Hazardous Waste Sectoral Inspections Form

Hazardous Waste Sectoral Inspections Form

Waste Managment Act 1996, as amended
Date*

MonthDayYear
Date of completion of form
Contact Details
Name of Pharmacy
Person completing the form*

First NameLast Name
Position held of person completing the form*
Office Phone Number*

Area CodePhone Number
Phone Number

PrefixNumber
Email*
example@example.com
Website
Registered Address of Pharmacy *

Street Address

Street Address Line 2

CityCounty

Eircode
Is all waste (hazardous and non-hazardous) generated on the premises collected by an authorised waste collector? (See www.nwcpo.ie for list of authorised waste collectors).*
If all waste (hazardous and non-hazardous) generated on the premises is not collected by an authorised waste collector, please insert reason /comment here:
Is all hazardous waste generated on the premises dealt with in line with the European Communities (Shipments of Hazardous Waste Exclusively Within Ireland) Regulations 2011 (S.I. No. 324 of 2011) and accompanied by a Waste Transfer Form (WTF)?
Please supply the name of each waste collector, employed by the pharmacy, for the collection of each type of waste i.e. Medical, Commercial. This information must include the collector's Waste Collection Permit Number (e.g. NWCPO-XX-XXXXX-XX).

Cancelof
Please supply the name and address of each authorised facility for each waste stream that is disposed of.

Cancelof
Please supply copies of waste collection receipts for the last three collections.

Cancelof
Please supply copies of waste disposal receipts for the last three collections.

Cancelof
We are asking you under Section 14 of the Waste Management Act 1996 (as amended), to supply details of your waste collection and disposal service and in particular matters egarding Medical Waste generated by your business activities at this address.

All data supplied will be processed in accordance with the Council's Data Protection Privacy Statement available here.
Declaration:

I hereby certify that all the information provided is correct:
Signed

Clear
Date

MonthDayYear
Date
Should be Empty:

Hazardous Waste Sectoral Inspections Form

Contact Details