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Q: Medical Waste Audit Questionnaire ( Answered 4 out of 5 stars,   0 Comments )
Subject: Medical Waste Audit Questionnaire
Category: Health
Asked by: jer17-ga
List Price: $100.00
Posted: 17 Dec 2003 11:18 PST
Expires: 16 Jan 2004 11:18 PST
Question ID: 288061
This request involves Medical Waste. I am looking for forms, that
probably exist, called Medical Waste Audit Questionnairs. They are
used to query medical,dental, labs, veterinary,radiology, pathology
and chemotherapy generators of medical waste.I would like to get a
variety of forms that are applicable to a major hospital that probably
generates virtually every form of medical waste, single or group
practioners in the medical, dental and veterinary sectors, labs of all
kinds. I wish to find very recent forms (12-36months), very
comprehensive and a big plus would include Federal or State EPA

Request for Question Clarification by cath-ga on 18 Dec 2003 13:02 PST
Hi jer17,

I am checking medical forms companies for your forms, but in
the meantime, perhaps you could check a form I found
online, for free. 

It is at:

for Word


for pdf.

Is this comprehensive enough? If not, what else would you like?
Thanks, cath-ga

Request for Question Clarification by cath-ga on 18 Dec 2003 14:47 PST
Hi again,

the previous form inventoried medical wastes. I am also finding forms
which audit safety procedures in dealing with wastes. Which are
you interested in? One or the other or both? Thanks, cath-ga

Request for Question Clarification by cath-ga on 18 Dec 2003 15:25 PST

Do you just want a template/prototype form, which you can have
copied? Or do you actually need completed forms? Perhaps if
you could tell me a little about why you need them it would
help too. Sorry, I have more questions than you do! cath-ga

Request for Question Clarification by cath-ga on 19 Dec 2003 09:59 PST
Regulations vary by state. Can you tell me what state you are in? 

Clarification of Question by jer17-ga on 19 Dec 2003 10:07 PST
The answer to your first question is both.
The answer to your second question is that I would like
template/prototypes which I can copy as well as completed forms.
My purpose in this project is to convince a Latin American government
that a medwaste audit is urgently needed and rather easy to do using
existing forms and procedures that exist in the USA or other places.
My emphasis on very current is important because there have been great
advances in alternative technologies to deal with Medwaste. I fear
that by using the free form frpm San Diego that I am using both
outdated questions and outdated treatment alternatives. I think the
questions are probably ok on this form but I would like to see a very
current form that may be more comprehensive.
The use of incineration, as you see on the San Diego form is in use
but not now in vogue due to the toxins emitted by incineration.A very
recent completed form might yield the use of newer, less dangerous
The request for different forms for different types of health sites is
an attempt to make it easier for a specific lab type to fill out a
form rather than a comprehensive form that may be 90% not applicable.
Same thinking for single or group medical, dental veterinary sites.
The less paperwork, the better.
Thank you,

Clarification of Question by jer17-ga on 19 Dec 2003 11:47 PST
I have today attempted to answer your questions and I would like to
know if you have received my answers.
I emphasize current blank and filled out forms in an attempt to use
the most recent questions and answers available in the Medwaste Audit

Request for Question Clarification by cath-ga on 19 Dec 2003 12:32 PST

Yes, I did receive your clarification. Thank you very much, knowing
what you are using it for really helps. I am working on your answer
now. Do you have a tight deadline? Just so you'll know...some of
the models EPA is recommending aren't totally new, but I
am still looking...cath-ga
Subject: Re: Medical Waste Audit Questionnaire
Answered By: cath-ga on 19 Dec 2003 16:55 PST
Rated:4 out of 5 stars
Hello jer17,

Thanks very much for your question, and for the clarification which
helped me to understand what would serve your purpose. What
an important project to be working on!

I went right to the ?horse?s mouth? and asked the EPA where to find 
the forms you are looking for. 

EPA & State  Recommendations

In its reply e-mail, the EPA included California?s and West
Virginia?s approaches to comprehensive medical waste management as
models. You will have to scroll through California?s Self Assessment Manual
for Proper Management of Medical Waste to get to the self-assessment
FORM at the end of Chapter 4. It is called the ?Self Assessment Tool?
for generators of medical waste. Go to:

The above is a 1999 document, but it is one the  EPA is citing as a model.

The State of California Dept. of Health Services also has a  FORMS
download site, at;

The above includes forms for Medical Waste Facility Permits, Sharps
Mailbacks, a Transporter Spreadsheet, a Medical Waste Management

The EPA also directs us to West Virginia?s Medical Waste Management
Program, to be found at:

They have an Annual Report Form for Large Quantity Generators
of Medical Waste at:

Once again, there?s no date on the form, but it?s one the EPA
is recommending.

Their Quarterly Report Form for Infectious Medical waste Transporters
can be found at:

There is also West Virginia?s  Infectious Medical Waste Manifest, at:

The EPA has posted a Medical Waste Tracking form at:

The EPA also posts a ?Transporter Report Form? to identify the
generator of medical waste, the type of waste, and the transporter,
and treatment facility:

Alternative Technologies

You mentioned the latest technologies. California has a document 
just released a week ago called Alternative Medical Waste Treatment
Technologies, at:

I spoke with Steve Kubo, an inspector of Medical Waste for California
Dept of Health Services. He confirmed that everyone?s looking for
new technologies, and that California no longer incinerates medical
waste here. However, much of the waste here is trucked out of state to 
Texas  and the Dakotas to incinerators there. 

