Health Care Waste Management Audit Guidelines

for Hospitals and Other Health Facilities

			Page
I.	INTRODUCTION		4-6
II.	DEFINITION OF TERMS		7-9
III.	PURPOSE OF THE OPERATIONAL	GUIDELINES	10
IV.	TARGET USER		10
V.	HEALTH CARE WASTE MANAGEMENT FRAMEWORK	(HCWM) AUDIT	11-14
VI.	QUALIFICATION OF HCWM AUDITOR		15
VII.	HEALTHCARE WASTE MANAGEMENT PROCESS	AUDIT	16-18
VIII.	MANAGEMENT AUDIT OF HEALTH CARE
	WASTE		19-29

List of Abbreviations

APP Annual Procurement Plan

BHDT Bureau of Health Devices and Technology

CHD Center for Health Development

CPR Certificate of Product Registration

DOH Department of Health

EMB-DENR Environmental Management Bureau -

Department of Environment and Natural Resources

HCWM Healthcare Waste Management

HF Health Facility

HO Hospital Order

IATF Inter-Agency Task Force

IEC Information, Education and Communication

MOA Memorandum of Agreement

PPE Personal Protective Equipment

PPMP Project Procurement Management Plan

Resources

STP Sewage Treatment Plant

WASH Water, Sanitation and Hygiene

WHO World Health Organization

WWTP WasteWater Treatment Plant

List of Annexes

Reference	Title	Page
Annex "1"	Flow of Activities During Actual	30
	HCWM Audit
Annex "2"	Flow of Activities During Online	33
	HCWM Audit
Annex "A"	Healthcare Waste Management	35
	Audit Tool
Annex "B"	HCWM Audit Report Form	48
Annex "C"	HCWM Audit Report Summary	50
	Form
Annex "D"	Health Facility Assessment	51
	Plan Form
Annex "E"	Online Health Facility	53
	Assessment Plan
Annex "F"	Corrective Action Report Form	55

I. INTRODUCTION

The Department of Health (DOH) and World Health Organization (WHO) have been progressively strengthening their mandate on waste management systems over the past four years. Numerous initiatives were launched, including the fourth edition of the Health Care Waste Management (HCWM) Manual, the first edition of the Green and Safe Health Facility Manual, and the adoption of the Water, Sanitation, and Hygiene (WASH) standard. HCWM is one of the eight pillars of the Green and Safe Health Facility Manual, also known as the Green Manual, developed by the DOH in collaboration with the WHO.

The recent pandemic is causing problems and changes the landscape with waste management, particularly with regard to medical waste. Relative thereto, the DOH would like to comprehend how the pandemic affects the volume of waste generated and the compliance of Health Facilities (HFs) to HCWM Manual. A HF must be thoroughly audited in order to evaluate the state of its waste management system, spot any gaps in present waste management procedures, and recommend how to strengthen procedures. Waste audit was considered as one of the crucial elements of the waste management system to ensure sustainability of HCWM's techniques. It is a useful tool that checks to see if waste is appropriately segregated as to its categories and if it is managed, processed, and disposed of according to its type and level of hazard.

Hence, the DOH with the WHO's technical and financial support, seeks to strengthen waste management in hospitals and other healthcare institutions while ensuring the long-term viability of the HCWM system. In doing so, the waste audit, which involves validating the actual practice of HFs particularly the appropriate segregation, safe handling, treatment, and disposal of waste based on its categories which is deemed one of the HCWM system's essential components was proposed. The procedures for audit must be identified in response to the emerging and re-emerging diseases such as COVID19 pandemic threat; and in order to stop the transmission and spread of the virus. The auditors must adhere to the safety and hygienic procedures

established by the DOH and Inter-Agency Task Force (IATF) on Emerging Infectious Diseases.

As a result of the previous study, the most frequent findings in the hospitals is the increase in the infectious wastes due to poor waste segregation procedures. All of the areas surveyed still struggle with single-use plastic usage, which is reasonable given how the epidemic worsened the issue. Even if the employees received training on waste segregation, the challenge faced by the management is monitoring and enforcement. At the same time, even though certain staff members received training, the majority of their patients and clients did not. The majority of the hospitals involved either their infection control unit or their infection prevention and control committee to undertake safety and sanitation measures, including the usage of personal protective equipment (PPE). Additionally, it was noted that the amount of non-biodegradable waste in the medicine wards have increased, during the pandemic mainly due to the use of PPEs and other medical plastic goods used in the management of COVID19 patients.

Due to lack of HFs numerical data, it was also found out that there is no monitoring mechanism to compile statistics on the quantity of plastic goods utilized and plastic garbage produced by hospitals. As a result, it is advised to maintain an up-to-date database for inventory tracking, to calculate the volume and type of waste produced daily, to monitor and evaluate the processes in each area, to identify hazardous waste more effectively so as to lower the cost of waste treatment, and to implement a system of ongoing education for both clients and staff.

It is in this context that the DOH, with its vision of achieving universal health for all people and in accordance with its new mandate under the Universal Health Care Act, proposed a project that deals with the HCWM audit of HFs. Additionally, in order to maintain the program's viability, HFs must be proactive in lowering their susceptibility to pandemics and other natural disasters. Being responsible stewards of all HFs, the DOH advocated capacity building among DOH professionals, CHD Engineers and DOH Managed Hospitals on how to conduct HCWM audits to evaluate the existing practice and implementation of HFs' HCWM Plan.

It is necessary to build and develop the capacity of DOH professionals, CHD Engineers and DOH managed hospitals in conducting HCWM audits through the learning interventions, training needs assessment, workshop and training. A program for developing long-term hospital waste audit capabilities was created by implementing a substantial institutionalization effort and ensuring continuous planning and management to achieve the set goals. Hence, these operational guidelines on HCWM Audit were created.

These operational guidelines will be the foundation and basis by the chosen auditors in conducting waste audits at particular hospitals and HFs. Additionally, this will show them how to evaluate the success of the implementation of HCWM in all HFs in terms of addressing the issue of spending a lot of money on the daily waste generated in hospitals and preventing the spread of infections as a result of improper waste handling.

II. DEFINITION OF TERMS

Audit a systematic, independent and documented process for obtaining

objective evidence and evaluating it objectively to determine the

extent to which the audit criteria are fulfilled

Auditor a person who is designated by the DOH to conduct an audit

Audit Criteria set of requirements used as a reference against which objective

evidence is compared

Audit Evidence records, statements of fact or other information, which are

relevant to the audit criteria and verifiable

Audit findings results of the evaluation of the collected audit evidence against

audit criteria

Conformity fulfilment of a requirement as against the audit criteria

Non-conformity non-fulfilment of a requirement as against the audit criteria

Janitor another name is waste collector, waste handler, cleaner

Collection act of safe transporting of HCW from source or from a central

storage area

Disinfection reduction or removal of disease-causing microorganisms in order

to minimize the potential for disease transmission

Disposal discharge, deposit, placing or release of any HCW into or any air,

land and water

Hazardous waste all waste generated by HF except general waste

Health care pertains to the maintenance or improvement of the health of individuals or populations through the prevention, diagnosis, treatment, rehabilitation, and chronic management of disease, illness, injury, and other physical and mental ailments or impairments of human beings

Health Facility an institution that has health care as its care service, function, or Business

Health care waste includes all the solid and liquid waste generated as a result of the following: a.) diagnosis, treatment, or immunization of human beings; b.) research pertaining to the above activities; c.) research using laboratory animals for the improvement of human health; d.) production or testing of biological products; and e.) other activities performed by a HF

Highly infectious

waste cultures and stocks of highly infectious agents, wastes from autopsies, animal bodies, and other waste items that have been inoculated, infected or in contact with such agents: waste contaminated with organisms belonging to Biosafety levels 3 and 4; waste contaminated with pathogens mentioned in DOH AO 2010-0033.

Infectious waste waste that contains pathogens like bacteria, viruses, parasites or fungi in sufficient concentration or quantity to cause disease in susceptible hosts.

Re-use process of recovering materials intended for the same or different purpose without the alteration of physical and chemical characteristics

Recyclable any waste material retrieved from the waste stream and free from contamination that can still be converted into suitable and beneficial use or for other purposes, including, but not limited to cardboard, glass, office paper, drink cans, newspapers, magazines and polyethylene or polypropylene plastics (PE and PET)

Segregation separating the waste generated by the HF according to the specific treatment and disposal requirements

Storage area or place where HCW is temporarily stored after generation and prior to collection for ultimate recovery or disposal

Waste generator any person, organization, or facility engaged in activities that generate waste

Waste management all the activities, administrative and operational, involved in the handling, treatment, storage, collection, transportation, and disposal of wastes

III. PURPOSE OF THE OPERATIONAL GUIDELINES

The main purpose of these operational guidelines is to serve as reference or standards for the DOH and other health professionals in conducting HCWM Audit. Specifically, these guidelines must be used by Health Professionals for them to:

• a.) Be aware on how to use the HCWM audit tool needed in conducting audit;
• b.) Apply the step by step procedures in conducting waste audit; and
• c.) Understand the standards in the implementation of HCWM.

IV. TARGET USER

The target user of this operational guidelines are the following:

• a.) DOH Professionals and CHD Engineers in conducting audit among assigned health facilities;
• b.) HF Engineers and Members of the HCWM Committee in conducting self-assessment and monitoring of their compliance to HCWM Manual; and
• c.) Head of the HFs to be aware how their organization performed as compared to other HFs in terms of compliance to standards.

V. HEALTH CARE WASTE MANAGEMENT (HCWM) AUDIT FRAMEWORK

In conducting HCWM Waste Audit the following criteria must be considered: Administrative Requirements, Waste Minimization, Waste Segregation, Waste Collection, Waste Storage, Waste Transport, Waste Treatment, Waste Disposal, Wastewater Management, as well as Health and Safety Practices. The auditors shall see to it that standards on these parameters must be complied by the HFs. They must look into the following standards and see to it being followed and observed.

Figure 1: Framework of HCWM Waste Audit

The Figure 1 below shows the Framework on how the Department of Health will conduct a HCWM Audit.

Administrative Requirements

It is important to have the full support of the top management for this program to succeed, hence, preferably the Head of the HF should be the Chairperson of the HCWM Committee. The composition and the roles and responsibilities of the Committee as cited in the HCWM Manual of DOH must be followed. The Head of the HF must appoint an individual who will:

• 1.) be accountable for its compliance;
• 2.) know the risks;
• 3.) write the plan;
• 4.) maintain confidentiality, integrity and availability;
• 5.) prepare and report immediately incidents related to HCWM; and
• 6.) ensure that Service Providers regularly collect their wastes based on the approved Memorandum of Agreement (MOA).

Waste Minimization

The main goal in practicing waste minimization is to reduce the volume of waste generated in the HF that must be treated prior to disposal. A lot of strategies were identified in the Manual to be followed in order to guide all the HFs. One of which is the application of 3Rs or the Reduce, Reuse and Recycle and the Green Procurement Policy as well as the "First-In-First-Out Policy" or the First-to-Expire First Out Policy" with regard to drugs and medicines.

Waste Segregation

Segregation means the sorting and separation of hazardous waste from the general waste to facilitate recycling and proper disposal. The color-coded waste liners and waste bins shall be followed to aid the employees, patients, watchers and visitors where to put their wastes. Through these measures, the collectors must be aware also of the proper handling of the wastes from the different areas in the HFs.

Waste Collection

In collecting waste, the collectors must be familiar with the appropriate PPE that they will be wearing. In addition, they must use the separate approved waste trolleys of good quality for hazardous and general waste. They must collect waste as per approved schedule and when the plastic liners are ¾ full. They must clean and disinfect the trolley after use.

Waste Transport

The waste collectors must use the approved route plan. They must use an elevator or ramp intended only for waste in transporting waste from the different areas of the HFs to the waste storage areas. However, if there is transport off-site, they must use an Environmental Management Bureau - Department of Environment and Natural Resources (EMB-DENR) approved transport vehicle with approved transport permit in transporting the hazardous wastes. Securing transport permits shall be the responsibility of the HF.

Waste Storage

The HF must have a separate compartment or storage area for biodegradables, non–biodegradables, recyclables and waste and devices containing mercury. The size of the storage area must be appropriate for the volume of waste generated by the HF considering its future expansion. It must be regularly cleaned and provided with padlock with only authorized personnel to have access.

Waste Treatment

The HF must treat the waste they generated with approved and appropriate treatment technologies based on the type of waste. They may treat the waste either on-site or off-site if they have the service providers who will treat their hazardous wastes. If they opt to have on-site treatment, the equipment to be used must have a Certificate of Product Registration and there must be a third party service provider who will test the treated waste that will pass the 6 log 10 efficiency of reducing bacteria, viruses and fungi. They also need a Permit to Operate from EMB-DENR. The

same with the requirements for the service providers who are treating the infectious waste from HFs.

Waste Disposal

After the treatment, the service provider must dispose of the treated waste in the EMB-DENR approved sanitary landfill. The HF may opt to also dispose of their treated waste on-site following the various options in the HCWM Manual.

Wastewater Management

The HF must have a WasteWater Treatment Plant (WWTP) or Sewage Treatment Plant (STP) in compliance with the Clean Water Act. All the liquid waste must pass through its WWTP or STP prior to its release to the nearest bodies of water. It should have regular preventive and corrective maintenance. The effluent must have passed the effluent standards by the EMB-DENR and be subject to testing by the third party accredited testing laboratory.

Health and Safety Practices

In conducting HF Audit, the auditors must ensure that the health and safety of the health workers particularly the collectors or waste handlers are taken care of by the HF. The appropriate PPEs were provided and safety protocols were being followed.

VI. QUALIFICATION OF HCWM AUDITOR

The pool of auditors must be selected based on the following qualifications: He or she must:

• a.) Have attended and passed both the pre and post-tests of the training on waste audit;
  • b.) Have been connected to hospitals or HFs for a minimum of five (5) years;
  • c.) Be familiar with the HCWM audit tool, and
  • d.) Have a clear understanding of the standards of HCWM.

An effective auditor should possess the following attributes:

• ethical, i.e. fair, truthful, sincere, honest and discreet;
• open-minded, i.e. willing to consider alternative ideas or points of view;
• diplomatic, i.e. tactful in dealing with individuals;
• observant, i.e. actively observing physical surroundings and activities;
• perceptive, i.e. aware of and able to understand situations;
• versatile, i.e. able to readily adapt to different situations;
• tenacious, i.e. persistent and focused on achieving objectives;
• decisive, i.e. able to reach timely conclusions based on logical reasoning and analysis;
• self-reliant, i.e. able to act and function independently while interacting effectively with others;
• able to act with fortitude, i.e. able to act responsibly and ethically, even though these actions may not always be popular and may sometimes result in disagreement or confrontation;
• open to improvement, i.e. willing to learn from situations;
• culturally sensitive, i.e. observant and respectful to the culture of the auditee;
• collaborative, i.e. effectively interacting with others, including audit team members and the auditee's personnel.

