Your name
Your practice name
Address
Address
Address
City
Postcode
17 February 2016
Contact name
Waste contractor organisation name
Address
Address
Address
City
Postcode
Re: Waste destination
Dear
As you know I have a legal responsibility to ensure my waste is properly dealt with and my responsibility does
not end when waste from my practice has been collected. Therefore, as my waste contractor, I would
appreciate it if you could complete the attached form and return it with the relevant supporting information for
my practice records. This will assist me in ensuring that I discharge my duty of care with respect to the waste
produced by my practice.
If there is anything which is not clear, please do not hesitate to contact me.
Kind regards
YOUR NAME
Waste destination checklist
Company information
Registered company name
Waste carrier registration number
Incineration only waste streams
Which clinical waste incinerator Contact name:
will be used to dispose of this Company name:
waste?
Site address:
Permit number:
Telephone number:
Please attach a copy of an Environment Agency site inspection form for
this incinerator that is less than 12 months old.
Wastes suitable for alternative treatment or clinical waste incineration
Is this waste being disposed of at Yes/No
the clinical waste incinerator
above?
If no, how will it be disposed of?
Incineration/Alternative treatment
If no, which clinical waste
incinerator/alternative treatment
plant will be used to dispose
of this waste?
Contact name:
Company name:
Site address:
Permit number:
Telephone number:
Please attach a copy of an Environment Agency site inspection form for
this facility that is less than 12 months old.
Wastes suitable for pet cremation
Which pet crematorium will be Contact name:
used to dispose of this waste?
Company name:
Site address:
Permit number:
Telephone number:
Please attach a copy of an Environment Agency waste management
licence or a local authority incineration permit for this crematorium.
Wastes suitable for landfill
What disposal option will be used Landfill/Other
for this waste?
If other, please specify
Which site will be used to dispose Contact name:
of this waste?
Company name:
Site address:
Permit number:
Telephone number:
Please attach a copy of an Environment Agency site inspection form for
this facility that is less than 12 months old.
Wastes suitable for recovery
What disposal option will be used Recovery/Other
for this waste?
If other, please specify
Which site will be used to dispose Contact name:
of this waste?
Company name:
Site address:
Permit number:
Telephone number:
Please attach a copy of an Environment Agency site inspection form for
this facility that is less than 12 months old.
Waste electricals
What disposal option will be used Recovery/Other
for this waste?
If other, please specify
Which site will be used to dispose Contact name:
of this waste?
Company name:
Site address:
Permit number:
Telephone number:
Please attach a copy of an Environment Agency site inspection form for
this facility that is less than 12 months old.
Onward transfer
Will all wastes be taken directly to Yes/No
the final disposal site?
If no, which wastes will not be
taken directly to the final disposal
site? (delete as appropriate)
cytotoxic and cytostatic waste
medicinally contaminated sharps
yellow clinical waste containers
orange clinical waste containers
photographic chemicals
pharmaceutical waste
offensive/hygiene waste
black bag (domestic type) waste
Where will this waste be taken
prior to final disposal?
Contact name:
Company name:
Site address:
Permit number:
Telephone number:
Please attach a) a copy of an Environment Agency site inspection form for
this facility that is less than 12 months old, and b) a copy of the permit for
this facility.
Documentation
Please provide an example completed copy of a) a hazardous waste consignment note and b) a waste
transfer note.
If the waste is being taken to the waste contractor’s site, please provide a completed example of a hazardous
waste consignee return to the producer.
If the waste is being transferred from an interim transfer site to a final disposal site(s), please provide example
copies of the consignment/transfer notes.