West Bengal Pollution Control Board

* indicates mandatory Field

Biomedical Waste Authorisation

APPLICATION FORM

Type of unit for which BMW Authorization is desired:*
BMW Authorization application to be submitted at :*			Help-Line on R.O.
(Please Check HelpLine before selecting)
Please Select Your Type Of Oraganization :*

GENERAL INFORMATION

Date Of Application:*	(DD/MM/YYYY)	Place Of Application:*
Name of Applicant:*		Designation of Applicant:
Applicant Address
Street/Road Name:*		Post Office:*
District:*		Pin Code:*
Police Station:*		Local Body:*
Mobile No.:*		Email ID:*

UNIT DETAILS

Unit Name:*		Local Authority:*
Address Of Unit
Street/Road Name:*		Post Office:*
District:*		Pin Code:*
Police Station:*		Local Body:*
Telephone No.:*		Email ID:*
Fax No.:*		Website Address:

APPLYING FOR*

Fresh BWA Application

CTO/CTE No.(if available):

Status of Consents:
a)under the Water (Prevention and Control of pollution) Act, 1974:
b)under the Air (Prevention and Control of pollution) Act, 1981:

APPLICATION FOR WHICH AUTHORIZATION IS SOUGHT

Generation & Segregation

Collection

Storage

Packaging

Reception

Transportation

Treatment / Processing / Conversion

Recycling

Disposal / Destruction

Use

Offering for sale / Transfer

Any Other Form Of Handling

INSTITUTE HANDLING BIO-MEDICAL WASTE DETAILS

Institute Name:*

Address Of Institution Handling Waste:

Plot Number:

Street/Road Name:*

Within KMC:*

Post Office:*

District:*

Pin Code:*

Address Of Place Of Treatment Facility:

Plot Number:

Street/Road Name:*

Post Office:*

District:*

Pin Code:*

Address Of Place Of Disposal Of Waste:

Plot Number:

Street/Road Name:*

Post Office:*

District:*

Pin Code:*

Mode Of Transportation:*

Modes Of Treatment:

Description Of Method Of Treatment and Disposal:

WASTE DETAILS

Category	Type of Waste	Quantity Generated or Collected (kg/day)	Method of Treatment and Disposal (Refer Schedule-1 of BMW Management Rules'2016)
Yellow	(a) Human Anatomical Waste
	(b) Animal Anatomical Waste
	(c) Soiled Waste
	(d) Expired or Discarded Medicines
	(e) Chemical Solid Waste
	(f) Chemical Liquid Waste
	(g) Discarded linen, matresses, beddings contaminated with blood or budy fluid
	(h) Microbiology, Biotechnology and other clinical laboratory Waste
Red	Contaminated Waste(Recyclable)
White (Translucent)	Waste Sharps including Metals
Blue	Glassware
Blue	Metallic Body Implants

TYPE OF ESTABLISHMENT*

State Government Institution

Type of Government Institution/Hospital:

Central Government Institution

Type of Government Institution/Hospital:

Private Institution

Type of Private Institution/Hospital:

Joint Sector

Type Of Joint Sector Institution/Hospital:

Trustees/N.G.Os

Type of Institution/Hospital:

Operator

Operator Type:

Others

INVESTMENT*

Capital Investment:

(Put 0 For Non Availability)

NATURE OF SERVICES PROVIDED BY HEALTH CARE UNIT

Bed Capacity:

Provides Treatment to Out-Patients:*

No. of Out-Patients (during last financial year):

Provides Treatment to In-Patients:*

No. of In-Patients (during last financial year):

Provides Pathological And Diagnostic Services:*

No. of Patients with such services provided (during last financial year):

Runs A Blood Bank:*

No. of Persons dealt with (during last financial year):

Carry out Research in Medical Science / Allied Fields:*

Components generated during the Research Activities:

Cytotoxic Drug Waste

Radio Active Waste

Animal Waste

Other

BIO-MEDICAL WASTE STORAGE INFORMATION

Facility for Storage of Bio Medical Waste :*

Maximum Storage Capacity available (In Days):

Actual duration of Storage Capacity (In Days):

Present Mode of Disposal:

BIO-MEDICAL TREATMENT FACILITY WITHIN OWN PREMISES

Facility Available for Treatment of BMW :*

Treatment Facility Available & Quantity Treated*

	No. of Units	Capacity of each unit (kg/day)	Actual Quantity Treated (avg.) (kg/day)
Incinerators:
Plasma Pyrolysis:
Autoclaves:
Microwave:
Hydroclave:
Shredder:
Needle tip cutter/Destroyer:
Sharps encapsulation/Concrete pit:
Deep burial pits:
Chemical disinfection:
Any other treatement equipment:


BIO-MEDICAL DISPOSAL INFORMATION

Facility Available for Disposal of BMW :*
Disposal Practice
Sent To Collection/Transport/Treatment/ Storage/Disposal Facility:
Actual Quantity Disposed (avg.):
Sent To Municipal Dumping Ground After Treatment:
Actual Quantity Disposed (avg.):
Sent To Municipal Dumping Ground Without Treatment:
Actual Quantity Disposed (avg.):
In-house Secured Landfill:
Actual Quantity Disposed (avg.):
Sent To Common Secured Landfill:
Actual Quantity Disposed (avg.):
Other:
Actual Quantity Disposed (avg.):
Total Quantity Disposed:

INFORMATION TO BE PROVIDED BY THE OPERATOR

BMW Collected/Transported (MT/Month):
Anatomical Waste Quantity:
Non-Anatomical Waste:
Sharps Quantity:		Liquid Quantity:
Other:		Total Waste non-anatomical Collected/Transported:
Total Waste Collected/Transported:
BMW Treatment Facility (MT/Month)
Autoclave:
	Treatment Capacity: (Litre/batch)
Microwave:
	Treatment Capacity: (Litre/batch)
Incinerator:
	Treatment Capacity: (Kg/hr)
Chemical Disinfections:
	Treatment Capacity: (Kg/hr)
Other:
	Shrcdder: (Kg/hr)
Quantity Of Actually BMW Treated(MT/Month):
Anatomical Waste Quantity:
Non-Anatomical Waste:
Sharps Quantity:		Liquid Quantity:
Other:		Total non-anatomical Waste treated
Total Waste treated:
BMW Treatment Facility (MT/Month):
Autoclave/Shredder:		Microwave/Shredder:
Incineration:		Chemical Disinfections:
Other:		Total Quantity Treated:
BMW Disposal Facility
Secured Landfill:		Sanitary Landfill:
Life Of Facility (In Years):		Life Of Facility (In Years):
Other:
Life Of Facility (In Years):
Quantity Of Waste Disposed From BMW Facility (MT/Month):
Incineration Ash:		Treated Non-anatomical Waste:
Other:		Total Quantity Of Waste Disposed:
Quantity Of Waste Actually Disposed (MT/Month):
Secured Landfill:		Sanitary Landfill:
Other:		Total Quantity Of Waste Disposed:
Any Other Pertinent Information :

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