Sharps & Waste Area Check Log (1-Page Table Format)
| SHARPS & WASTE AREA CHECK LOG (OR / PACU / NORA) | |
| Hospital: ________________________ | Dept Anesthesia / OR / PACU | Form Code: F-29 | Version: ___ | Effective: ___ | PAGE 1 of 1 |
| SECTION 1 — AREA IDENTIFICATION | ||
| Area: ☐ OR ☐ PACU ☐ NORA |
Unit / Room: ___________________________ |
Month / Year: ___________________________ |
| SECTION 2 — DAILY / SHIFT CHECK LOG | ||||||||
| Date | Shift (AM/PM/Night) |
Sharps Bin at Point-of-Use (Y/N) |
Not Overfilled (Y/N) |
Lid Functional (Y/N) |
Waste Segregation Correct (Y/N) |
Regulated Waste Bin Available (Y/N) |
Issues Noted | Initials |
| SECTION 3 — STANDARD REQUIREMENTS (Daily Verification) |
|
☐ Sharps containers upright and secured (not on floor)
☐ Containers replaced before overfill ☐ No recapping observed (unless approved technique)
☐ Sharps and waste bins labeled correctly
☐ Spill kit available (where required) ☐ Waste removed on schedule (no accumulation) |
| SECTION 4 — CORRECTIVE ACTION |
|
If any "N" above → Action Taken:
☐ Replaced sharps bin
☐ Educated staff
☐ Reported to supervisor
☐ EVS notified Notes / Ticket #: ____________________________________________________________________________________________________ Resolved by (Name/Sign): _____________________________________________
Time: ________________
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