Exemption Notification for Infectious Waste Annual Report

You may use this form to notify the DNR when your facility is exempt from filing the Infectious Waste Annual Report. Do not use this form if your facility was not operating during a reporting year, instead, use the Contact Update Form to notify the DNR of facility operational changes.
Your name (first and last)
Choose the reporting year for which you are filing this exemption notification. You must submit a separate notification for each reporting year.
Enter the Facility Identification Number (FID) of the facility for which you are reporting.
Enter the name of the facility for which you are reporting
Enter the street address of the facility for which you are reporting.
Enter the location city of the facility for which you are reporting.
What is the Tax ID Number of the owner for which you are reporting?
What is the owner's legal name, as it appears with this Tax ID Number?
Did this owner generate infectious waste at this location during the entire report year you selected above, that is, from January 1 to December 31? If this owner only generated waste during part of the year, choose "No."
During this reporting year, what was the first date on which this owner generated infectious waste at this location? If this owner continued operations from the previous year, enter 01/01/YYYY. (MM/DD/YYYY)
During this reporting year, what was the last date on which this owner generated infectious waste at this location? If this owner operated through the end of the reporting year, enter 12/31/YYYY. (MM/DD/YYYY)

Off-Site Treatment Report Exemption Statements

Confirm the reason why this facility is exempt from filing the Off-Site Treatment Report.
This facility is exempt from filing the Off-Site Treatment Report because it transported or sent away for treatment less than 50 pounds of infectious waste in every calendar month of the reporting year.
This facility transported or sent away for treatment only sharps that were collected at a registered sharps collection station.

Medical Waste Reduction Progress Report Exemption Statements

Confirm the reason why the facility is exempt from filing the Medical Waste Reduction Progress Report.
Medical facilities include hospitals, surgery centers, nursing homes and clinics (e.g., dialysis, dental and veterinary clinics). Free-standing clinical laboratories, home health agencies and other generators are not medical facilities.
This facility is exempt from filing the Medical Waste Reduction Progress Report because it is not a medical facility.
This medical facility is exempt from filing the Medical Waste Reduction Progress Report because it generated less than 50 pounds in every calendar month of the reporting year.
This medical facility is exempt from filing the Medical Waste Reduction Progress Report because it generated more than 50 pounds in only one calendar month and also generated an average of less than 50 pounds of medical waste per calendar month for the same reporting year.
If the facility is operating, it is the facility's contacts responsibility to evaluate its exemption status each year. Would you like the DNR to notify you of the Infectious Waste Annual Report for this location next year?
Please explain why you do not wish to receive a notice from DNR next year.

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