VII. HCWM AUDIT PROCESS

Pre-Audit

Step 1: Define Audit Objectives

Preceding the document review, the Audit Team leads a primer preparation and data gathering stage. The Audit Team Leader sets the review goals and possible extent of the review. The auditor begins to foster the review program to administer the review testing techniques. This step happens after the document review has been assigned and where relevant, commonly includes a survey of the outcomes from the last time an

audit of the area happened.

Step 2: Audit Announcement

The Audit Team Leader formally issues an audit engagement document or letter to the management of the HF to be audited once the audit objectives have been established. The Head of the HF, along with the Chairperson, members of the HCWM, and relevant staff from the General Service Department, should be the recipients of the memo, as they are responsible for the HF. The memo is intended to establish expectations for the audit, explain the planned review procedure in detail, and clearly outline its objectives.

Audit Proper

Step 3: Audit Entrance Meeting

The Audit Team at first meets with the auditee to examine the review scope and resulting review steps. At this gathering, the auditee ought to give an outline of HCWM projects and plans, applicable contact names, significant approaches and methods, and other data that will help the auditors in the assessment. They will likewise talk about the normal length of the review.

16

Step 4: Walk Through Inspection

The Audit Team assembles data and performs review testing to acquire a comprehension of internal controls; they look at reports and different records for proof to decide if compelling internal controls are set up. During the review investigation, they may likewise perform definite testing of exchanges; assess consistency with existing wellbeing office strategies and adherence to policies and guidelines; and survey framework related controls for information uprightness and fulfillment. The auditor will demand extra data and records on a case to case basis.

Risk Issue Levels: During the course of the audit process, detected risks are rated as High, Moderate, or Low within their work papers. This guarantees uniformity in the reporting of audit findings and guarantees that the importance of each finding is assessed in accordance with predetermined criteria and level of concern. Throughout the audit, the risk level is adjusted to reflect existing internal controls that reduce risk. The residual risk level aids the Audit Team in determining if the controls are sufficient and whether further risk mitigation recommendations are required.

Step 5: Reviewing and Communicating Results

During the course of the inspection, if the Audit Team discovers any potential control weaknesses, policy or procedure violations, or other areas of concern, these are reviewed with the auditee. In order to ensure that any detected issue and associated risks are properly understood and to get buy-in on recommended changes, the auditor will regularly share any findings with management. Once they have been verified, the audit report communicates the findings.

Step 6: Audit Exit Meeting

Following the ocular inspection, the Audit Team meets with management in a formal setting to go through their findings and the audit recommendations that will be included in the audit report. Both parties discuss and accept recommendations to make sure the management reaction is acceptable and doable and in most instances when the corrective action will occur.

Step 7: Audit Report

Management must check the audit's findings and recommendations for correctness and completeness before drafting a formal response and action plan.

The official audit report is produced by the Audit Team and is used to advise the Head of the HF, the management group, and its HCWM Committee of any concerns and control deficiencies that have been found, as well as where and how these areas should be addressed. A separate report contains a summary of each audit report.

Post Audit

Audit Survey

The accountable management may be requested to complete a Post Audit Survey following the release of the final audit report to assist the Audit Team in assessing the efficiency of the audit process, including audit planning and communications, auditor professionalism and performance, audit timing, and the applicability of the report recommendations.

Follow-up Audits

Within six (6) to twelve (12) months after the initial audit is finished, the Audit Team conducts a follow-up audit if any major audit findings are included in the final audit report. The Audit Team will then inquire as to the status of the management's agreed-upon corrective actions.

VIII. MANAGEMENT AUDIT OF HEALTHCARE WASTE

A. Audit Objectives

The main objective of this HCWM Audit is to determine whether the organization management system conforms to the standards of the HCWM Manual and other applicable statutory and regulatory requirements and ensure that specified objectives are continually met and identification of areas for potential improvement where applicable.

B. Audit Methodology

The audit will be conducted using the HCWM Audit Tool. The auditors will conduct walk-through inspection of the HF, conduct interviews among selected staff and will be having document review.

In conducting walk through inspection, the auditor measures, checks, gauges, and observes the practice being implemented by the HF. The auditor subsequently compares their findings with the standards, policies and procedures as contained in the HF manual. In conducting interviews, the auditor can validate and assess whether the employees are aware of the standards, policies and procedures being implemented by the HF. Subsequently, in conducting document review, the auditor can determine the completeness of the required policies and guidelines that must be included in the manual as well as the required documentation or proof of implementations needed.

C. Audit Scope and Depth of Investigation

The audit covers the Provisions on Administrative Requirements, Waste Minimization, Waste Segregation, Collection and Transport, Waste Treatment and Disposal, and Wastewater Management. The audit will be based on the organization's management compliance to HCWM Manual 4 th Edition and HCW Audit Tool.

D. Audit Frequency

The DOH shall prioritize the HFs to be audited as well as the determination of frequency of HFs Waste Audit Assessment. The following audit timing may be considered based on Garnered Audit Rating Assessment:

• a.) Very satisfactory re-assessment of HF will be three (3) years after initial visit;
• b.) Satisfactory with highly adequate compliance re-assessment of HF will be two (2) years after initial visit; and
• c.) Poor compliance re-assessment will be one (1) year after initial visit.

E. Audit Criteria

Table 1 depicts the equivalent rating for each criteria of the Waste Audit Tool. The magnitude of the ratings was agreed upon by consulting the Technical Working Group (TWG) who were part of the initial audit team for the project. Higher ratings were assigned to those criteria which the team see as a significant factor to be monitored for the HCWM of the HFs. In addition, all the participants in the training on Capacity Building for the Conduct of Waste Audit were requested to evaluate the weighted ratings for each category or parameter and the results of the evaluation were also considered in the final weighted ratings.

Finally, after the conduct of either onsite or online audit, the audit team shall convene in a separate meeting and will deliberate the final audit ratings of all the hospitals to be audited. In coming up with the final audit ratings, without changing the weighted percentage allotted per criteria, each quality audit questions were given its corresponding points or percentage if compliant.

Table 1: Equivalent Rating per Criteria of the Waste Audit Tool

CATEGORIES OR PARAMETERS	Weighted Rating
Waste Minimization Practices	20%
Waste Segregation	25%
Waste On-Site Collection, Transport, and Storage	20%
Waste Treatment On-Site	10%
Wastewater Management	15%
Administrative	10%
Total	100%

Table 2 below shows the audit rating and its interpretation based on the score or final rating that they will garner from the Waste Audit Tool. For example, if the HF will get an overall rating between 85% - 100%, then a Certificate of Very Satisfactory Compliance Recognition shall be issued by the DOH after the audit for having the best practice or good observations and or conformance to the HCWM Manual 4 th Edition. However, if the HF will get an overall rating of 75% and below, a Certificate of Participation in the recently concluded audit shall be given. The other ranges of scores or ratings are shown below with its respective rating interpretation.

Table 2: Waste Audit Rating and its Interpretation

Audit Rating	Interpretation
85%-100%	Very Satisfactory
76%-84%	Satisfactory
75% and below	Poor Compliance

F. Audit Conduct

As discussed in the design framework, the full support of the top management is important in order for the HCWM Program to become successful. Through this process, the responsibilities of top management were defined. They need to establish a management control system for the HCWM Program. This management control system can be implemented by initially establishing the organizational structure of the HCWM Committee with an approved designation or appointment. The indicators of having this committee is through the Hospital Order or Hospital Memorandum, therefore the auditors must be furnished with a copy. For them to determine if this committee is working or functional, they need to check whether there is a point person or sub-committee who is in charge of monitoring and inspection of the facility to determine the compliance with the standards of HCWM Plan. They need to be furnished with a copy of either agenda or minutes of the meeting to determine if they are regularly conducting.

