Medical Facility Hazardous Waste Declaration Form
Medical Facility Information
Facility Name
Address
Contact Person
Phone Number
Hazardous Waste Details
Type of Waste
Quantity (kg/liters)
Container Type
Storage Location
Date of Waste Generation
Transporter (if applicable)
Final Disposal Method
Additional Comments
Declaration
I declare that the information provided above is accurate and complete to the best of my knowledge.
Authorized Personnel Signature
Date