Health Facility Assessment

1

Facility Details

District *

Health Facility *

2

Present Status *

Functional Non Functional

Building Condition *

New Old Condemned

Repair / Upgradation Required *

Yes No

Repair / Upgradation Details

3

Present Services Delivered

Service Gaps

4

GDMO (General Duty Medical Officer)

Sanctioned

Present

Required

Specialist Medical Officers

Discipline	Sanctioned	Present	Required

e.g. Medicine, Surgery, Anaesthesia, Paediatrics, Gynaecology

Nursing Staff

Category	Sanctioned	Present	Required

e.g. Staff Nurse, ANM, GNM, Head Nurse

MT / Lab / Support / Others

Staff Type	Sanctioned	Present	Required

e.g. Lab Technician, Pharmacist, Radiographer, Driver, Sweeper

5

Equipment Availability & Condition

6

Additional Observations