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-s Hospital QMartment In,-Service Sign In g&etOf ADh9IN. <br /> T...I ucn All fields must be filled in — PLEAS RINT <br /> CLASS TITLE <br /> Hazardous W ste Management <br /> DATE May 1 st _ <br /> CIRCLE ONE I lWandatory on-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 Discussion Demonstration Video <br /> Circle all that apply esource Binder <br /> DEPARTMENTS ICS, MSS, Perinatal, OR, ED <br /> LEARNING OBJECTIVES roper identification of hazardous waste <br /> Clean 2. Proper identification of waste disposal containers <br /> y Stat@) 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 -Equipment Technolo New/Revised Policy Procedure <br /> PARTICIPANT Post test Return demo Competency Re-monitor <br /> EVALUATION METHOD I QI Change in clinical practice OTHER <br /> PRINT NAME First & Last) DEPT EMP Contract/ ADMIN <br /> Non-Em <br /> 3 -20 ra� Graf 7f 7 <br /> 4 <br /> 5 <br /> 6 <br /> s Zv c I'm J 10 <br /> J <br /> s . <br /> J <br /> 10 <br /> 11 <br /> 7Tev el-P,iNI f"w/\- <br /> 42 don <br /> wmmv <br /> n i� <br /> ffl <br /> HAN Service Sign-In sheets.doc _ i <br />