They need to show proof or documents showing a system of taking corrective action when the requirements are not met. Moreover, request for a proof of implementation of monitoring and evaluation of the HCWM Plan. The auditors should also check when was the last time this plan or manual was revised or updated. It is also imperative that the HCWM policies and procedures must be consolidated into HCWM Manual. So, in conducting hospital waste audits, the review of the document is a must. This can be done preferably prior to the conduct of walk through inspection. They need to check if written policies and procedures are effectively implemented. Examples of these policies are whether their waste handlers and collectors have immunization against tetanus or hepatitis and if they are provided with appropriate PPE as well as the required training.

In conducting walk through inspection, the auditors must check the availability of waste collection bins, waste liners, and transport trolleys. Auditors need to check the records on files, if HF has records on how many kilos of hazardous and general wastes the HF generates daily. They must also check if they are submitting the Quarterly Self- Monitoring Report to EMB-DENR as well as written reports of waste collection to the Head of the HF. Further, they should ask for the copy of the reports that were submitted to EMB-DENR. Please see attached Annex 1- Flow of Activities During Actual HCWM Audit and Annex "2" – Flow of Activities During Online HCWM Audit, for reference. The attached Annex "A" HCWM Audit Tool is used in conducting an audit.

Waste Minimization Practices

An important criteria in conducting waste audit is waste minimization practices. The auditors must see to it that the HF implements the 3Rs (Reduce, Reuse and Recycle) concept. An example would be reusing and recycling of used containers, papers, etc. If the HF sells the recyclable materials collected in their wards, there is an increase in hospital income. They need to check what happened to the proceeds of sales of the recyclables, and validate this from the logbook or storage area for recyclables. AConfirm with the staff if the HF uses the income from its sales for the implementation of its program or they share part of it to the waste collectors.

In addition, the auditor must check if the HF uses environment-friendly products and materials. Verify if they have a green procurement policy and audit if they are still using mercury containing devices and products. They should verify whether chemical disinfection is permitted, and if so, which chemicals are being used. Additionally, they need to confirm if suppliers are required to provide the Material Safety Data Sheet (MSDS). The use of styrofoam and single-use plastics in the healthcare facility (HF) should also be addressed. These practices should be verified, especially if styrofoam and single-use plastics are not observed in the wards, and if no mercury-containing devices or products are being used in the wards. Furthermore, they should request a copy of the green procurement policy.

Waste Segregation

As to waste segregation, the auditors must look into if the waste is properly segregated in correct waste bins and consistent with color-coded plastic liners. The HF must comply with the updated HCWM Manual such as:

• Brown plastic liners or containers chemical and pharmaceutical wastes
• Orange plastic liners or containers radioactive wastes
• Yellow plastic liners or containers infectious wastes
• Green plastic liners or containers biodegradable wastes
• Black plastic liners or containers general wastes

They must check if the amount allotted for treatment of the hazardous waste is reduced. To validate during the conduct of waste audit, in facility walk through there should be no observed mixed waste inside the waste bins. Check the Project Procurement Management Plan (PPMP) and the Annual Procurement Plan (APP) of the facility if the allotted budget for HCWM is included. Ask the staff how much is the budget for HCWM to determine if it is sufficient. Check for proofs or documents if they have a long term financing plan or mechanism to cover the cost for sustainable HCWM. The color-coded plastic liners inside waste bins should be consistent with proper tagging and labeling. Check also if the HF uses alternatives or has innovations in case plastic liners are not available. During the walk through inspection, they need to check the following: proper tagging and labelling, records of waste collected, and if there are innovations being used.

The HF must use puncture-resistant, leak-proof, and good quality containers for sharps. Verify whether the HF is using reusable or disposable sharp containers. During the ocular visit, check for the presence of sharp containers and ask the staff if there have been any incidents of needle stick injuries due to sharp container spillage. If such incidents have occurred, inquire if staff are aware of the proper procedures to follow in case of spillage, and whether these procedures are documented in the HCWM Manual. Check if a spillage kit is available for use in such events. Assess whether waste bins are strategically placed in designated areas, especially in high-traffic or conspicuous locations like nurse stations. Request a copy of the HCWM plan to verify if a location map of waste bins is included, or validate this through a walkthrough inspection. Confirm whether recyclable items, such as plastic and glass bottles, and cartons, are being properly segregated. Inquire about the sale price per kilo of recyclable waste and determine whether the sale of recyclables supports the implementation of the HCWM plan. Check the record of the weight of waste being collected per collection. Check if there is a constant increase or decrease in the volume of waste generated relative to the HF's bed capacity as well as to the number of patients admitted at the said period of time. Additionally, check whether hazardous chemical, pharmaceutical, and radioactive waste are segregated from the infectious and general waste. Check also the HCWM Plan for recyclable wastes.

The empty vials must be brought to the pharmacy section by the nursing attendant or personnel-in-charge for proper recording and crushing. Check if there is a logbook available at Pharmacy Department for the returned empty vials and how are these vials being crushed, whether in house or out-sourced. Check also if there is a policy in the disposal of empty vials.

Waste On-Site Collection, Transport and Storage

The on-site collection schedule must be strictly followed. The auditors should check if there is no overflowing of wastes in the waste bins. Additionally, verify how often waste is collected each day and ensure that it is collected when the bins are 3/4 full. Check if spare waste liners are available on site and review the collection schedule. There should be no visible overflow of waste from the bins. During the ocular visit, observe whether the waste collected is indeed 3/4 full.

The janitorial service must use standard trolleys with cover in collecting wastes and ensure that no waste spillage occurs during collection. Waste must be collected in sequence, from aseptic to septic areas. Verify the quality and condition of the trolley being used. Confirm that no spillage is observed throughout the collection process. Check whether collectors are equipped with appropriate PPEs during collection, and review the policy on waste collection.

● Does the Janitorial service directly transport waste collected to the Central Storage Area?

• Are they using elevators or ramps in transporting wastes?
• To validate, directly ask the collectors where they pass in transporting the wastes. Ask for the route plan and check if it is being followed.

There must be no spillage during the collection and transport of wastes, and a spillage kit should be readily available in case of an incident. If spillage occurs, verify whether it is reported and whether a standard form is used for documenting accidents or incidents. Review the facility's occupational risk plans or observe practices directly on-site. Additionally, examine any available accident or incident reports.

The designated waste transportation route must be strictly followed. To verify, observe the process during the visit. The route plan should be included in the manual. Review the facility's waste transport policy and request a copy of the route plan. During the walkthrough inspection, confirm whether hospital wastes are disposed of in a DENR-approved facility. Check if waste disposal is conducted on-site or off-site, and review the licenses and agreements with the service provider. If on-site disposal exists, inspect the facility accordingly.

Waste Treatment On-Site

The laboratory cultures and stocks of infectious agents must be treated within the healthcare facility before being taken away from the facility to prevent cross contamination.

• How was it being treated? What treatment technology are they using on-site if any?
• Check if there is on-site and off-site treatment; If off-site treatment, request for a copy of the contract with the service provider.
• Check the treatment technology used by the service provider.

Also, if there is a contingency plan for the treatment of infectious waste in the event that the equipment is shut down for the repair. Finally, check also for the copies of manifests or shipments records.

A HF which uses chemical disinfection should only be allowed to use chemicals such as sodium hypochlorite solution at 0.5% for disinfecting surfaces and 0.05% for hand washing. Discuss and clarify this matter with the personnel concerned. If it is not applicable, exclude it from the audit. In case the HF is using the microwave or autoclave, it must have a valid Certificate of Product Registration (CPR) from the DOH-Bureau of Health Devices and Technology (BHDT). In addition, they must subject the sample of treated wastes for testing. To validate this, check the result of the validation test; or if offsite do not include this.

Wastewater Management

In compliance with the Clean Water Act, the HF must have a WWTP or STP. There must be a regular testing of effluents conducted. The auditors must check if the effluents are being tested and how frequent is the testing conducted. They also need to check what they do in case the testing of effluents fails. Check also for the regular effluent testing result annually or semi-annually or as deemed necessary; in case of a surge such as Covid-19 pandemic. The preventive maintenance schedule for STP must be followed. Check how frequent the preventive maintenance is conducted. If applicable, check also the maintenance schedule and inspect the STP or the WWTP.

Administrative Requirements

Staff should have formal training and education on proper HCWM with the following considerations:

• Is there training on-site being conducted?
• How often the training was conducted, if any?
• Is there an established HCWM Committee? Have all the members of the committee attended training on HCWM? Are the old and new staff undergoing HCWM Training?
• Is there refresher training conducted at least once a year?

Check if the healthcare workers are familiar with the classification and segregation requirements. Also, check for proof of training programs such as certificates or Hospital Orders (HO). Infection control protocol must be observed and practiced. Moreover, below are for consideration:

• Are collectors aware of what to do in case of spillage?
• Are all collectors given hepatitis and tetanus vaccination prior to their assignment?
• Is the Infection Prevention and Control included in the training program on HCWM?
• Are waste handlers provided with appropriate PPEs? Check if there is a policy on used syringe needles that are being collected without recapping. Observe if sharp wastes are collected in a container and destroyed using needle destroyers.

Interview the health workers on what they do in the event of needle-stick injuries or in case of a waste spillage. Observe if the waste handlers are wearing PPEs. Additionally, interview the health workers if they were given hepatitis and tetanus vaccination.

Posters and other IEC materials must be available on-site and posted in conspicuous places. Are they written or translated in Tagalog or Filipino? Verify the placement of posters and IEC materials, ensuring they are displayed in conspicuous areas.

The accident or incident reports must be prepared and submitted, to wit:

• Is there a standard format for reporting purposes? Who is being provided with the reports if any?
• Check for incident reports like needle prick injuries, violation of infection control practices.
• Submit a report even if no accidents have occurred; simply indicate 'no accident reported'. Ask for the copy of the reports.

G. Evaluating and Reporting Audit Findings

In evaluating the findings, the auditors should gauge whether there were opportunities for improvements, conformities or non-conformities to the standards of the HCWM Manual. They should look into the overall impacts and effects of the findings in the operations of the HFs. In reporting audit findings, the auditors must indicate the date when the audit was conducted, the name and location of the HF, the objective,

criteria and scope of the audit. They should also include the specific area audited, the auditor/s and auditee/s. First, they need to list down the good observations or conformities. It will be followed by the summary of non-conformities or findings including its corresponding code number. Then, the list of the opportunities for improvement to guide the HF on what other aspects of waste handling they need to look into. In addition, they need to include their recommendations or suggestions to further improve the waste management of the HF. Lastly, they need to indicate the name and designation of the persons who prepared, verified, and approved the audit report.

In reporting the audit findings, the auditor may use the attached Annex "B" – HCWM Audit Report form and Annex "C"- Audit Report Summary form.

Annex "1"

Flow of Activities During Actual HCWM Audit

Table 5 below shows the flow of activities during site assessment of HFs. Initially, there will be a courtesy call to the Medical Center Chief or Chief of the Hospital to be assessed. Immediately, the main objective or purpose of the visit will be discussed including other details. Then, the interview will be conducted as well as the verification of documents or proof of evidence. It will be followed by the actual site visit assessment, then preparation of the initial findings and the conduct of the closing or exit conference.

Table 3: Flow of Activities During HCWM Audit of HFs Duration: 9:00 AM onwards

TIME	ACTIVITIES
Depending on the location of HF	Travel time
9:00 am to 12:00 noon	Courtesy Call to the Head of the HF and Opening Conference
	Presentation of the Objective of the Waste Audit Assessment – c/o Team Leader
	Presentation of the flow of activities during the actual visit
	Brief presentation on the waste management practice of HF
	Actual Waste Audit
	Assessment/interview with the HF
	representatives and verification of
	documents and or proof of evidence
12:00 noon to 1:00 pm	Lunch Break c/o HF
1pm onward	Actual Site Assessment together with
	the HF representatives
	Drafting of the initial report of findings
	Closing or exit conference -
	presentation of the initial findings to the
	Head of the HF based on the site visit
	conducted
	Closing

Flow of Activities During Actual HCWM Audit

A. During Courtesy Call

The Team Leader will introduce the team members to the Top Management or MANCOM or EXECOM representatives of the HF and then allow the Medical Center Chief or the Chief of Hospital to introduce the participants from their hospital. Then, a brief presentation of the project will be conducted. He or she will allow the HF or hospital's representative to have a short presentation of their waste management practice. Finally, he or she will present the assessment plan as well as the flow of activities during the actual waste audit.

B. During the Actual Waste Audit

The Team Leader will assign members who will assess the compliance of the HF on the parameters or standards of the HCWM Manual. The assigned member of the team will also check or request the evidence or proof of compliance to the designated personnel to be assessed. The DOH-Health Facility Development Bureau (HFDB) may request observers and representatives from the other government agencies, non-government organizations (NGOs) or funding donors like World Health Organization (WHO), United States Agency for International Development (USAID), Philippine Society of Sanitary Engineers (PSSE), Health Care Without Harm (HCWH), Philippine Hospital Association (PHA), etc. who will join the members of the team during the actual HCWM audit for transparency purposes.

C. Drafting of Initial Report

The Team Leader including the assigned members will be given ample time to draft his or her initial report after the HCWM audit or assessment of the assigned areas in the facility. The report should include the team's findings and recommendations for further improvement on its compliance to HCWM Manual.

D. During the Closing or exit conference

The Team Leader will allow each member to present his or her initial findings to the management of the HF. He or she will summarize the report and make the final conclusions and recommendations.

E. Preparation and Presentation of the Final Report:

The Team Leader will be in-charge in the preparation and submission of the final report of the group findings and analysis of the visited facility. He or she will submit the prepared findings and analysis to the TWG or Committee under the HFDB.

Annex "2"

Flow of Activities During Online HCWM Audit

Table 4 below shows the flow of activities during the online waste audit assessment of HFs. Initially, there will be a courtesy call to the Medical Center Chief or Chief of the Hospital to be assessed. The main objective of the waste audit will be discussed including other details. The assessment team will be divided based on the number of HFs to be assessed simultaneously and will proceed to their respective assigned breakout rooms together with the representatives of the HFs. An assessment or interview will be conducted as well as the verification of documents or proof of evidence, based on the Waste Audit tool. It will be followed by the preparation for the closing or exit conference.

