DOH / CHD SELF ASSESSMENT TOOL

Facility:
Major Requirements: YES NO
1. Trained Physician and Nurse on Management of Animal Bites from DOH
recognized training institution
2. Cold Chain equipment (Refrigerator and Vaccine carrier)
3. Standard recording & reporting system

PART I PART II
Item Criterion Evidence by Facility Certifiers’ Certifiers’ Team
Progress and Rating Comments Rating
Achievements
The Animal Bite Treatment Center/ Animal Bite Center provides a safe and
Goal 1
effective physical environment to its patients and staff
The ABTC/ABC is easily located and patients have convenient and safe access to
Standard 1
the center
This standard will be achieved when:
1.1. ABTC signage is
There is appropriate signage bearing the name properly installed
at the main road, 2
of the ABTC/ABC to assist patients
hospital gate and
accessing the center inside hospital
premise
1.2 ABTC is located
Physical access is appropriate for the needs at the OPD ground 2
of the patients floor Room 1.
Lobby is free from
obstruction.
1.3 Entrance and Exit
Entrance/exits are clearly marked and free of is clearly marked
with No 2
obstruction and of other hazardous
Obstruction
conditions
1.4 Aside from the
There are resources to inform patients of the clinic hour posted 2
daily schedule of the facility on the signage,
Schedule is posted
at the treatment
center itself.
TOTAL RATING 8

Rating Scale
0 – Non
Compliant 1-
Incomplete
2- Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility
staff)

Goal: The Animal Bite Treatment Center/Animal Bite Center provides a safe and effective physical
environment to its patients and staff.
Standard 1: The Animal Bite (and) Treatment Center/Animal Bite Center is easily located and
patients have convenient and safe access to the center.

DOH-RO3-LHSD-WI-19-00- Form1 Rev.0

 PART I PART II
Evidence by Facility Rating Certifiers’ Certifiers’
Item Criterion
Progress and Comments Team
Achievements Rating
The Animal Bite Treatment Center/Animal Bite Center provides a safe and effective physical
Goal 1 environment to its staff and patients
The ABTC/ABC provides facilities for the comfort and privacy of its patients and staff.
Standard 2
This standard will be achieved when:
2.1 Trash Bin is
The ABTC/ABC maintains a clean and health available in the area. 2
promoting environment within and immediately
outside its premises.
2.2 There are IEC
There are resources and processes to ensure the materials available 2
quality of patient waiting time. in the waiting area.
There are chairs
provided while
waiting.
2.3 Proper lighting is 2
The facility is adequately lighted. maintained in the
room.
2.4 Only one patient is 2
The privacy of every patient is assured allowed inside the
treatment room.
TOTAL RATING 8

Rating Scale

0 – Non Compliant
1 – Incomplete
2 - Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff)

Goal: The Animal Bite Treatment Center/Animal Bite Center provides a safe and effective physical
environment to its patients and staff
Standard 2: The ABTC/ABC provides facilities for the comfort and privacy of its patients and staff.

DOH-RO3-LHSD-WI-19-00- Form1 Rev.0

 PART I PART II
Evidence by Facility Rating Certifiers’ Certifiers’
Item Criterion
Progress and Comments Team
Achievements Rating
The Animal Bite Treatment Center/Animal Bite Center Provides a safe and effective physical
Goal 1 environment to its patients and staff
Standard 3 The ABTC/ABC provides safety to its patients and staff

This standard will be achieved when:

3.1 Clean Water,
The facility has adequate clean water for wound soap and alcohol
cleaning, personal hygiene, and sanitation is always 2
purposes available. Wash
area is also
available.
3.2 Maintained
The facility maintains appropriate levels of Cleanliness and
cleanliness and antisepsis of all physical areas, sterilized 2
equipment and instruments. equipment.
3.3 Properly disposal
General waste, sharps, pathological and and segregation 2
infectious waste, pharmaceutical and chemical of waste. Color
wastes are appropriately segregated, safely coded Waste bags
are used.
handled and disposed of according to accepted
safe disposal practices.
3.4 There is Policy
There are documented, disseminated, and and procedure for 2
implemented procedures to identify and address implementation
the risks of contamination of patients and staff of risk
contamination of
from sources of infectious diseases.
patient and staff.
8
TOTAL RATING

Rating Scale

0 – Non Compliant
1 – Incomplete
2 – Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff)

Goal: The Animal Bite Treatment Center/Animal Bite Center provides a safe and effective physical
environment to its patients and staff

Standard 3 The ABTC/ABC provides safety to its patients and staff

DOH-RO3-LHSD-WI-19-00- Form1 Rev.0

 PART I PART II
Evidence by Facility Rating Certifiers’ Certifiers’
Item Criterion
Progress and Comments Team Rating
Achievements
Patients receive appropriate and effective clinical management based on rabies exposure category.
Goal 2
Standard 4 All patients have continuous access to accurate and reliable animal bite exposure management.

