Hospital Survey

Name Of The Health Group*

Address

City State / Province / Region Country

Name Of Main Contact*

First Middle Last

Email Of Main Contact*

General Profile

Type Of Scavenging System

Dedicated WAGD or AGSS

Number Of ORs

Number Of ORs Centrally Connected

Type Of Anesthetic Gas Machine(s) Manufacturer and Model

Any Anesthesia Locations Not Connected To Hospital's Scavenging System, Such As MRI ICU, Other?

Type Of Inhalation Anesthetic

Click All That Apply

Number Of Desflurane Bottles Used Annually

Number Of Sevoflurane Bottles Used Annually

Number Of Isoflurane Bottles Used Annually

Do You Have A Budget For Greenhouse Gas Reduction?

Do You Own Or Rent Your Anesthetic Vaporizers?