Hospital Recycling Approval Request Form
Submit your recycling request for review and approval in accordance with hospital recycling protocols.
Requester Full Name
*
First Name
Last Name
Department
*
Please Select
Surgery
Emergency
Radiology
Pathology
Pharmacy
Housekeeping
Facilities
Other
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Recycling Item/Material Type
*
Please Select
Paper/Cardboard
Plastics
Glass
Metals
Electronics (e-waste)
Medical Equipment (Non-hazardous)
Batteries
Other
Description of Item(s) for Recycling
*
Quantity (please specify units)
*
Pickup or Storage Location
*
Are there any contamination or safety handling concerns?
*
Yes
No
If yes, please describe contamination or handling precautions
Requested Approval Date
*
-
Month
-
Day
Year
Date
Operational Notes or Special Instructions
Upload Supporting Documents or Photos (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
Should be Empty: