HOSPITAL SITE ASSESSMENT CHECKLIST
PROFILE
1. Year facility was built?
Year and type of any facility addition?
2. Does the facility have an on-site incinerator?
3. How many beds?
4. How many patient days?
5. Public or private?
6. Is purchasing handled internally or by an outside buying
group/organization?
7. How many employees?
8. Are dental services provided?
9. How much Potentially Infectious Medical Waste (PIMW)
was generated last year?
10. How mush solid waste was generated last year?
11. How much hazardous waste was generated last year?
12. How much waste was recycled? Types?
13. What is the facilities definition of PIMW for waste
segregation purposes?
14. Does the facility have on-site sterilization/disinfection
equipment? What type?
15. Does the facility have an on-site laundry operation?
ANSWER
COMMENTS
HOSPITAL SITE ASSESSMENT CHECKLIST
MANAGEMENT
1. Does the facility have a Mercury (Hg) elimination
policy/program?
2. Does the facility have a program for purchasing Hg
alternative materials?
3. Has the facility inventoried all Hg containing materials?
4. Does the facility have recycling programs?
What are they? (ie: paper, plastic, aluminum, steel,
cardboard, pallets, food waste, etc.)
5. Are waste volumes tracked? If so, how?(ie: by dept., floor)
6. Has the facility performed a waste audit in the last 3 years?
If so, can a copy be provided to the assessment team?
7. Has a committee been formed to investigate waste
reduction efforts? If so, what departments are on the
committee?
8. Does the facility have a written waste management plan
for potentially infectious waste?
If so, can a copy be provided to the assessment team?
9. Staff trained on waste segregation methods? How often?
10. Staff trained on health effects of Hg and spill response?
11. Does the facility have an internal newsletter?
12. Are successful waste reduction/recycling projects
published within the hospital?
13. Are Hg spill kits available?
Personnel trained on proper clean up procedures?
YES NO
COMMENTS
HOSPITAL SITE ASSESSMENT CHECKLIST
PATIENT CARE
1. Are Hg thermometers used?
2. Are Hg blood pressure cuffs used?
3. Does the room have a redbag and general waste container?
Are they the same size? If not, which is larger?
4. Are visual aids or instructions present near the waste
receptacles to help in proper segregation? What's used?
5. Are patient kits (bedpans, pitchers, etc.) reusable?
6. Are chemotherapy wastes collected separately?
7. Are Hg containing Cantor tubes/Miller Abbot tubes used?
8. Are Hg containing esophageal dilators used?
9. Are Hg thermometers sent home with patients and/or new
mothers?
10. Are paper and cardboard recycled?
11. Does redbag waste contain non-infectious materials ?
If so, list examples.
12. Are decubitus-care mattresses used instead of disposable
egg-crate mattresses?
13. Are reusable underpads, linens, gowns, and bedpans used?
14. Are sharps containers reusable?
15. Are PVC (vinyl) ID bracelets, shower curtains, mattress
covers, aprons, overshoes or x-ray sleeves used?
16. Is there a program for nurses to evaluate personnel care
items such as aspirin packets, tissues, shampoo, baby
wipes and diapers for reuse (following infection control
guidelines) instead of disposing of them?
17. Is waste dental amalgam from lab and drain traps collected
for off-site recycling/retort?
18. Are Selenium shampoos used?
YES
NO
COMMENTS
HOSPITAL SITE ASSESSMENT CHECKLIST
LABORATORY
YES NO
COMMENTS
YES NO
COMMENTS
1. Are Hg thermometers used for bench-top practices?
2. Do incubators and refrigerators contain Hg thermometers?
3. Do tissue fixatives contain mercuric (II) chloride (ie:
Zenker's and B5)?
4. Are Hg containing preservatives used in staining solution
and reagents used (i.e. thimerosal, mercuric chloride)?
5. Are solvents recycled (ie: xylene, alcohol)? Volumes?
6. Are formaldehyde/formalin and glutaraldehyde recycled?
Volumes?
7. Do labs contain both redbag and general waste containers?
Are they different sizes? Which is larger?
8. Are paper and cardboard recycled?
9. Does the redbag waste contain non-infectious materials?
If so, list examples.
10. Is there a program to reuse/recycle lab glassware?
11. Has the lab requested full disclosure of mercury content of
chemicals from vendors?
PHARMACY
1. Are drugs supplied in reusable shipping containers?
2. Is inventory maintained as first-in/first-out?
3. Are expired drugs sent back to supplier/manufacturer?
4. Are non-PVC IV bags used?
5. Are compounding methods performed using secondary
containment?
Staff trained on cleanup procedures?
6. Are reusable containers used for in-house distribution?
7. Are mercury-containing materils used in pharmaceuticals
such as contact lens solutions, nasal spray, vaccines, and
early pregnancy kits? (i.e. thimerosal, phenyl mercuric
acetate, phenyl mercuric nitrate, Merbromin/water solution)
HOSPITAL SITE ASSESSMENT CHECKLIST
OPERATING ROOM
YES NO
COMMENTS
YES NO
COMMENTS
YES NO
COMMENTS
1. Are surgical packs reviewed for efficient usage (ie: all tools
utilized, limited packaging used)
2. Is general waste segregated from infectious waste before
and/or during surgical operations (ie: packaging)?
3. Are plastic surgical tools reused?
4. Are single use equipment assessed and reused?
5. Are unused materials (ie: from packs) collected, disinfected
and reused on-site or in other countries?
6. Are washable surgical and isolation gowns, surgical drapes,
and sterilization trays used?
CENTRAL SUPPLY (STORE ROOM)
1. Are materials purchased in bulk?
2. Does the facility have specifications requiring vendors to
supply materials in minimal packaging?
3. Are reusable shipping containers used?
4. Are pallets and cardboard recycled?
5. Have vendors been asked to investigate use of non-toxic
inks for printing on packaging?
FOOD SERVICE
1. Is food waste used for compost or recycled?
2. Are washable dishes and utensils used?
3. Are costs for beverages reduced for employees who supply
their own reusable cups?
4. Are grease traps cleaned periodically?
Is grease recycled? How?
5. Do refrigerators use mercury thermometers?
HOSPITAL SITE ASSESSMENT CHECKLIST
GENERAL FACILITIES
1. Has the facility requested full disclosure of Hg content in
housekeeping chemicals (<1% from on MSDS)?
2. Has the facility requested full disclosure of Hg in
conditioning chemicals for boilers and cooling towers?
3. Have drain traps been checked for historical Hg?
4. Are fluorescent lamps recycled?
5. Is there a program to collect and recycle batteries?
6. Are cleaning chemicals purchased in bulk and/or
concentrated for later dilution and use?
7. Does the facility have program to identify and replace Hg
containing switches and gauges?
8. If materials are supplied in drums, are drums recycled?
9. Has the facility investigated using non-toxic x-ray
developing solutions or digital imagery systems?
10. If the facility has a print shop, are water based inks used?
11. Have redbags been investigated for Cadmium content from
dye?
YES NO
COMMENTS
