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Q-2, r. 12 - Regulation respecting biomedical waste

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SCHEDULE I
(s. 15)
ANNUAL REPORT OF THE BIOMEDICAL WASTE GENERATOR WHO TREATS BIOMEDICAL WASTE ON THE GENERATION SITE
  
O.C. 583-92, Sch. I; I.N. 2019-12-01; O.C. 996-2023, s. 20.
SCHEDULE I
(s. 15)
ANNUAL BIOMEDICAL WASTE GENERATION REPORT

_________________________________________________________________________________
| |
| GENERATOR |
| |
| Name: _____________________________________ Province/State: ________________ |
| |
| Address: __________________________________ Country: _______________________ |
| |
| __________________________________ Postal Code: ___________________ |
| |
| __________________________________ |
| |
| PERSON IN CHARGE |
| |
| Name: _____________________________________ Signature: _____________________ |
| |
| Title: ____________________________________ Date: __________________________ |
| |
| Telephone No.: _________________ |
| |
| TREATMENT EQUIPMENT ON SITE |
| |
| □ Incineration capacity: ______kg/hr Authorized by the MDDEPQ: ____/_____|
| |
| □ Disinfection capacity: ______kg/hr Authorized by the MDDEPQ: ____/_____|
| year month |
|_________________________________________________________________________________|
| |
| CLASS 1 - HUMAN ANATOMICAL WASTE |
| |
| (a) Total quantity generated: ______kg (c) Total quantity incinerated |
| on site: ______kg |
| |
| (b) Quantity shipped out: ______kg |
| |
| Carrier(s) Authorization No. Consignee(s) Authorization No. |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
|________________________________________________________________________________ |
| |
| CLASS 2 - ANIMAL ANATOMICAL WASTE |
| |
| (a) Total quantity generated: ______kg (c) Total quantity incinerated |
| on site: ______kg |
| |
| (b) Quantity shipped out: ______kg |
| |
| Carrier(s) Authorization No. Consignee(s) Authorization No. |
| __________________________________________ _________________________________|
| |
| ___________________________________________ _________________________________|
| |
| ___________________________________________ _________________________________|
| |
| ___________________________________________ _________________________________|
| |
|_________________________________________________________________________________|
| |
| CLASS 3 - NON-ANATOMICAL WASTE |
| |
| (a) Total quantity generated: ______kg (c) Total quantity incinerated |
| on site: ______kg |
| |
| (b) Quantity shipped out: ______kg (d) Total quantity disinfected |
| on site: ______kg |
| |
| Carrier(s) Authorization No. Consignee(s) Authorization No. |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| _______________________________________________________________________________ |
O.C. 583-92, Sch. I; I.N. 2019-12-01.
SCHEDULE I
(s. 15)
ANNUAL BIOMEDICAL WASTE GENERATION REPORT

_________________________________________________________________________________
| |
| GENERATOR |
| |
| Name: _____________________________________ Province/State: ________________ |
| |
| Address: __________________________________ Country: _______________________ |
| |
| __________________________________ Postal Code: ___________________ |
| |
| __________________________________ |
| |
| PERSON IN CHARGE |
| |
| Name: _____________________________________ Signature: _____________________ |
| |
| Title: ____________________________________ Date: __________________________ |
| |
| Telephone No.: _________________ |
| |
| TREATMENT EQUIPMENT ON SITE |
| |
| □ Incineration capacity: ______kg/hr Authorized by the MDDEPQ: ____/_____|
| |
| □ Disinfection capacity: ______kg/hr Authorized by the MDDEPQ: ____/_____|
| year month |
|_________________________________________________________________________________|
| |
| CLASS 1 - HUMAN ANATOMICAL WASTE |
| |
| (a) Total quantity generated: ______kg (c) Total quantity incinerated |
| on site: ______kg |
| |
| (b) Quantity shipped out: ______kg |
| |
| Carrier(s) Permit No. Consignee(s) Permit No. |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
|________________________________________________________________________________ |
| |
| CLASS 2 - ANIMAL ANATOMICAL WASTE |
| |
| (a) Total quantity generated: ______kg (c) Total quantity incinerated |
| on site: ______kg |
| |
| (b) Quantity shipped out: ______kg |
| |
| Carrier(s) Permit No. Consignee(s) Permit No. |
| __________________________________________ _________________________________|
| |
| ___________________________________________ _________________________________|
| |
| ___________________________________________ _________________________________|
| |
| ___________________________________________ _________________________________|
| |
|_________________________________________________________________________________|
| |
| CLASS 3 - NON-ANATOMICAL WASTE |
| |
| (a) Total quantity generated: ______kg (c) Total quantity incinerated |
| on site: ______kg |
| |
| (b) Quantity shipped out: ______kg (d) Total quantity disinfected |
| on site: ______kg |
| |
| Carrier(s) Permit No. Consignee(s) Permit No. |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| ___________________________________________ ________________________________ |
| |
| _______________________________________________________________________________ |
O.C. 583-92, Sch. I.
© Gouvernement du Québec