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Number of beds? __________ Average number of beds occupied per day? __________ Number of staff) __________ Average number of staff in 24 hour period? __________ Do departments generating dangerous wastes have satellite accumulation areas? 6. Are the collection/satellite areas properly and clearly identified and labelled? 7. Does your hospital have a centralized collection area for dangerous waste? 8. Is hazardous waste containers kept closed except when adding disposed waste? 9. Are all waste containers properly labelled with the type of dangerous waste and accumulation start date? 10.Are all hazardous waste containers maintained in good condition? 11.Do staff who handle waste receive hazardous waste management training? 12.Does your department keep a log of the amounts of dangerous waste generated per month? 13.Does your hospital account for all dangerous waste generated hospitalwide? 14.Does your hospital use a hazardous waste firm to service, properly transport, and dispose of your dangerous waste? 15.Does your hospital keep records of hazardous waste shipping manifests and other dangerous waste reports/analyses for at least five years? 16.Do you have emergency response information posted near a telephone? 17.Do you have a contingency plan with a copy filed at your local fire department? 18.Does your facility ensure that medical wastes are labelled and managed properly, segregated from dangerous wastes and solid wastes? 19.Are sharps segregated from other wastes and kept in puncture-resistant biomedical waste containers? 20.Are all biomedical waste containers labelled biomedical waste?

21.Does your wastewater discharge to: sewer septic system surface water

22.Have you sampled your wastewater discharge? Yes No 23.Do you have a discharge permit or authorization to discharge a pollutant? Yes No 24.Do you have a diagram of your sewer discharge? Yes No 25.Does your facility discharge dangerous waste down the drain? Yes No