Appendix E - Biohazard Waste Documentation Form/Log-In


 

Biohazard Waste Documentation Form/Log-In
 
PLEASE NOTE:  This form must be filled out and available to Safety & Security, Custodial, or Environmental Health personnel at time of waste pickup for “Biohazard” Waste (Red) Bags, EXCEPT SHARPS CONTAINERS. 
 

This form will serve as a potential exposure and waste documentation record, and as such, shall be retained by the Environmental Health Office. 

 
 

Date_______________________________  

Bag Contents (e.g., bloody bandages)____________________________________________________________________

____________________________________________________________________________

Name(s) of Person(s) Handling This Waste ___________________________________________ 

____________________________________________________________________________

Briefly Describe Process That Generated Waste (e.g., accidental cut to the skin)

____________________________________________________________________________

Personal Protective Equipment Used (e.g., latex gloves)__________________________________

____________________________________________________________________________

Process Used For Cleanup/Disinfection (e.g., area wiped with bleach)______________________________________________________________________

____________________________________________________________________________ 

SIGNATURE:                                                         DATE:                            TIME:

SUPERVISOR’S SIGNATURE___________________________________________________  

DATE________________________________ 

 

 

 

Gary Lee
Director, Environmental Health

San Juan College
4601 College Blvd.
Farmington, NM  87401
(505) 566-3063