Table 4: Flow of Activities During Online HCWM Audit of HFs Duration: 8:30 AM – 12:00 NN

TIME	ACTIVITIES
30	Courtesy Call and Open Conference to the Head of
minutes	the HF
	Presentation of the Objective of the Online Waste
	Audit Assessment
	– c/o Team Leader
	Presentation of the basis to be used during the
	Online Waste Audit Assessment
2 hours	Waste Audit Assessment or interview together
	with the HF representatives
30	Drafting of the initial report of findings
minutes
30	Closing or exit conference - presentation of the
minutes	initial findings to the Head of the HF based on the
	waste audit assessment or interview conducted

XII. Templates/Forms

Reference	Title	Form Code
Annex "A"	HCWM Audit Tool	FM 001
Annex "B"	HCWM Audit Report Form	FM 002
Annex "C"	HCWM Audit Report Summary Form	FM 003
Annex "D"	HF Assessment Plan	FM 004
Annex "E"	Online HF Assessment Plan	FM 005
Annex "F"	Corrective Action Report Form	FM 006

Annex A: HCWM Audit Tool

Healthcare Waste Management Audit Tool

Date of
Audit:
Name of Health	Facility:
Location of	Health Facility:
Head of the	Health Facility:
	CRITERIA	SCORE		INDICATORS	QUALITY AUDIT QUESTIONS	VALIDATION
		Ref.	Actual
A. Code No. Minimization	/ Waste Practices	20%
1 WM 001	Reduces, re-uses and recycles used containers, papers, and etc.	10		% of recyclable wastes that were recycled multiplied to 0.10	a. Does the HF reduces, re-uses and recycles the used containers, papers, etc.? b. Does the HF sell the recyclable materials collected in their wards? If yes, is there an increase in the amount from its sales? c. What happened to the proceeds of sales of the recyclables?	Check the logbook or storage area for recyclables. Check whether it is reported during coordination meetings with the management with corrective and preventive action.

	2 WM 002	Use of environment friendly products and materials	10	No styrofoam (polystyrene) and plastic (PVC) = 5 otherwise, the score is 0; and No mercury containing devices used = 5, otherwise, the score is 0	a. Does the HF use environment-friendly products and materials? b. Does the HF have a green procurement policy? c. Does the HF still use mercury containing devices and products? d. Does the HF use chemical disinfection? If yes, what are the chemicals being used? e. Does the HF allow the use of styrofoam and single use of plastics? f. Is the Green Procurement Policy included in the HCWM Plan?	No observed styrofoam and single use plastics in wards; No observed mercury containing devices and products used in wards; Request for a copy of green procurement policy.
B.	Waste 1 WS 001	Segregation Waste properly segregated in correct plastic liners such as: • Black/Clear: Non-Biodegradable General Waste	25% 5	No mixed wastes seen at all times = 5, otherwise, the score is 0	a. Are wastes properly segregated in correct waste bins with color-coded plastic liners? b. Does the HF comply with the updated HCWM Manual such as color	Conduct of waste audit, walk through in the facility; No observed mixed waste inside waste bins. Check the PPMP/APP of the facility allotted budget for HCWM. Ask the staff how much is the budget for HCWM to

		• Green: Biodegradable General Waste • Yellow: Infectious Waste			brown plastic liners for the chemical and pharmaceutical wastes, and orange plastic liners/containers for the radioactive wastes? c. Is there a decrease in the amount allotted for treatment of the hazardous waste?	determine if it is sufficient. Check for proofs/documents if they have a long term financing plan or mechanism to cover the cost for sustainable HCWM.
2	WS 002	Color-coded plastic liners with proper tagging and labeling	4	Color coding and proper tagging and labeling strictly followed at all times = 4, otherwise, the score is 0	a. Are color-coded plastic liners inside waste bins consistent with proper tagging and labeling? b. Does the HF use alternatives or has innovations in case plastic liners are not available? c. Is the placement of tagging appropriate and compliant with the standards?	Check the proper tagging and labelling; Check also records of waste collected. Check if there are innovations being used.
3	WS 003	Use puncture - resistant and leak - proof sharps	4	Only puncture-resis tant and leak-proof	a. Does HF use puncture-resistant and leak-proof containers for sharps?	Check for sharp container. Ask staff if there are incidents of needle pricks injuries due to sharp container spillage.

		container for sharps		sharps container used for sharps waste = 4, otherwise, the score is 0	b. Are the sharp containers of good quality, are they reusable or disposable? c. Are there used/recycled sharp containers being used in the facility?
4	WS 004	Waste bins strategically placed in designated area	4	Waste bins are placed in strategically designated areas = 4, otherwise, the score is 0	a. Are waste bins strategically placed in designated areas? b. Are there available waste bins in areas with crowded and conspicuous places, nurse stations, etc.? c. Are waste bins placed at least 5 mtrs. from the source of generations?	Ask for the copy of HCWM plan if there is a location plan of the waste bins, or conduct walk through inspection
5	WS 005	Proper segregation of recyclable items	4	Proper segregation practices at all times = 4, otherwise, the score is 0	a. Are the recyclable items, properly segregated such as plastic and glass bottles, cartons, etc.? b. How much is the price per kilo of recyclable waste? c. Does it help in the	Have a record of the weight of waste being collected per collection. Check if there is a constant increase/decrease in the volume of waste generated relative to the HF's bed capacity. Check whether hazardous chemical, pharmaceutical, and

	6	WS 006	Empty vials brought to the pharmacy section by the nursing attendant/personn el-in-charge for proper recording and crushing (logbook available)	4	Proper management of empty vials practiced at all times = 4, otherwise, the score is 0	implementation of the HCWM plan? a. Are empty vials brought to the pharmacy section by the nursing attendant or personnel-in-charge for proper recording and crushing? b. Is there a logbook available at the Pharmacy Department for the returned empty vials? c. How are these vials being crushed, in house or out-sourced?	radioactive waste are segregated from the infectious and general waste. Check also the HCWM Plan for recyclable wastes. Check the logbook at the Pharmacy Department. Check also if there is a policy in the disposal of empty vials. Check if the crushing is conducted in-house. *If outsourced, look for MOA.
C.		Waste Transport,	On-Site Collection, and Storage	20%
	1	WCTS 001	On-site collection scheduled strictly followed	2	Strict adherence to on-site collection schedule = 2, otherwise, the score is 0	a. Is the on-site collection scheduled strictly followed? b. Is there no overflowing of wastes in the waste bins? c. How often is the	Check the collection schedule. No observed overflowing of waste in the waste bins. Observe if the waste collected is 3/4 full.

					collection of wastes per day? d. Are the wastes collected when 3/4 full? e. Are there spare waste liners on site?
2	WCTS 002	Janitorial service uses standard trolley with cover in collecting waste	3	Standard trolley is used to collect waste on-site = 3, otherwise, the score is 0	a. Does the janitorial service use standard trolleys with cover in collecting wastes? b. Is there no observed spillage of wastes during the collection? c. Is there a different trolley for each type of waste? d. Is waste collected from the septic to aseptic areas?	Check the quality of the trolley being used. No observed spillage of wastes during the collection. Check if the collectors are wearing appropriate PPEs during the collection. Check the policy in collecting waste.
3	WCTS 003	Janitorial service directly transports waste collected to Central Storage Area	3	Waste are directly transported to Central Storage Area = 3, otherwise, the score is 0	a. Does the Janitorial service directly transport waste collected to the Central Storage Area? b. Are they using elevators or ramps in transporting wastes?	Directly ask the collectors where they pass in transporting the wastes; Ask for the route plan and check if it is being followed. Observe if the collected waste from wards are at least 3/4 full. Observe also if the janitorial

						service is wearing appropriate PPE.
4	WCTS 004	No observed spillage during collection and transport	3	No observed spillage during collection and transport = 3, otherwise, the score is 0	a. Is there no observed spillage during collection and transport? b. Is there an available spillage kit in case of spillage? c. In case of spillage, is it being reported? d. Is there a standard form for reporting of accidents or incidents?	Check on occupational risk plans; or observe directly at the facility. Check the accidents/incidents reports if any.
5	WCTS 005	Waste bins thoroughly cleaned, washed, and disinfected by janitors	3	Waste bins thoroughly cleaned and disinfected at all times = 3, otherwise, the score is 0	a. Are waste bins used in collection of good quality, thoroughly cleaned, washed, and disinfected by janitors? b. How often or when the waste bins are being cleaned or washed? c. How often do they disinfect the waste bins, do they have policies on this?	Observe if waste bins are of good quality and clean. Check the policy if any.

