Community Clinics Initiative
Green Buildings Self-Audit
FACILITY INFORMATION
Name of Facility
Location (city, state)
Size of Facility
Number of Employees
Hours of Operation
Services Offered
If applicable, who (m) is
responsible for
sustainability in your
clinic?
Who is responsible for
supply/ product
purchasing ?
Use the key below to respond to the following sections.
A = Always
O = Often
S = Sometimes
N= Never
Community Clinics Initiative in collaboration with Teleosis Institute
CCI Green Buildings Self-Audit
SOLID WASTE
1. Reduce Paper & Other Waste
Internal communication styles (not referring to patient charts)
Email
Personal Files per employee
Continuous circulation of hard copies
Double-sided Printing
Maximize Forms to minimize paper
Order supplies by phone
Other:
A
A
A
A
A
A
O
O
O
O
O
O
S
S
S
S
S
S
N
N
N
N
N
N
A
A
A
A
A
A
A
A
A
O
O
O
O
O
O
O
O
O
S
S
S
S
S
S
S
S
S
N
N
N
N
N
N
N
N
N
S
S
S
S
S
S
S
S
N
N
N
N
N
N
N
N
2. Recycle
a. We recycle the following.....
Office Paper
Newspaper
Mixed Paper
Glass
Plastic
Cardboard
Carpeting
Yard Waste
Food Scraps
Other:
b. Office supplies purchasing
How often do you purchase the following office supplies with RECYCLED content?
Paper
Letterhead
Folders
Toilet Paper
Paper Towels
Garbage can/ bags
Desks, shelves, furniture
Construction materials
A
A
A
A
A
A
A
A
Community Clinics Initiative in collaboration with Teleosis Institute
O
O
O
O
O
O
O
O
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CCI Green Buildings Self-Audit
Other:
c. We recycle the following hazardous waste materials...…
Fluorescent lights
Spent ink/toner cartridges
Batteries
Unused/ Expired Pharmaceutical Waste
Other:
A
A
A
A
O
O
O
O
S
S
S
S
N
N
N
N
A
O
S
N
A
A
A
A
A
O
O
O
O
O
S
S
S
S
S
N
N
N
N
N
A
O
S
N
A
A
A
O
O
O
S
S
S
N
N
N
A
A
A
A
O
O
O
O
S
S
S
S
N
N
N
N
3. Reuse
Donate unwanted but usable items to schools, churches,
libraries, nonprofits, other community organizations…
Enroll in a waste exchange program
Have customers return packaging to you for reuse
Purchase products in bulk
Order products in reusable containers
Use permanent ware (mugs, dishes, utensils, towels, etc..) in
break room
Purchase reusable office items
Other:
ENERGY
1. Equipment
Use office equipment with energy saving features
Purchase all-in-one copier/fax/scanner
Replace energy efficient refrigeration
Other:
2. Lighting
What type of lighting do you use?
Incandescent bulbs
Compact Fluorescents
Halogen PAR lamps
Solar Power (Photovoltaic)
Other:
3. Heating/ Cooling
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CCI Green Buildings Self-Audit
Perform regular HVAC maintenance
Install ceiling fans
Shade sun-exposed windows and walls during hot season
Use weatherizing or caulking to seal windows
Solar Heating system
A
A
A
A
A
O
O
O
O
O
S
S
S
S
S
N
N
N
N
N
A
A
A
O
O
O
S
S
S
N
N
N
A
A
A
O
O
O
S
S
S
N
N
N
A
O
S
N
A
A
A
O
O
O
S
S
S
N
N
N
A
O
S
N
A
O
S
N
A
A
A
A
O
O
O
O
S
S
S
S
N
N
N
N
A
O
S
N
A
O
S
N
A
O
S
N
4. Energy conservation
Use task lighting where extra light needed
Rearrange workspace to make use of natural lighting
Institute a formal policy to turn off equipment and lights
when not in use.
Set thermostat at 68˚ for heating and 78˚ for cooling
Use standby mode on equipment
Use small fans and space heaters during off hours instead of
heating entire office
Install solar energy source
WATER
1. Simple conservation
Review your water bill monthly for spikes
Regularly check for leaks
Get windows cleaned on an as needed basis
2. Larger conservation
Install/Use low-flow aerators in kitchen and bathroom
faucets
Install/Use water efficient toilets
3. Landscaping
Install water efficient/ drought resistant plants
Utilize rainwater catchement system
Install rainwater shut-off devices
Replace irrigation with drip irrigation system
POLLUTION PREVENTION
1. Environmentally Preferable Purchasing
Specify non-toxic, eco-friendly cleaning supplies in janitorial
contract
Purchase organically or sustainably grown produce, foods.
