Ph lc 7

(Ban hnh km theo Quyt nh 617/Q-UBND-HC

ngy 28 thng 6 nm 2013 ca Ch tch U ban nhn dn Tnh)

UBND TNH NG THP

S Y T

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
., ngy

thng

nm 20.

BIN BN THM NH
PHNG XT NGHIM AN TON SINH HC CP I
I. THNG TIN V C S C PHNG XT NGHIM
1. Tn c s c phng xt nghim:..............................
2. a ch: .............
3. in thoi:. Email (nu c):......................
4. Fax: ......
5. Tn phng xt nghim: ............................................................
6. a ch phng xt nghim: ...
II. THNH PHN THAM GIA THM NH
A. Thnh phn on thm nh
+ S Y t:
1. .......................................................; Chc v:...........................................
2. .......................................................; Chc v:...........................................
3. .......................................................; Chc v:...........................................
4. .......................................................; Chc v:...........................................
+ Phng Y t:
1. .......................................................; Chc v:............................................
2. .......................................................; Chc v:............................................
B. i din ca c s c phng xt nghim:
1. ..
2. ..
III. CN C PHP L THM NH
- Cn c Lut Phng, chng bnh truyn nhim ngy 21 thng 11 nm 2007;
-1-

Ph lc 7
(Ban hnh km theo Quyt nh 617/Q-UBND-HC
ngy 28 thng 6 nm 2013 ca Ch tch U ban nhn dn Tnh)

- Cn c Ngh nh s 92/2010/N-CP ngy 30 thng 8 nm 2010 ca Chnh ph quy nh chi tit thi hnh mt s iu ca
Lut Phng, chng bnh truyn nhim v m bo an ton sinh hc ti phng xt nghim;
- Cn c Thng t s 29/2012/TT-BYT ngy 04 thng 12 nm 2012 ca B trng B Y t Quy nh th tc cp mi, cp li
giy chng nhn phng xt nghim t tiu chun an ton sinh hc;
- Theo n ngh cp giy php hot ng khm bnh, cha bnh ca ng (B):
IV. NI DUNG THM NH
4.1. Th tc hnh chnh
Ni dung
S lng h s (01 bn chnh, 01 bn sao)
n ngh cp GCN PXN ATSH
1. S mt bng
- Din tch PXN
- H thng ca i
- H thng ca s
- H thng in
- H thng nc
- H thng phng chy, cha chy
2. Bng k khai danh mc trang thit b ca PXN
3. Bng k khai nhn s phng xt nghim
4. Vn bng chng ch ca ngi ph trch v nhn vin PXN
5. Giy t chng minh vic thnh lp v hot ng ca c s xt
nghim

6. Giy t khc (Ghi c th cc loi giy t khc tham kho)

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Khng

Din gii

Ph lc 7
(Ban hnh km theo Quyt nh 617/Q-UBND-HC
ngy 28 thng 6 nm 2013 ca Ch tch U ban nhn dn Tnh)

4.2. Ni dung thm nh

H s
Ni dung thm nh

C Khng

A. iu kin v c s vt cht
1. Phng thc hin xt nghim c din tch ti thiu l 12m2
(Thit k phng xt nghim lu gi di dng vn bn)
2. H thng ca i, ca s
- Ca i: C khun, cht, kha an ton; cnh ca bng g, vt liu tng hp
hoc kim loi kt hp vi knh trong.
- Ca s: C khun, cht an ton; cnh ca bng g, vt liu tng hp hoc
kim loi kt hp vi knh trong hoc m chiu sng t nhin.
(Ca s, ca i xem trn bn thit k, m t trong h s loi vt liu sn
xut)
3. Sn, tng v trn
- Sn:
+ Khng chnh ct, khng c g ca bo m phng, nhn, khng trn
trt, chu c ha cht, chng thm v d c ra v sinh;
+ Trong cc phng ra tit trng, chun b mi trng hoc chun b mu
phi c ch thu nc khi c ra;
+ Giao tuyn ca sn vi tng m bo d v sinh, chng ng.
- Tng: Bng phng, d lau chi, khng thm nc v chng c cc loi
ha cht thng dng trong phng xt nghim.
- Trn: phng, nhn, chng thm v lp t c cc thit b (chiu sng,
phng chy cha chy, iu ha khng kh hoc thit b khc).
4. Mt bn xt nghim
Khng thm nc, chu c cc dung dch cht kh trng, axit, kim, dung
mi hu c v chu nhit
(Ti liu m t cht liu bn)
5. Bn nc ra tay, thit b ra mt khn cp, hp s cu
6. nh sng:
- Khu vc xt nghim c ri ti thiu l 400 lux.