6 WCTS 006	Waste transportation route being followed	3	Waste transportation route strictly followed at all times = 3, otherwise, the score is 0	a. Is the waste transportation route being followed?	Observe during the visit; the route plan must be included in the manual. Check the policy in transporting waste.
7 WCTS 007	Final disposal of waste in approved DENR facility	3	Final disposal of waste in accredited DENR facility = 3, otherwise, the score is 0	a. Are the hospital wastes disposed of in an approved DENR Facility? b. Is there a waste disposal on-site or off-site?	Check license/s and agreement with Service Provider. Inspect the disposal on-site if any.
D. Waste Applicable)	Treatment On-Site (As	10%
1 WT	001 Treatment of highly infectious waste conducted	4	Highly infectious waste treated at all times = 4, otherwise, the score is 0	a. Are the laboratory cultures and stocks of infectious agents treated within the healthcare facility before being taken away from the facility? b. How was it being treated? c. What treatment technology are they using on-site if any? d. Is there a	Check if there is on-site and off-site treatment; If off-site treatment, request for a copy of the contract with the service provider. Check the treatment technology used by the service provider. Also, if there is a contingency plan for the treatment of infectious waste in the event that the equipment is shut down for the repair. Check also for the copies of

				contingency plan in case the equipment is shut down for repair?	manifests/shipments records. If on-site, check also for the treatment technology /strategy used.
2 WT 002	In case of chemical disinfection, used only allowed chemicals such as Sodium Hypochlorite, Chlorine Dioxide and Hydrogen Peroxide	3	Only the allowed chemicals are used for chemical disinfection = 3, otherwise, the score is 0	a. Does HF in case of chemical disinfection, use only allowed chemicals such as Sodium Hypochlorite, Chlorine Dioxide and Hydrogen Peroxide?	Investigate or clarify with personnel regarding this. If not applicable do not include this section. Check for the percent solution being used.
3 WT 003	In case of the use of any approved equipment, the treated waste must passed the validation test	3	Treated waste have passed the validation test = 3, otherwise, the score is 0	a. Does the HF in case of using the microwave or autoclave, have a valid CPR from the DOH-BHDT? b. Is there a DENR permit for the on-site treatment? c. Do they subject the sample of treated wastes for testing?	Check the result of the validation test; or if offsite do not include this. Check for the use of bio-indicator if the treatment is complete.

E. Wastewater	Management	15%
1 WW 001	Regular testing of effluents	5	Effluents tested regularly = 5, otherwise, the score is 0	a. Is there a regular testing of effluents conducted? b. How frequent is the testing of effluents conducted? c. What do they do in case the testing of effluents fails? d. Is there an accredited PCO? In relation to compliance to RA 9275 and DAO 2016-08: e. Is the effluent subject to LLDA or DENR third party accredited testing laboratory?	Check for the regular testing result annually or semi-annually or as deemed necessary; in case of surge such as covid-19 pandemic.
2 WW 002	Preventive maintenance schedule for Sewage Treatment Plant (STP) followed	10	Strict adherence to STP maintenance schedule = 10, otherwise, the score is 0	a. Is the preventive maintenance schedule for Sewage Treatment Plant (STP) being followed? b. How frequent is the preventive maintenance conducted? c. Is there a mandatory	If applicable, check maintenance schedule; Inspect the WWTP/STP

						operator for the STP, in
						24-hours operation?
F.	1	Administrative AR 001	Requirements Staff with formal training and education on proper Healthcare Waste Management (HCWM)	10% 2	Staff had undergone formal training and education on proper HCWM = 2, otherwise, the score is 0	a. Do staff have formal training and education on proper health care waste management (HCWM)? b. Is there training on-site being conducted? How often, if any? c. Does the health facility have an established Healthcare Waste Management Committee? d. Have all the members of the committee attended training on HCWM? e. Are the old and new staff undergoing HCWM Training? f. Is there refresher training conducted at	Check if the healthcare workers are familiar with the classification and segregation requirements. Also, check for proof of training program (certificate/HO).

2	AR 002	Infection control protocol observed and practiced	4	Strict adherence to infection control protocols at all-time = 4, otherwise, the score is 0	a. Is the infection control protocol being observed and practiced? b. Are collectors aware of what to do in case of spillage? c. Are all collectors given hepatitis and tetanus vaccination prior to their assignment? d. Is the Infection Prevention and Control included in the training	Check if there is a policy on used syringe needles that are being collected without recapping. Observe if sharp wastes are collected in a container and destroyed using needle destroyers. Interview the health workers on what they do in the event of needle-stick injuries or in case of a waste spillage. Additionally, interview the health workers if they were given hepatitis and tetanus vaccination. Check also for
3	AR 003	Posters and other IEC materials	2	On-site presence and	program on HCWM? e. Are standing policies on IPC and HCWM complementing, co-existing, co-inclusive? a. Are posters and other IEC materials available	the frequency of vaccination. Check where these Posters and IEC Materials are located;
		available on-site		visibility of posters and other IEC materials = 2, otherwise, the score is 0	on-site and posted in conspicuous places? b. Are they written or translated in Tagalog or Filipino?	If it is located in a conspicuous place.

4	AR 004	Accident/incident reports submitted	2		Prompt submission of complete accident/ incident reports, if any = 2, otherwise, the score is 0	a. Are accident/incident reports submitted, if any? Is there a standard format for reporting purposes? c. Who is being provided with the	b.	Check for incident reports (like needle prick injuries, violation of infection control practices); Check if they submit a report even if there is no accident.
		Total Percentage	100%	0		reports if any?

Audit Rating:

Signature Over Printed Name of Audit Team Leader

Note: Color Red for Non-Compliance; Green for Compliance and Yellow for Opportunities for Improvement

Signature Over Printed Name of HF Representative Date:

Monitoring Rating:

Grade/Actual Score/Interpretation:

85%-100% Very Satisfactory Compliance 76%- 84% Satisfactory with adequate compliance 75% and below Poor Compliance

Annex B: HCWM Audit Report Form

HCWM AUDIT REPORT

Date of Audit:
Name of Health	Facility:
Location of Health	Facility:
Head of the Health	Facility:
Audit Objective:	To conforms	determine whether to the Management Manual regulatory requirements continually met and improvement where	the organization standards of the DOH th Ed. 4 and other and ensure identification of applicable.	management Healthcare applicable that specified areas for potential	system Waste statutory and objectives are
Audit Criteria:	Manual	The organization's and HCWM	management Audit Tool	compliance	to DOH HCWM
Audit Scope:	Waste and	Provisions on Segregation, Disposal, and	Administrative Requirements, Collection and Wastewater Management.	Waste Transport, Waste	Minimization, Treatment
Area Audited			Auditor/s		Auditee/s
Summary of Good		Observations/	Conformities
1.
2.
3.
4.
5.
Summary of	Non-conformities:
Non-conformities			Proof of Evidence	Code No.

