Health Care Waste Management Program Self-Monitoring Assessment Tool

Name of Health Care Facility: Date:

Type of HCF: Ownership:
Classification (General / Specialty):
Service Capability:
Licensed Authorized Bed Capacity (ABC): Implementing Bed Capacity (IBC):
Location of HCF:

General Information
Chief of Health Care Facility:
Contact No.: Email Address:
Pollution Control Officer (PCO):
Certificate of Accreditation (COA) No.:
Contact No.: Email Address:
Number of Employees / Workers:
Clinical Staff: Non-clinical Staff:
Medical Doctor/s Administrative Personnel/s
Staff Nurse/s Janitorial and Security Personnel/s
Other/s: (Business Office, Admitting,
Allied Health Personnel/s
Maintenance, Dietary, Driver and CSD
Other/s
Bed Occupancy Rate:
List of all medical and supporting departments of the facility. (Including Pharmacy, Laboratories, Dietary, and Etc.)
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Health Care Waste Management
What are the wastes generated daily at in the HCF? (Please "Shade / Fill" the selected areas)
General or non-infectious wastes Chemical wastes Radioactive waste
Sharps wastes Pathological wastes Other/s (If any)
Pharmaceutical wastes Anatomical wastes
How much is generated per type of waste by each department or ward in the HCF? (Kg/Month) (Please "Fill" the selected areas)
General or non-infectious wastes Chemical wastes Radioactive waste
Sharps wastes Pathological Other/s (If any):
wastes
Pharmaceutical wastes Anatomical
wastes
Is the HCF practicing segregation at point of generation?
Yes No
If not, please provide explanation/s:

Are there functional waste collection containers in close proximity to all waste generation points for non-infectious wastes, infectious waste, and sharp waste?

Yes No
If not, please provide explanation/s: n/a

DOH-CHD7-LHSD-SOP-01 Form2 Rev.0

How and where is the facility's health care waste stored before collection?
General or non-infectious wastes:
Sharps wastes:
Pharmaceutical wastes:
Chemical wastes:
Pathological wastes:
Anatomical wastes:
Radioactive wastes:
Other/s:
Are the wastes stored separately? (Please provide photo evidence)
Yes No
If not, please provide explanation/s: n/a

Are all the infectious wastes stored in a protected area before treatment for no longer than the default and safe time?
Yes No
If not, please provide explanation/s:

How is the hazardous liquid waste handled? (Please "Shade / Fill" the selected areas if applicable)
Specify for:
Chemical Waste
Cytotoxic Waste
Reagents
Used x-ray film processing liquids
Other/s (If any):
If the liquid waste is discharged in the sanitation system, where does the latter discharged, and what is its capacity?
Capacity:
HCWM Treatment and Disposal
What acceptable treatment technology (if any) are done to the wastes before disposal? What type of wastes? (Please "Shade / Fill" the selected areas if applicable)
Waste Treatment Technology Applied:
General or non-infectious wastes
Sharps wastes
Pharmaceutical wastes
Chemical wastes
Pathological wastes
Anatomical wastes
Radioactive wastes
Other/s if any
Where is the health care waste disposed of? At the HCF Off-site
If the wastes are disposed at the facility:
Are concrete vaults used for the disposal of sharp wastes? (If Yes, please provide photo evidence)
Yes No
If not, please provide explanation/s:

Are placentas disinfected prior to disposal to placenta pit? (If Yes, please provide photo evidence)
Yes No
If yes, what method of disinfection is used? If not, please provide explanation/s:

Are treated infectious wastes, sharps, chemical, and pharmaceutical waste encapsulated/inertisized and disposed through safe burial? (If
Yes, please provide photo evidence)
Yes No
If not, please provide explanation/s:

If any waste is taken off-site, are the wastes transported for treatment by a DENR-accredited transporter?
Yes No
Transporter Name:
Address:
Contact No.: Accreditation No.:
Type of Waste Transported: Quantity (Kg):
How is the waste packed? (Kindly provide photo evidence)

What types of vehicles are used to transport the wastes?

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DOH-CHD7-LHSD-SOP-01 Form2 Rev.0

Is any of the waste taken to an engineered or sanitary landfill?
Yes No
If not, what happens to the waste at this facility?

Is the HCW buried immediately after arriving at the dump or landfill site?
Yes No
Is it burned on the site?
Yes No
Is it left unattended at any time after being unloaded?
Yes No
Do waste pickers, children, or others have access to the dump or landfill site?
Yes No
Wastewater Management
What are the uses of water (potable, non-potable, and wastewater) in the facility?
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What departments/wards in the HCF generate wastewater? (Provide estimated volume generated)
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Is the wastewater treated in a centralized wastewater treatment facility? (Please provide photo evidence)
On-Site Off-Site
Operations Management
Is there a trained person responsible for the management of the health care wastes in the HCF? If yes, provide the name of personnel.
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How many people are involved in waste collection? No. of Personnel:
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Are special skills required by the HCF?
Yes No
If yes, please specify the special skills required in your HCF.
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What sort of worker safety measures are in place?
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What are the current operational standards for HCW and what are the applicable national, regional, and local policies?
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List down any written standards operating procedures for the segregation, storage, treatment, and disposal of the HCW.
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DOH-CHD7-LHSD-SOP-01 Form2 Rev.0

Are appropriate personal protective equipment (PPE) provided to all staff in charge of the waste management?
Yes No
What personal protective equipment (PPE) are provided to the staff? (Please specify)
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Is procurement of new health care materials reviewed to reduce the waste stream and to avoid potential treatment problems?
Yes No
What are the daily waste collection routines, including waste packaging?
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How much does HCW operational cost in the HCF?
Does the budget provision cover these costs?
Yes No
Risks of the Current Waste Management System
Does the management of the HCF have concerns about the facility's current HCW practices?
Yes No
If so, what problems do they identify?
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Does the assessment above indicate that the facility's current waste management practices pose any health risks to patients, nurses or doctors, other staff, or visitors?
Yes No
If yes, what kind of risks?
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Does the waste presented pose any risk to waste collectors?
Yes No
If yes, what kind of risks?
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DOH-CHD7-LHSD-SOP-01 Form2 Rev.0