Kubo also says that the forms the state puts out are mainly for
large waste generators, they don?t really have them out yet
for small doctors, dentists, and vet offices. Since California
is pretty much on the leading edge of environmental regulation,
it may be difficult to find government forms for small generators.

Small Generators

Here is the San Diego County Medical Waste Management Form you
previously viewed, posted at:

The above form may be suitable for small generators, as
I have not found forms designed specifically for them.

There is a ?Medical Waste Tracking Document,? prepared by
El Dorado County, CA , very simple, possibly for small

Animal Facilities

Animal Biosafety Self- Audit. The following URL gives two checklists
for safety and health measures in laboratories where animals are kept.

Here is another checklist for Laboratories containing animals and
their waste:

Dental Waste

This is an article on managing Dental Waste:

This site has good information on Recycling Dental Wastes
(a slide show, not a form, though) 

(You have to fill in the form to download the slides.)

Waste Safety Precautions Checks

The New York University Medical Center has a good list
of safety and health precautions to check:

There is an article on ?Managing Environmental  Audits at Healthcare
Facilities at:

Medical Waste Management Company

I spoke with a representative at Stericycle, a Medical Waste
Management Company. This company picks up medical waste
from veterinarians, hospitals, pediatricians, and dental offices. 
The drivers from Stericycle are the ones who inventory the 
containers of waste from each facility, and weigh them. According 
to their representative, they have the forms that are used, and 
fill them out. You can obtain forms from them. They are at:

Medical Forms Company

I also talked with George Fletcher of Medical Forms and Graphics.
He says he can make up forms for you from anything you
have downloaded. His phone number is 1-800-997-3575.
He is in Georgia, but has distribution centers throughout
the U.S.

Another Resource

Hospitals for a Healthy Environment is at:

It posts a good article on Hospital Waste Assessment at:

I have many calls out to medical facility plant managers, but it
being the Friday before Christmas break, I have not heard back.
I am going to go ahead and post this answer. Then I will post any 
call backs I get next week that are useful. Once you have
looked at the forms listed, please feel free to press the
?Clarify Answer Button? and ask me any follow-ups, before
you rate my work.


search strategy on Google:

medical forms + waste audit
medical waste + audit forms
medical waste + inventory forms
epa + medical waste + audit
medical waste + self assessment
medical waste + assessment
veterinary waste + assessment
veterinary waste + self audit
dental waste + self assessment
dental waste + self audit
laboratory + self assessment
laboratory + self audit

Request for Answer Clarification by jer17-ga on 19 Dec 2003 20:21 PST
It would be helpful to get all the data from you as soon as possible
but with the holiday season upon us that may not be easily done. If I
can get everything by January 10th, that would be really appreciated.
Thank you and I will rate after you tell me that you are finished.

Request for Answer Clarification by jer17-ga on 21 Dec 2003 07:44 PST
I apologize! One of the items that slipped my mind. An audit form for
a large health site will necessarily include the various departments
that generate medwaste. If you can find a form that details a dept. by
dept. report and then a summary report for the entire site,that would
be very useful.

Clarification of Answer by cath-ga on 21 Dec 2003 12:25 PST

I received your two requests for clarification and will respond
as soon as I get any new info. cath-ga

Clarification of Answer by cath-ga on 23 Dec 2003 15:53 PST

I just received in the mail a catalogue I ordered last week
from Briggs Corporation, apparently "the leading vendor 
of medical forms." You will probably want to phone up and order 
the free catalogue as I did. It seems to have several forms you 
would be interested in. (Call 1-800-247-2343) It came in 5 days.
If you call the phone number, they will also fax you any
form you want to see up close. But you pretty much have
to know what you want to see first.

You can go to the Briggs website and see them at:

You don? have to log in, just click  Products, and search.

Their ?Right to Know Regulatory Compliance and Training 
Manual? contains information detailing what the workers need 
to know about working around hazardous chemicals. Product 
# 8646E has it in English, 8648S has it in Spanish. They also
have a video on this, also in English and Spanish

It?s on p 306 of the catalogue.
Also on 306 and 307 are:

Form CFS 14-24, their Hazardous Materials Log. 
You can find it on the Website, but unfortunately they
have included the blurb for 14-25 in its place. So you
have to phone and ask them to fax it to you to see
what it really says.  It is a form assessing the 
facilities' programs for dealing with hazardous materials.

Form CFS 14-9 is their Safety-Infection Control Quality 
Assurance Checklist. It is a checklist auditing the facilities? 
procedures for dealing with infection and infectious waste. 
Once again, they will fax you any form you want to see up close.

This company seems like a really good resource for you. They are
accustomed to providing products in Spanish, and also offer
custom forms.


Clarification of Answer by cath-ga on 07 Jan 2004 13:28 PST

Thank you for your kind rating. Here is some further information
from a PR officer at H2E who just got back to me:

"I apologize for the delay in getting back to you; I am still wading 
through work piled up over the holidays.  I believe you were trying to 
locate forms from the Hospitals for a Healthy Environment Waste Reduction 
Guide page ( I've been able
to download these forms (in PDF format) from my computer without a
please let me know if there's something I'm missing, or if the trouble 
you were having was a temporary glitch that's since corrected itself.  
I believe that the forms you needed are located at the web addresses 
Appendix D: Waste Assessment Forms
Appendix E: Records Review Worksheets
Another comprehensive resource on this subject is the H2E
Self-Assessment Guide ("

Happy New Year, cath-ga
jer17-ga rated this answer:4 out of 5 stars
This answer may be very helpful as it directs me to what may be a
really valuble source.

There are no comments at this time.

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