Medical Waste Removal Request

Please fill out the following form and print and sign the confirmation page. Place the printed form with the waste that will be removed. Thank you.

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Required - please enter numbers only

All biohazard boxes must be secured with tape at the bottom and top. Crossing the box flaps is not sufficient.

Special Medical Waste type to be removed from laboratory Number of containers to be removed
250 characters remaining
Comments:
Replacement container(s) requested
Declaration: I hereby certify that the above information is accurate to the best of my knowledge and ability to determine that no deliberate or willful omissions of composition or properties exist and that all known or suspected hazards have been disclosed and all infectious organisms/agents have been rendered nonviable.