHazardous.Waste Management <br /> may 1 — 10 2p 9 <br /> CIRCLE ONE Mandatory y Non-mandatory <br /> START TIME <br /> TOTAL HOURS <br /> C.E.U. APPROVED-H-0-URS <br /> LOCATION Unit Roundin <br /> tIVSTRUCTURS Department Directors Clinical Manage Shift Mana ers <br /> TARGET AUDIENCEM All•clinical staff <br /> TEACHING METHODS; Lecture Self study Discussion Video <br /> Circle all mat aA i Resource Binder <br /> DEPARTMENTS ICU, MS, MSS, Perinatal,�Zsje, ED <br /> LEARNI G f?BJECTIVES Proper idenfi5cat�on of haz2rdo <br /> (clearly slate} 2, Proper Identification of waste dit posat containers <br /> 3. Verbalize understanding of taws and regulations pertaining to was <br /> 4. Otsq�t25ton of Mnproper Changing of Containers and e45t reiated to inappropriate use <br /> REASON: Circle all that Individual staff needs Patlent populationlAge specific <br /> a /y EcluiPment Technolo New/Revised POlic Procedure <br /> PARTICIPANT Posttest Retum demo Competency Re-mon for <br /> EVALUATIQN METHOD QI Change in clinical practice OTHER <br /> PRINT NAME First & List) DEPT E . >zCgittracr% Ao�r� <br /> on-gym <br /> 2 <br /> CAR <br /> 3 ?' <br /> t� <br /> 4 l l� <br /> JAL <br /> s <br /> b <br /> 7 <br /> 8 <br /> 9 <br /> iQ <br /> Z1 <br /> 12 <br /> 13 <br /> 1010$crvke Siop-fii Shcci9,noc <br /> 10/I0 0 6 2 d Z81# 6ti 0 Wt Z: 0 6IOZ/t0/SO <br />