MSE Environmental - USP 800 Compliance Questionnaire

This questionnaire will help us better compile a quote for USP 800 testing based off the needs of your facility. Please complete and SEND when completed.

Email *

Contact Name *

Contact Phone Number *

What is your facility's name? *

What type of Healthcare facility represents your setting? *

Hospital

Pharmacy

Surgical Center

Veterinary Hospital

Home Health Care

Skilled Nursing Facility

Other

Are you a new or existing customer? *

I am a new customer

I am an existing customer

Does your facility currently implement a USP 800 sampling plan? *

Yes

Other

Who is the responsible party for managing your USP 800 compliance? *

List of Hazardous Drugs your facility uses? *

5-Fluorouracil

Busulfan

Cyclophosphamide

Doxorubicin

Epirubicin

Etoposide

Methotrexate

Mitomycin

Paclitaxol

Gemcitabine

Cytarabine

Daunorubicin

Oxaliplatin

Platinum Analogues

Vincristine

Other

Please check all the hazardous drugs your facility uses

How frequently would you like sampling performed at your facility? *

Quarterly

Semi-Annualy

Annualy

Other

How many locations do you want to be sampled? *

How many samples per location? *

Do you know how interpret HD sampling data *

Yes

Other

Would you be interest in 3D Virtual Capture of your Facilities and Sampling Locations *

Yes

https://my.matterport.com/show/?m=J99fhbfK3U9

Are you interested in a presentation for your facility regarding USP 800 Compliance taking effect December 2019 *

Yes

Where does your facility need help in reducing Exposure to the Healthcare Worker? *

Transport

Storing

Compounding

Dispensing

Administering

Patient Care

Spills

Disposal

Managing Waste

Receiving

Cleaning

Other

Please check off the boxes where your facility can use more compliance.

How soon are you looking to implement USP 800 sampling program *

1 month

2 months

3 months

Other

Does your USP 800 compliance team know how to decontaminate, clean and disinfect your facility if HD's are found *

Yes