Form - IV

(See rule 13)

Bio Medical Waste Annual Return for the Calender Year - 2021

Application Type: HCF

Calender Year 2021

Submit To SRO-Kalyan I

Member of CBMWTF: Yes

Type of Health Care Facility Bedded

1) Particulars

i) First Name
Ronak

ii) Middle Name
Pradip

iii) Last Name
Tejani

iv) Designation
Administrator

v) Aadhaar No
48804209360

vi) PAN No
AGTPT8371N

vii) Address
Ram Lakhan Apt, Block No. 101, Geeta Nagar-4, Rajkot - 360002

viii) Tel No.
9426432104

ix) Fax No.
02512709971

x) Email
centuryhospital.shahad@gmail.com

xi) URL
https://centuryrayonhospital.com

2) Details of Health Care Facility

i) Name of the HCF
CENTURY RAYON HOSPITAL TRUST

ii) Email
centuryhospital.shahad@gmail.com

iii) Name of contact person
Shri Ronak Tejani

iv) Contact No.
9426432104

3) Address of the Health Care Facility

i) Building Name / Survey Number
CENTURY RAYON HOSPITAL TRUST

ii) Street / Village
Shahad

iii) City / Taluka
ULHASNAGAR

iv) District
Thane

v) Pin-Code Number
421103

vi) Near by Landmark
-

vii) Latitude coordinate
19.2451402

viii) Longitude coordinate
73.1637283

ix) Ownership
Private

4) Details of valid Combined Consent and BMW Authorization (CCA)

i) CCA / Authorization No.
Formate1.0/BO/PSO / HOD - 1806000119 dt 04.06.2018

ii) Valid Upto
Jun 4 2021 12:00:00 AM

5) Total No of Beds (As per valid Authorization)

6) Registration Number (e.g. Bombay Nursing Home reg. no., MSDC, MBTC)

UMC/MHD/BNH/45/09

7) Registration Expiry Date

May 8 2023 12:00:00 AM

8) Faculty of Medicine

9) Whether HCE Having Captive Treatment Facility

M/s. SMS Envoclean Pvt. Ltd, Mumbai

10) Details of BMW

i) Authorized Bio Medical Waste Quantity Kg/month (as per valid CCA)

Yellow
275.00000

Red
100.00000

Blue
20.00000

White
100.00000

ii) Bio Medical Waste Generated (Kg/Month)

Yellow
230.33000

Red
79.42000

Blue
16.00000

White
82.17000

iii) Quantity of Biomedical waste given to CBMWTDF (kg/Month)

Yellow
230.33000

Red
79.42000

Blue
16.00000

White
82.17000

General Solid Waste

11) Details of Trainings Conducted on BMW

i) Number of trainings conducted on BMW Management: 2

ii) Number of personnel trained: 36

iii) Number of personnel trained at the time of induction: 4

iv) Number of personnel not undergone any training so far:

v) Whether standard manual for training is available? No

vi) Any other information: Segregation chart of BMW waste is displayed.

12) Details of the Accident Occurred During the Year

i) Number of Accidents occurred:

ii) Number of persons affected:

iii) Remedial Action taken: No

iv) Any Fatality occurred: No

13) Liquid Waste Generated and Treatment Methods

Yes

14) Is the disinfection method or sterilization meeting the log 4 standards?

Yes

15) Whether HCE intended to Sale / Handover liquid BMW for R&D purpose

Place
Shahad

Designation
Administrator

Date
06-06-2022