-3-

Thm nh ti PXN
Khng
Thc trng
Ph hp
ph hp

Ghi ch

Ph lc 7
(Ban hnh km theo Quyt nh 617/Q-UBND-HC
ngy 28 thng 6 nm 2013 ca Ch tch U ban nhn dn Tnh)

H s
Ni dung thm nh

C Khng

- Khu vc ra, tit trng, chun b mu, mi trng, tm, thay l 250 lux.
- Khu vc hnh chnh v ph tr l 140 lux;
7. H thng in
- Ngun cp in n nh
- H thng dy dn v thit b kim sot, cung cp in m bo an ton v
ph hp cc thng s k thut (cng sut, cht lng)
- H thng bo v qu ti
- Tip t ton b h thng
- cm in cao hn nn PXN t nht 40cm, khng gn vi nc
8. H thng cp nc sch
(S h thng cung cp nc sch. Ti liu chng minh l c nc sch
thc hin cc xt nghim, c van chng chy ngc)
9. Thit b phng chy, cha chy
(Danh sch cc thit b phng chy, cha chy. Bin bn kim tra v phng
chy, cha chy)
B. iu kin v trang thit b
1. Cc thit b xt nghim ph hp vi k thut v loi vi sinh vt c xt
nghim
(Danh sch cc xt nghim c thc hin. Danh sch thit b theo tng xt
nghim, kt qu xt nghim, quy trnh xt nghim)
2. Dng c cha cht thi p ng tiu chun qui nh i vi tng loi cht
thi
(Lit k cc dng c cha cht thi, v tr dng c cha cht thi)
4. Cc trang thit b bo h c nhn ph hp vi loi k thut xt nghim
thc hin trong phng xt nghim an ton sinh hc cp I
(Danh sch cc thit b bo h c nhn theo Quyt nh s 205/2002/QBLTBXH nm 2002 ca B Lao ng Thng binh v X hi)
- Qun o vi trng;
- M vi trng hoc m bao tc;
- Gng tay cao su;

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Thm nh ti PXN
Khng
Thc trng
Ph hp
ph hp

Ghi ch

Ph lc 7
(Ban hnh km theo Quyt nh 617/Q-UBND-HC
ngy 28 thng 6 nm 2013 ca Ch tch U ban nhn dn Tnh)

H s
Ni dung thm nh

C Khng

- Dp nha;
- ng cao su;
- Khu trang;
- Ym hoc tp d chng ho cht chuyn dng(1);
- Knh trng chng bi hoc chng ho cht chuyn dng(1);
- X phng.
(1):Nu c trang b ng phc th thi
C. iu kin v nhn s
1. S lng nhn vin: t nht 02 nhn vin xt nghim
2. Trnh nhn vin PXN:
- C vn bng, chng ch o to ph hp vi loi hnh xt nghim v c
giy xc nhn qua tp hun v an ton sinh hc t cp I tr ln do c s
trong nc c ch nh hoc nc ngoi cp
- Thnh tho trong cc thao tc thc hnh v cc k thut xt nghim
(Danh sch nhn vin phng xt nghim, vn bng chng ch v xt nghim
v an ton sinh hc, kinh nghim lm vic trong PXN)
D. Quy nh v thc hnh
1. Qun l v iu hnh
- Quy nh ch bo co
- K hoch o to, tp hun cho nhn vin ca c s c phng xt nghim
- Quy nh v lu tr h s
2. Thc hnh
- Quy nh ra vo phng xt nghim
- C v tun th cc quy trnh xt nghim
- Kh nhim v x l cht thi
- Quy trnh x l s c
3. Gim st sc khe v y t
H s sc khe ca nhn vin phng xt nghim theo qui nh (kim tra sc
khe trc khi bt u lm vic ti phng xt nghim v nh k hng nm)
(Thc hin theo ng thng t s 19/2011/TT-BYT ngy 06/6/2011 ca B
trng B Y t v Hng dn qun l v sinh lao ng sc khe ngi lao

-5-

Thm nh ti PXN
Khng
Thc trng
Ph hp
ph hp

Ghi ch

Ph lc 7
(Ban hnh km theo Quyt nh 617/Q-UBND-HC
ngy 28 thng 6 nm 2013 ca Ch tch U ban nhn dn Tnh)

H s
Ni dung thm nh

C Khng

Thm nh ti PXN
Khng
Thc trng
Ph hp
ph hp

Ghi ch

ng v bnh ngh nghip)

- Giy chng nhn sc khe
- H s sc khe
- Khm sc khe nh k
V. KT LUN V KIN NGH
5.1. Kt lun: .
5.2. Kin ngh (nu c):.
...

5.3. kin khng ng vi kt lun v kin ngh ca on thm nh (nu c):

i din c s
(k tn, ng du)

on thm nh
(cc thnh vin k tn, ghi r h tn)

-6-