coffee, and tea for staff kitchen and events
Use unbleached and/or chlorine free paper products (copy
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CCI Green Buildings Self-Audit
paper, paper towels, coffee filters)
Buy recycled/remanufactured toner and ink-jet cartridges
for office copiers and printers
Buy recycled paint and low VOC products when needed
Have promotional materials printed with soy or other low
VOC inks
Use “green” vendors for catering, printing, landscaping,
cleaning
Create a formal policy for a fragrance-free environment
A
O
S
N
A
A
O
O
S
S
N
N
A
O
S
N
A
O
S
N
2. Pest Management
Pesticide products are formulations of a number of different materials, including active and “inert”
ingredients, as well as contaminants and impurities. In addition, pesticides, when subject to
various environmental conditions, break down into other materials known as metabolites, which
are sometimes more toxic than the parent material.*
Which of the following techniques are used?
Specify use of least toxic pest control methods and products
in landscaping contracts
Use pest traps, baits, and barriers
Use less toxic pesticides such as soaps, oils, and microbials
and apply on an “as needed” basis
Correct situations that attract and harbor pests with proper
food and garbage storage and improved landscaping
Implement Integrated Pest Management for pest control
Other:
A
O
S
N
A
A
O
O
S
S
N
N
A
O
S
N
A
O
S
N
3. Facilities Maintenance, Hazardous Waste and Storm Runoff
Store any potentially hazardous materials securely, control
access and rotate stock to use oldest material first.
Label all storm water drains with “no dumping” message.
Keep receiving areas, parking, landscape and dumpster
areas clean and free from litter, oil drips and debris.
Store deliveries and supplies under a roof.
A
O
S
N
A
A
O
O
S
S
N
N
A
O
S
N
A
A
A
A
A
A
O
O
O
O
O
O
S
S
S
S
S
S
N
N
N
N
N
N
4. Hazardous Waste Disposal
Recycle spent toner and ink-jet cartridges
Recycle spent fluorescent lamps
Recycle batteries that cannot be recharged and reused
Recycle paints, solvents, etc.
Recycle electronic equipment
Replace Mercury Thermometers with digital thermometers
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CCI Green Buildings Self-Audit
Educate on proper “red bag” waste disposal; all waste is not
hazardous waste (increases cost and environmental
pollution)
A
O
S
N
A
O
S
N
A
O
S
N
A
O
S
N
A
A
O
O
S
S
N
N
A
O
S
N
A
O
S
N
5. Vehicle Air Pollution
Help encourage commute alternatives by informing
employees, customers and others who visit your office about
transportation options for reaching your location. Post
transit schedules and routes.
Offer telecommuting opportunities and/or flexible
schedules so workers can avoid heavy traffic commutes.
When possible, arrange for a single vendor who makes
deliveries for several items
Provide car/van pool parking.
Offer a shuttle service to and from bus, train and/or light rail
stops.
Encourage bicycling to work by offering rebates on bicycles
bought for commuting.
Provide secured and enclosed bicycle parking for employees
(e.g., bike lockers)
MEDICAL EQUIPMENT
1. Mercury
Mercury is a reproductive toxin and a potent neurotoxin—it affects the brain and the central nervous
system. Hospitals are also known to contribute 4-5% of the total wastewater mercury load. Mercury
fever thermometers alone contribute about 17 tons of mercury to solid waste landfills annually.*
Do you use the following instruments in your facility?
Mercury-filled thermometers
Miller-Abbott Tubes
Mercury-filled blood pressure devices
Hold mercury thermometer exchange at your facility
A
A
A
A
O
O
O
O
S
S
S
S
N
N
N
N
Are you interested in learning more about how to make medicine mercury-free?
_______________________________________________________________________
_________________________________________________
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CCI Green Buildings Self-Audit
2. PVC
PVC (polyvinyl chloride) releases dioxin, a known human carcinogen, during the manufacture and
during the incineration or burning of PVC products. In addition, DEHP, a phthalate used to soften
PVC plastic, can leach from PVC medical devices. DEHP is linked to reproductive birth defects and
other illnesses, according to animal studies.*
Do you use the following products in your facility?
Blood bags and tubing
Dialysis, peritoneal drainage bags
Catheters
Enteral feeding sets (bags and tubes)
Bedpans
Inflatable splints
Oxygen masks, tents, tubing
IV solution bags
A
A
A
A
A
A
A
A
O
O
O
O
O
O
O
O
S
S
S
S
S
S
S
S
N
N
N
N
N
N
N
N
Are you interested in learning more about how to make medicine PVC-free?
_______________________________________________________________________
_________
* Health Care Without Harm (www.noharm.org) provided the useful definitions in this self-audit.
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