Laserfiche WebLink
PRE-APPLICATION QUESTIONNAIRE <br /> Below is a list of regulated medical wastes. Check the type(s)of waste that your facility generates. If you do not <br /> generate any of the medical wastes listed below,please complete only the certification statement on the reverse side <br /> of this form. <br /> REGULATED MEDICAL WASTES <br /> ® Laboratory wastes - specimen or microbiologic cultures, stocks of infectious agents, live and attenuated <br /> vaccines, and culture mediums. <br /> ® Blood or body fluids- liquid blood elements or other regulated body fluids,or articles contaminated with <br /> blood or body fluids. <br /> ® Sharps - syringes, needles,blades, broken glass. <br /> Contaminated animals - animal carcasses, body parts,bedding materials. <br /> Surgical specimens -human or animal parts or tissues removed surgically or by autopsy. <br /> Waste contaminated with fixatives or chemotherapeutic agents. <br /> Isolation waste -waste contaminated with excretion,exudate,or secretions from humans or animals who are <br /> isolated due to highly communicable diseases. (Centers for Disease Control, Biosafety Level 4)* <br /> *Biosafety Level 4 viruses and diseases are:Congo-Crimean hemorrhagic fever,Tick-borne encephalitis virus complex(Absettarov, <br /> Hanzalova, Hypr, Kumlinge, Kyasanur Forest Disease, Omsk hemorrhagic fever, and Russian Spring-Summer encephalitis), Marburg <br /> disease,Ebola,Junin virus,Lassa fever virus, Machupo virus. <br /> Average monthly quantity generated 750 pounds. <br /> Licensed hauler BFI Medical Waste Systems <br /> Do you plan to treat your medical waste on site (at you facility) by Isolyser, autoclaving, incinerating or using <br /> microwave technology? <br /> ® yes ® no <br /> If you generate less than 20 pounds of medical waste per week, do you want to apply for a Limited Quantity <br /> Hauling Exemption?This allows your facility to transport medical waste to a medical waste treatment facility or <br /> transfer station without hiring a registered hazardous waste hauler. <br /> yes ® no ® N/A <br />