Form – IV
(See rule 13)
To, be submitted to the prescribed authority on or before 30th June every year for the period from january to December of
the preceding year, by the occupier of care facility (HCF) of common bio – medical waste trearment facility (CBWTF)
SL. NO.ParticularsDr. T.R. kunwar (civil surgeon cum hospital suptt.
1Particulars of the Occupler
(i) name of the authorised person
(occupler or : operator of facility)
District Hospital Bijapur
(ii) Name of HCF or CBMWTFDistrict Hospital Bijapur
(iii) Address for CorrespondenceDist. Bijapur c.g.
(iv) Address of Facility
(v) Tel. no. Fax. No9407907177
(vi) E-mail
(vii) URL of Website
(viii) GPS coordinates of HCF or CBMWTF
(ix) ownership of HCF or CBMWTF(State Government or {rivate or Semi Govt. or any other)
(x) Status of Authorisation under the Bio-Medical Wasre (Management and Fandling) Rule ActAuthorisation No. 3848/BMW/HO/CECB/2015
Valid up To : DTD. 10-11-2015
(xi) Status of Consents under Water Act and Air ActValid up to : 09/11/2016
2Type of Health Care Facility
(i) Bedded HospitalLaboratry, Blood Bank, OT
(ii) Laboratory (Clinic or Blood Bank or Clinically or Research Institute of Veterinary Hospital or any other)
(iii) License number and irs date of expiry
3Derails of CBMWTF
(i) Number Healthcare facilities covered by CBMWTF
(ii) No of beds covered by CBMWTF
(iii) Installed treatment and disposal capacity of CBMWTF4.5 kg per day
(iv) Quantity off biomedical waste treated or disposed by CBMWTF4.5 kg per day
4Quantity of waste generated or disposd in kg per annum (on monthly average basis)Yellow Category : 30 kg/manth x 12
Red Category : 60kg/manth x 12
White : 15 kg/manth x 12
Blue Category : 70 kg/manth x 12
General Solid waste : 30 kg/manth x 12
5Details of the Storafge, tretment, transportation, precessing and Disposal Facility
(i) Details of the on-site storage facilitySize : 15 x 30
Capacity :
Provision of on site Storage :
(cold storage or any other provision
(ii) Disposal FacilitiesType of treatment equimentNo of unitsCapacity kg/dayQuantity treated or disposed in kg/annm
Autoclaves224 x 45
Needle tip cutter or destroyer15
sharps encapsulation or concrete pit25 x 5depth 10 fit
Deep burial pits13.5 x 3.5depth 7 fit
Chemical disinfection
Any other treatment equipment
(iii) Recyclable Quantity of recyclable wastes sold to authorized recyclers treatment in kg per annumRed Category (like plastic, glass etc)
(iv) No of vehicles used for collection and transportation collection and transportation of biomedical waste
(v) Details of incineration ash and ETP sludge generated and disposed during the trantment of wastes in kg per annuminciner ation Ash ETP SludgeQuantity generatedwhere disposed
(vi) Name of the common Bio – Medical waste Treatment Facillty Operator through which wastes are disposed of
(viii) Do you have bio – medical waste management commirree ? If yes, attach minutes of the meetings help during the reporting periodYes
6Details trainings couducted on BMWYes
(i) Number of trainings conducted on BMW Management3
(ii) Number of personnel trained-81
(iii) Number of personnel trained at the time of induction
(iv) Number of personnel not undergone any training so far
(v) Whether standard manual for training is availble?Yes
(vi) any other information)
7Details of the accident occurred during the year
(i) Number of Accidents occurred
(ii) Number of the persons affected
(iii) Remedial Action talen (Please attach detalis if any)
(iv) Any Fatality occurred details.
8Are you meeting the standards of air Pollution from the incinerator? How many times in last year could nat met the standards?
Details of Continuous online emission monitoring systems installed
9Liquid waste generated and treatment methods in place. How many times you have nor mer the standards in a tear?
10Is the disinfection method or sterilization meeting the log 4 standards? How many times you have not met the standards in a year?
11Any other relevant information(Air Pollution control Devices attached with the Incinerator)
Certified thar the above report is for the period from 2016-17
Date :- 31-07-2017Name and signature of the Head of the Institution
Place :- Bijapur