Audit

About the Organisation -

Introduction - Audit Scope - Audits of the healthcare waste management activities of this facility are undertaken by a member of the HEG Compliance Team on behalf of HEG GROUP LTD. These audits include a pre meeting and accompanied tour with the facilities designated Waste Management Representative.
The audits included the inspection of clinical and non-clinical waste handling areas, and where appropriate some random questioning of staff.
These audits are carried out in accordance of the guidance document:
Department of Health HTM 07:01 Safe Management of Healthcare Waste – Version 2 March 2013.
Other guidance documents (listed below) may also be taken into consideration when carrying out these audits:
• The Environmental Protection Act 1990 (including the Duty of Care Regulations)
• The Controlled Waste Regulations 2012.
• The Hazardous Waste Directive 2011.
• The Carriage of Dangerous Goods Regulations.
• The Chartered Institution of Wastes Management pre-acceptance guidance published in January 2014.

Photographic evidence of good practice and bad practice (where relevant) is included in each of the Departmental Summary pages and the Appendix section of this report.

Please note that the action plan / recommendations made in this report are made in good faith and in line with our current understanding of legislation & guidance. However, the waste producing organisation is responsible for correct categorisation, segregation & description of waste and should satisfy itself that systems are safe, compliant and effective to ensure waste is disposed of correctly.

Waste Produced Table -

Audit Report & Scoring System - This report describes findings and observations and recommends certain improvements. A summary of recommendations common throughout the audit can be found on the Action Plan / Recommendations page(s), with department specific recommendations found on the relevant departmental summary pages.


Please note that the action plan / recommendations made in this report are made in good faith and in line with our current understanding of legislation & guidance. However, the waste producing organisation is responsible for correct categorisation, segregation & description of waste and should satisfy itself that systems are safe, compliant and effective to ensure waste is disposed of correctly.

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

If 180103 (Orange) waste is produced is this segregated correctly

If 180103/180106/180109 (Yellow) waste is produced is this segregated correctly

If Cytotoxic 180108 (Purple) waste is produced is this segregated correctly

If Pharmaceutical 180109 (Blue) waste is produced is this segregated correctly

If Chemical 180106 (Yellow) waste is produced is this segregated correctly

If Offensive 180104 (Yellow/Black Stripe) waste is produced is this segregated correctly

If Anatomical 180102/180103 (Red) waste is produced is this segregated correctly

Is Amalgam 180110 waste is produced is this segregated correctly

Are Municipal type wastes found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Waste Storage Compound

Is the Waste Compound Secure

Are bin lids closed and locked

Are bin tags set on the correct segment according to the waste types within the bins

Do all bins contain correctly segregated waste type

Container Inspections Summary Table - The following table summarises the results of all the container inspections carried out during the audits. The audit results are highlighted using a ‘traffic light’
system explained below.
Highlighted Green - Fully Compliant – no non-conformance witnessed
Highlighted Amber - Area of minor non-conformance – waste is being over treated or an error in best practice (e.g. domestic waste in clinical waste stream).
Highlighted Red - Area of major non-conformance – waste is being under treated or incorrectly consigned which could result in incorrect disposal process (e.g. cytotoxic waste or other medicinal wastes in Orange infectious waste stream).

Summary of Wastes Inspected - 0.0% fully compliant, 0.0% minor non-compliance, 0.0% major non-compliance

Waste Policy

Is the Waste Policy to be reviewed as part of this audit

Action Plan / Recommendations

Please note that recommendations are made in good faith and in line with our current understanding of legislation & guidance. However, the waste producing organisation is responsible for correct categorisation, segregation & description of waste and should satisfy itself that systems are safe, compliant and effective to ensure waste is disposed of correctly.

Signatures
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Audit - duplicate

Pre-Acceptance Audit in accordance of HTM 07:01
Enter department name or number in TEXT box below

Waste stream charts are posted in prominent areas.

Is 180103 (Orange) waste produced

Is 180103 (Orange) waste produced

Is 180103/180106/180109 (Yellow) waste produced

Is Cytotoxic 180108 (Purple) waste produced

Is Cytotoxic 180108 (Purple) waste produced

Is Pharmaceutical 180109 (Blue) waste produced

Is Chemical 180106 (Yellow) waste produced

Is Offensive 180104 (Yellow/Black Stripe) waste produced

Is Offensive 180104 (Yellow/Black Stripe) waste produced

Is Anatomical 180102/180103 (Red) wastes produced

Is Amalgam 180110 waste produced

Municipal waste found in any containment.

Are waste hold area/rooms locked.

Are all containers properly labelled/signed off/tied off

Additional Comments / Findings

Enter department name or number in TEXT box below

Waste Storage Compound

Is the Waste Compound Secure

Are wastes in bins segregated correctly

Are bins segregated correctly into their waste types

Are all bin lids locked on all bins stored

Waste Policy

Is the Waste Policy to be reviewed as part of this audit

Action Plan / Recommendations

Please note that the action plan / recommendations made in this report are made in good faith and in line with our current understanding of legislation & guidance. However, the waste producing organisation is responsible for correct categorisation, segregation & description of waste and should satisfy itself that systems are safe, compliant and effective to ensure waste is disposed of correctly.

Signatures
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.