Title Page

  • Ward Area

  • Conducted on

  • Prepared by

  • Location

Condition of Waste Receptacles

  • Are there color-coded waste bins for bio-medical wastes available in the ward?

  • Are bags securely fitted with the bin?

  • Are waste bins covered?

  • Is there a biohazard symbol imprinted over waste bags?

  • Are there posters displayed near the waste bins to guide staff and/or users?

  • Take or attach photo evidence of waste bins available in the ward

Segregation of Waste

  • Do each colored waste-bin contain items assigned to it?

Mutilation of Recyclable Waste

  • Are used hypodermic needles destroyed, re-capped or bent?

  • Are used plastic bottles cut?

  • Is nozzle of syringes destroyed?

  • Are used plastic tubings cut?

Disinfection of Plastics and Sharps

  • Is a disinfectant solution put into waste bins?

Completion

  • Additional comments

  • Name & Signature of Assigned Personnel

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