Laserfiche WebLink
GUIDELINES F##THE MEDICAL WASTE MAftGEMENT PLAN <br /> (Please Type or Print) <br /> Small quantity generators that provide onsite treatment and all large quantity generators shall have a medical waste <br /> management plan on file with the local enforcement agency. Minimum required information: <br /> Business Name: <br /> Business Address: <br /> Business Phone: ( ) <br /> Type Of FacilityBusiness: <br /> Registered As: (Check One) <br /> () Small Quantity Generator With Onsite Treatment. (Generates<200 lbsJmo.) <br /> O Large Quantity Generator.(Generates 200 lbs.or more/mo.) <br /> () Large Quantity Generator With Onsite Treatment. (Generates 200 lbs.or more/mo.) <br /> O Common Storage Facility(Small Quantity Generators only.) <br /> Person Responsible For Implementation Of The Plan: <br /> Title: Phone: <br /> Name: 1 <br /> ATTACH THE FOLLOWING ADDMONAL INFORMATION <br /> 1. List the types of regulated medical waste generated at your facility(refer to list on page 2). <br /> 2. Estimate the monthly amount, in pounds,of medical waste generated at your facility. <br /> 3. Describe the medical waste handling procedures utilized by and applicable to your facility: <br /> a. Onsite location and method for segregation,containment,packaging, labelling,and collection. <br /> re methods utilized, including duration and temperature <br /> b. Storage area description with stora <br /> controls, if applicable. <br /> C. Onsite treatment facility description, including type of treatment utilized,maximum capacity,time <br /> and temperature necessary, alternate contingency plan in case of equipment failure,etc. <br /> d. Name, address, registration number, and phone number, of the registered hazardous.waste hauler <br /> employed by your facility. <br /> e. Name, address, and phone number of offsite treatment facility where medical waste is transported <br /> for treatment,if different than the hauler. . <br /> f. Do you have a Limited Quantity Hauling Exemption? Who on your staff is authorized to transport <br /> your medical waste? <br /> g. Do you have tracking documents for all medical wastes handled at your facility? All medical <br /> waste generators are required to keep accurate records regarding containment, storage,hauling, <br /> treatment and disposal. All medical waste records are to be maintained and available for' years. <br /> h. Describe your medical waste emergency action plan, including procedures for handling spills, <br /> exposures,equipment failures,etc. <br /> I hereby certify that to the best of my knowledge and belief that the statements made herein are correct and true. <br /> SIGNATURE: TITLE: DATE: <br /> 5 <br />