Form - IV
(See rule 13)
Annual Report
[To be submitted to the prescribed authority on or before 30th June every year for the period from January to December of the preceding year, by the occupier of health care facility (HCF) or common bio-medical waste treatment facility (CBWTF)]
Sl. No.
Particulars
1.
Particulars of the Occupier
:
(i) Name of the authorised person (occupier or operator of
facility)
:
(ii) Name of HCF or CBMWTF
:
(iii) Address for Correspondence
:
(iv) Address of Facility
(v) Tel. No, Fax. No
:
(vi) E-mail ID
:
(vii) URL of Website
(viii) GPS coordinates of HCF or CBMWTF
(ix) Ownership of HCF or CBMWTF
:
(State Government or Private or Semi Government or any other)
(x) Status of Authorisation under the Bio-Medical Waste
(Management and Handling) Rules
:
Authorisation
No.:...............................................
.............valid up to ..........
(xi) Status of Consents under Water Act and Air Act
:
Valid up to:
2.
Type of Health Care Facility
:
(i) Bedded Hospital
:
No. of Beds:....
(ii) Non-bedded hospital (Clinic or Blood Bank or Clinical
Laboratory or Research Institute or Veterinary Hospital or any
other)
:
(iii) License number and its date of expiry
3.
Details of CBMWTF
:
(i) Number healthcare facilities covered by CBMWTF
:
(ii) No of beds covered by CBMWTF
:
(iii) Installed treatment and disposal capacity of CBMWTF
:
_______ Kg per day
(iv) Quantity of biomedical waste treated or disposed by
CBMWTF
:
_____ Kg/day
4.
Quantity of waste generated or disposed in Kg per annum (on
monthly average basis)
:
Yellow Category:
Red Category :
White:
Blue Category :
General Solid waste:
5.
Details of the Storage, treatment, transportation, processing
and Disposal Facility
(i) Details of the on-site storage facility
:
Size :
Capacity :
Provision of on-site storage : (cold storage or any other
provision)
disposal facilities
Type of treatment equipment
No of units
Capacity Kg/day
Quantity treatedor disposed in kg per annum
Incinerators
Plasma Pyrolysis
Autoclaves
Microwave
Hydroclave
Shredder
Needle tip cutter or destroyer
-
Sharps encapsulation
or concrete pit
-
Deep burial pits:
Chemical disinfection:-
-
Any other treatment equipment:
(iii) Quantity of recyclable wastes sold to authorized
recyclers after treatment in kg per annum.
:
Red Category (like plastic, glass etc.)
(iv) No of vehicles used for collection and transportation of
biomedical waste
:
(v) Details of incineration ash and ETP sludge generated and
disposed during the treatment of wastes in Kg per annum
IncinerationAshETP Sludge
Quantity generated
Where disposed
(vi) Name of the Common Bio-Medical Waste Treatment Facility
Operator through which wastes are disposed of
:
(vii) List of member HCF not handed over bio-medical waste.
6.
Do you have bio-medical waste management committee? If yes,
attach minutes of the meetings held during the reporting period
7.
Details trainings conducted on BMW
(i) Number of trainings conducted on BMW Management.
(ii) number of personnel trained
(iii) number of personnel trained at the time of induction
(iv) number of personnel not undergone any training so far
(v) whether standard manual for training is available?
(vi) any other information)
8.
Details of the accident occurred during the year
(i) Number of Accidents occurred
(ii) Number of the persons affected
(iii) Remedial Action taken (Please attach details if any)
(iv) Any Fatality occurred, details.
9.
Are you meeting the standards of air Pollution from the
incinerator? How many times in last year could not met the
standards?
Details of Continuous online emission monitoring systems
installed
10.
Liquid waste generated and treatment methods in place. How
many times you have not met the standards in a year?
11.
Is the disinfection method or sterilization meeting the log 4
standards? How many times you have not met the standards in a
year?
12.
Any other relevant information
:
(Air Pollution Control Devices attached with the Incinerator)
Certified that the above report is for the period from
..................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...........................
Name and Signature of the Head of the Institution
Date:
Place
[Form IVA] [Inserted by Notification No. G.S.R. 234(E), dated 16.3.2018 (w.e.f. 28.3.2016).]
[See rule 13(2)]
Format for Submission of the Annual Report Information on Bio-medical Waste Management (to be submitted by the State Pollution Control Boards or Pollution Control Committees and Director General Armed Forces Medical Services to Central Pollution Control Board on or before 31st July of every year for the period from January to December of the preceding calendar year)
Part-1 (Summary of Information)
(1)
Name of the Organisation :
(2)
Name of the Nodal Officer with contact telephone number and e-mail :
(3)
Total no. of Health Care Facilities / Occupiers :
(i) Bedded Hospitals and Nursing Homes (bedded) :
(ii) Clinics, dispensaries :
(iii) Veterinary institutions :
(iv) Animal houses :
(v) Pathological laboratories :
(vi) Blood banks :
(vii) Clinical establishment :
(viii) Research Institutions :
(ix) Ayush
(4)
Total no. of beds :
(5)
Status of authorisation :
(i) Total number of Occupiers applied for authorisation :
(ii) Total number of Occupiers granted authorisation :
(iii) Total number of application under consideration :
(iv) Total number of applications rejected :
(v) Total number of Occupiers in operation without applying for authorisation :
(6)
Quantity of Bio-medical Waste Generation (in kg/day) :
(please enclose District Wise Bio-medical Waste Generation as per Part-2)
(i) Bio-medical waste generation by bedded hospitals(in kg/day) :
(ii) Bio-medical waste generation by non-bedded hospitals (in kg/day) :
(iii) Any other :
(7)
Bio-medical waste treatment and disposal
(a) By Captive bio-medical waste treatment and disposal by Health Care Facilities (please enclose details as per Part-3)
(b) Bio-medical waste treatment and disposal by Common Bio Medical Waste Treatment Facilities (please enclose details as per Part 4)
(8)
Total no. of violation by :
(i) Health Care Facilities (bedded and non-bedded) :
(ii) Common Bio Medical Waste Treatment Facilities :
(iii) Others (please specify) :
(9)
Show cause notices/directions issued to defaulters :
(i) Health Care Facilities (bedded and non-bedded) :
(ii) Common Bio Medical Waste Treatment Facilities :
(iii) Others :
(10)
Any other relevant information:
(i) Number of workshops / trainings conducted during the year :
(ii) Number of occupiers installed liquid waste treatment facility :
(iii) Number of captive incinerators complying to the norms :
(iv) Number of occupiers organised trainings :
(v) Number of occupiers constituted Bio-medical Waste Management Committees :
(vi) Number of occupiers submitted Annual Report for the previous calendar year :
(vii) Number of occupiers practising pre-treatment of lab microbiology and Bio-technology waste :
(viii) Number of Common Bio Medical Waste Treatment Facilities that have installed Continuous Online Emission Monitoring Systems :