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Environmental Infection Control <br />Policy Statement <br />A medical waste tracking form (or manifest) will be used to maintain a record (log) of infectious waste generated <br />by and transported from this facility, as applicable. <br />Policy Interpretation and Implementation <br />1. Should our facility generate more than fifty (50) pounds of regulated medical waste (or the state - <br />designated limit) monthly, we will prepare and maintain approved medical waste tracking forms of all <br />waste transported from our premises. <br />2. Should our facility generate less than fifty (50) pounds a month of regulated waste (or the state -designated <br />limit), we will prepare and maintain a shipment log of all waste transported from our premises. <br />3. All medical waste generated by this facility, including waste treated, destroyed, and disposed of on site, <br />must be stored in accordance with medical waste storage policies. <br />4. Our tracking form (manifest) will contain at least: <br />a. The date of the pickup or shipment; <br />b. The weight of the shipment; <br />c. The type of medical waste shipped (e.g., cultures and stocks of infectious agents/biologicals, <br />pathological waste, human blood, blood products, contaminated sharps, etc.); <br />d. Whether or not shipment contains treated or untreated medical waste,- <br />e. <br />aste;e. Any special handling instructions; <br />f. Appropriate permit or identification numbers (e.g,, state permit/ID number; EPA medical waste ID <br />number, etc.); <br />g. Name and address of facility; <br />h. Name, address, telephone number, and permit/ID numbers of waste hauler; and <br />i. Signatures of facility representative, waste hauler, and employee accepting containers forshipment. <br />5. If a shipment log is maintained, it shall include at least: <br />a. The name, address, and telephone number of the transporter; <br />b. The transporter's state permit or ID number; <br />c. The quantity and category of waste transported (e.g., treated or untreated); <br />d. The number of containers transported; <br />e. The weight of the shipment; <br />f. The date of shipment; and <br />g. The signature of the person accepting the waste for transport. <br />6. Within thirty-five (35) days of the removal of medical waste from our premises, the destination facility's <br />owner/operator must provide this facility with a completed copy of the tracking form, which includes the <br />following: <br />a. The method of treatment of the medical waste received from this facility; <br />b. The location of the landfill used to deposit our medical waste; and <br />c. The date and signature of the destination facility's owner/operator. <br />eondrurec on nest page <br />Qtr 3, 2018 <br />t <br />