Date of Assessment: _____________________

Hospital Name or ID: ______________________________

Hospital Type: ___________________________________
Title or role of person completing tool: ______________________________________ Other, Please
Specify:____________________ Years of experience at facility: ____________ (Numeric Response)

General Information
Comments
3 Do you have Covid-19 wards
4 How many number of other wards
5 How many number of bed in Covid-19 ward
6 How many number of bed in other ward
7 With temporary storage?
8 Use of personal protective equipment
9 Disinfection method
10 Final disposal method
11 Total waste generation Kgr/day Before Covid-19
12 Total waste generation Kgr/day in Covid-19
13 Infectious waste generation Kgr/day Before Covid-19
14 Infectious waste generation Kgr/day in Covid-19
15 Total waste generation Kgr/day/bed Before Covid-19
16 Total waste generation Kgr/day/bed in Covid-19
17 Increase ratio in covid-19 compare with before covid-19
18 HCW team have Knowledge of about COVID-19 and non-
COVID-19 waste
19 Hospitals using their own incinerator facilities

Hospital Waste Disposal

Total waste Total waste Infectious Infectious Total waste Total waste
generation generation waste waste generation generation
Kgr/day Kgr/day in generation generation Kgr/day/bed Kgr/day/bed
Before Covid- Covid-19 Kgr/day Kgr/day in Before Covid- in Covid-19
19 Before Covid-19 19
Covid-19
COVID-19
ward
Emergency
ICU
CCU
Hospital Administrative Functions.
Sr.N yes No
o
1 Presence of hospital COVID-19 waste management team
2 Presence of designated officer/staff COVID-19 waste management officers
3 Written record of waste generated available
4 Waste audit done by the external agency
5 Training program organized for concerned staff
6 Indication of separate disposal points for COVID-19 and non-COVID-19
waste.
7 Availability of different color coded contains for COVID-19 and non-COVID-
19 waste
8 COVID-19 and non-COVID-19 waste thrown in separate containers.
9 Separate trolleys used for onsite transport of COVID-19 and COVID-19
waste