Environmental Health & Safety

Request for Medical Waste Pick Up

Instructions:

  1. Please fill out form completely - incomplete forms will result in pickup delays.
  2. Room must be the location of the medical waste.
  3. Press the submit button
Company Name: Date:
Building: Room:
Phone: Alt Phone:
Contact Person:
Email:
Number of bins for Pick-up:
* Security:

Enter the code below, including spaces, as it appears to the right.

12 seven 2023