Noted By:	Acknowledged by:
Signature of Team Member over Printed Name	Signature of Team Leader Over Printed Name
Prepared by:	Checked and Reviewed by:
5.
4.
3.
2.
1.
Recommendation/s
5.
4.
3.
2.
1.
Opportunities for Improvement

Printed Printed Name Printed Name

Annex C: HCWM Audit Report Summary Form

SUMMARY OF HEALTHCARE WASTE MANAGEMENT AUDIT REPORT

Date of Audit:
--------------------------

Audit Team Secretariat		Audit Noted	Team Member by:	Audit Team Leader
Prepared By:		Verified By:		Approved By:
TOTAL
AREAS			NUMBER	IMPROVEMENT
AUDIT	CONFORMITIES	NON-CONFORMITIES	CODE	OPPORTUNITIES FOR	RECOMMENDATIONS

DOH Representative WHO Representative

Annex D: Health Facility Assessment Plan Form

HEALTH FACILITY ASSESSMENT PLAN FORM

Health Facility
Address
Assessment	The organization's management compliance to Healthcare Waste
Criteria	th Edition Management Manual 4 and HCW Audit Tool
Assessment	Provisions on Administrative Requirements, Waste Minimization,
Scope	Waste Segregation, Collection and Transport, Waste Treatment and
	Disposal, and Wastewater	Management.
Assessment	To determine whether the organization management system
Objective	conforms to the standards of the Healthcare Waste Management
	Manual and other	applicable statutory and regulatory	requirements
	and ensure that specified	objectives are continually	met and
	identification of areas	for potential improvement	where applicable.
Assessment
Details
Reference	Healthcare Waste	th Edition Management Manual 4	and HCW Audit
Standards	Tool
Assessment	Team Leader
Team 4
	Assessment Team
	Member
	Team Facility Guide
	DOH
	Representative
	WHO
	Representative
	HOCS
	Representative
Date/Time	Standards to be	Area/Division/Section/	Personnel to be
	Assessed	Unit	Assessed
/	Opening	Office of the Head of	Top Management
30 mins	Conference/Courte	Health Facility/Hospital	EXECOM/
	sy Call		MANCOM
/	Administrative	Any Available Conference	Top Management
30 mins	Requirements	Room	EXECOM/
	Top Management		MANCOM
	Responsibility
/	Document Review	Any Available Conference	Designated
2 hours		Room	WMO/Chairperson
			HCWM Committee
1 hour	Lunch Break

/ 30 mins	Waste Minimization	Selected Ward/s	Designated WMO/Chairperson HCWM Committee
/ 30 mins	Waste Segregation, Collection and Transport	Selected Ward/s, Waste Storage Area/MRF	Designated WMO/Chairperson HCWM Committee
/ 30 mins	Waste Treatment and Disposal	Waste Storage Area/MRF	Head of GSD
/ 30 mins	Wastewater Management	Waste Water Treatment Plant/STP	Head of EFMD/PCO
/ 30 mins	Discussion of Findings, Observation for Improvements and Recommendations	Any Available Conference Room	Waste Audit Team
/ 30 mins	Closing Conference Presentation of Findings, Observation for Improvements and Recommendations	Office of the Head of Health Facility/Hospital or any available conference room	EXECOM/MANCO M Designated WMO/Chairperson HCWM Committee
Total Hours: 7 Hrs.

Prepared By:	Reviewed By:
Signature of Team Member over Printed Name	Signature of Team Leader Over Printed Name

Annex E: Online Health Facility Assessment Plan

ONLINE HEALTH FACILITY ASSESSMENT PLAN

Health	Selected HFs or	Hospitals
Facility Address
Assessment
Criteria	The organization's management compliance to Healthcare Waste th Edition Management Manual 4 and HCW Audit Tool
Assessment	Provisions on	Administrative Requirements, Waste	Minimization,
Scope	Waste Segregation,	Collection and Transport,	Treatment and
	Waste Disposal, and Wastewater Management.
Assessment	To determine whether the organization management system
Objective	conforms to the standards of the Healthcare Waste Management
	Manual and other	applicable statutory and regulatory	requirements
	and ensure that	specified objectives are continually	met and
	identification of areas	for potential improvement	where applicable.
Assessment	(8:00am	– 5pm), For the Document	Review the HFs are
Details	required to email in	advance
Reference	Healthcare Waste	th Edition Management Manual 4	and HCW Audit
Standards	Tool
Designated	Team Leader	Team Members	Remarks
Teams
Assessment
Team A
Assessment
Team B
Assessment
Team C
Assessment
Team D
Date/Time	Standards to be	Area/Division/Section/	Personnel to be
	Assessed	Unit	Assessed
		Combined Teams
	Opening	Office of the Head of	Top Management
/	Conference /	Health Facility/Hospital	EXECOM /
30 mins	Courtesy Call		MANCOM
Breakout Rooms
	Administrative	Any Available Conference	Top Management
/	Requirements	Room	EXECOM /
30 mins	Top Management		MANCOM
	Responsibility
	Waste	Selected Ward/s	Designated
/	Minimization		WMO/Chairperson
2 hours			HCWM Committee

			or staff
			concerned
	Waste	Selected Ward/s, Waste	Designated
	Segregation,	Storage Area/MRF	WMO/Chairperson
	Collection and		HCWM Committee
	Transport		or staff
			concerned
	Waste Treatment	Waste Storage Area/MRF	Head of GSD or
	and Disposal		staff concerned
	Wastewater	Waste Water Treatment	Head of
	Management	Plant/STP	EFMD/PCO
	Discussion of	Any Available Conference	Waste Audit Team
/	Findings,	Room
30 mins	Observation for
	Improvements and
	Recommendations
	Closing	Office of the Head of	EXECOM /
/	Conference	Health Facility/Hospital	MANCOM
30 mins	Presentation of	or any available	Designated
	Findings,	conference room	WMO/Chairperson
	Observation for		HCWM Committee
	Improvements and		or staff
	Recommendations		concerned
Total Hours:	For AM and PM
4 Hrs.	Audit

Prepared By:	Reviewed By:
Signature of Team Member over Printed Name	Signature of Team Leader Over Printed Name

Annex F: Corrective Action Report Form

CORRECTIVE ACTION REPORT

A. Name of Health Facility:	B. Location:		C. Reference No.
D. Name of Auditee/s		E. Office Concern	F. Issuance Date:
G. Auditor:		H. Relevant Code Number:
Signature Over Printed Name/Date
I. Description of Non-conformity/Problem in Detail:			J. Source: (check one) Internal Audit Customer Feedback Internal Discovery External Audit Others (please specify)
K. Validator: (Lead Auditor) Signature Over Printed Name	Valid Not Valid
L. Correction (Immediate Action):
M. Consequence/s:
N. Investigation (Root Cause of non-conformity): Brief description only. Use page 2 for details.			O. Recurring Issue: Yes No
P. Corrective Action (Brief description only):Use Action Plan template form for details.		Accountable Person	Expected date of implementation / completion
Auditee:
Immediate Supervisor: Signature Over Printed Name/Date Signature Over Printed Name/ Date
Q. Follow upactions: (To be filled up by Auditor)		R. Validation: (To be filled up by Validator)
Determine if similar NC exist or could potentially occur ● ● Review the effectiveness of any corrective action taken		Recommended for Closure
st FF 1 UP:(To be filled up by Auditor) Verification of Action Plan/Correction ( Calendar days) Remarks:		Not effective (Recurrence/ potential recurrence)
nd FF UP:(To Be filled Up by Auditor) 2 st follow-up) Verification of Effectiveness ( Calendar Days After 1 Remarks:		Update risks and opportunities Make changes in thequality management system Issue another CAR Remarks:

S. CLOSE-OUT Date:
Lead Auditor
(Using the Fishbone Diagram)
(Using 5 Why Technique)
Problem Description:
WHY?
WHY?
WHY?
WHY?
WHY