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Fumigation Form

This document is a fumigation form used by Diva Healthcare Pvt. Ltd and Diva Eye Institute. The form collects information about fumigation processes including the name and location of places fumigated, fumigants used, dosage rates, dates, durations, air pressure during fumigation, and descriptions of the fumigation process. The form is to be filled out by the nursing superintendent when fumigation is carried out and recorded in the fumigation maintenance register or file.

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Ziaul Haque
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354 views2 pages

Fumigation Form

This document is a fumigation form used by Diva Healthcare Pvt. Ltd and Diva Eye Institute. The form collects information about fumigation processes including the name and location of places fumigated, fumigants used, dosage rates, dates, durations, air pressure during fumigation, and descriptions of the fumigation process. The form is to be filled out by the nursing superintendent when fumigation is carried out and recorded in the fumigation maintenance register or file.

Uploaded by

Ziaul Haque
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DIVA HEALTHCARE PVT.

LTD DIVA EYE INSTITUTE


17, Parimal Society, Core House Lane 17, Parimal Society, Core House Lane
Parimal Garden, Ahmedabad: 380006 Parimal Garden, Ahmedabad: 380006

H E A LT H C A R E P V T. LT D .

DIVA EYE INSTITUTE

Fumigation Form
Name:………………………………………………………………………………………………………………………………………..

Place:………………………………………………………………………………………………………………………………………….

Address:
……………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………

Name of Fumigant used:…………………………………………………………………………………………………………………….

Place of Fumigant:……………………………………………………………………………………………………………………………..

Dosage rate:………………………………………………………………………………………………………………………………………

Date of fumigation:…………………………………….

Air Pressure:……………………………………………….

Duration of fumigation:……………………………..

Describe the process:……………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………..

Name of fumigant incharge:……………………………………………………………………………………………………………..

Date :……………………………………….

Place :………………………………………

Name and signature:………………………………………………………………


Note** To be filled by- nursing supdt
When to be filled- In case where fumigation is carried out.
Where to be recorded- fumigation maintenance register/file.
DIVA HEALTHCARE PVT. LTD DIVA EYE INSTITUTE
17, Parimal Society, Core House Lane 17, Parimal Society, Core House Lane
Parimal Garden, Ahmedabad: 380006 Parimal Garden, Ahmedabad: 380006

H E A LT H C A R E P V T. LT D .

DIVA EYE INSTITUTE

Note** To be filled by- nursing supdt


When to be filled- In case where fumigation is carried out.
Where to be recorded- fumigation maintenance register/file.

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