Hazardous Waste Sectoral Inspections Form - Nursing Homes
Waste Management Act 1996, as amended
To complete this form, you will need the name and waste collection permit number of your commercial (general, recycling and organic/food waste) and hazardous waste collectors, recent copies of commercial waste collection receipts and recent copies of hazardous waste disposal receipts (e.g. ADRs or Certificates of Destruction).
Name of Nursing Home
*
Person completing this form
*
Position held of person completing the form
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address of Nursing Home
*
Street Address
Street Address Line 2
City
County
Eircode
Is all waste (hazardous and commercial) generated on the premises collected by an authorised waste collector? (See www.nwcpo.ie for list of authorised waste collectors).
Yes
No
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)?
*
Yes
No
Please supply the name of the waste collector, employed by the nursing home, for the collection of COMMERCIAL waste. This information must include the collector's Waste Collection Permit Number (e.g. NWCPO-XX-XXXXX-XX).
Please supply the name of the waste collector, employed by the nursing home, for the collection of HAZARDOUS waste. This information must include the collector's Waste Collection Permit Number (e.g. NWCPO-XX-XXXXX-XX).
Please supply copies of waste collection receipts for the last three COMMERCIAL collections.
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Please supply copies of waste disposal receipts (ADRs) for the last three HAZARDOUS collections.
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Date form completed
*
-
Month
-
Day
Year
Date
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