This standard will be achieved when:

4.1 Completeness
A physician completes and documents the relevant of every patient 2
history for each patient record.
4.2 Available
The facility implements policies and procedures for policy and 2
assuring the quality of bite exposure management. procedure on
the quality of
bite exposure
and managment
4.3 Available
If Rabies Vaccine/RIG is not available, policies policy and 2
and procedures for referring patients to another procedure on
accessible ABTC/ABC are implemented and referral.
monitored for effectiveness.
4.4 Accurate 2
Rabies Vaccine / RIG are secured and proper cold temperature for
chain management is observed. vaccines are
maintained.
TOTAL RATING 8

Rating Scale

0 – Non Compliant
1 – Incomplete
2 - Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff)

Goal: Patients receive appropriate and effective clinical management based on rabies exposure category.

Standard 4: All patients have continuous access to accurate and reliable animal bite exposure management.

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 PART I PART II
Evidence by Facility Certifiers’ Certifiers’
Item Criterion
Progress and Rating Comments Team
Achievements Rating
Patients receive appropriate and effective clinical management based on rabies exposure
Goal 2 category.
A comprehensive management approach is developed and followed for all patients
Standard 5

This standard will be achieved when:

5.1 Management of
Management of rabies exposure is consistent rabies exposure is 2
with Rabies Prevention and Control Program based on the
Guidelines. Guidelines.
5.2 Available flow
Flow chart of patient management is visible chart of patient 2
and accessible to expedite the provision of management in
services to patients. the center.
5.3 Completeness of
A comprehensive evaluation of the patient’s Medical Record. 2
progress is documented.
5.4 Health Education
Health education is provided to all patients on is conducted in 2
adherence to management and on responsible every patient.
pet ownership.
5.5 Available
Policies and procedures for detecting PEP Policies and
defaulters and getting them back for procedures 2
management are implemented and monitored for detecting
for effectiveness. PEP
defaulters.
.
TOTAL RATING 10

Scale Rating

0 – Non Compliant
1 – Incomplete
2 - Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff)

Goal: Patients receive appropriate and effective clinical management based on rabies exposure category.

Standard 5: A comprehensive management approach is developed and followed for all patients

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 PART I PART II
Evidence by Facility Certifiers’ Certifiers’
Item Criterion
Progress and Rating Comments Team
Achievements Rating
Goal 3 The health staff adheres to clear policies and guidelines on efficient ABTC /ABC operation
The ABTC/ABC maintains accurate and updated records and reports to all animal bite victims.
Standard 6

This standard will be achieved when:

6.1 Identifying patient
Each patient is uniquely identified throughout the correctly is always 2
course of management. observed and
practiced.
6.2 Completeness and
The facility maintains an updated database of updated Patient 2
patient records that is accessible to authorized Record. Logbooks
personnel. are available.
6.3 Properly recorded
The facility maintains quarterly reports of both and timely 2
animal and human bite cases. submitted animal
bite and human bite
quarterly.
6.4 Inventory of
The facility maintains a quarterly inventory of vaccine is done 2
Rabies vaccine/RIG. quarterly.
Requisition slip is
properly filed.
TOTAL RATING 8

Rating Scale

0 – Non Compliant
1 – Incomplete
2 – Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff)

Goal: The health staff adheres to clear policies and guidelines on efficient ABTC /ABC operation

Standard 6: The ABTC/ABC maintains accurate and updated records and reports of all animal bite victims.

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 PART I PART II
Evidence by Facility Certifiers’ Certifiers’
Item Criterion
Progress and Rating Comments Team
Achievements Rating
Goal IV The ABTC/ABC Provides quality services with competent manpower to its patient
The ABTC/ABC has complete manpower complement performing assigned tasks.
Standard 7

This standard will be achieved when:

7.1 The facility has qualified personnel 1 Trained Doctor and 1 2
trained on Animal Bite Management Nurse in the Animal Bite
Management
7.2 There are personnel responsible for
the following
7.2.1 Diagnosis and Management 1 Trained Doctor and 1 2
Nurse in the Animal Bite
Management
7.2.2 Provision of Rabies Vaccine/RIG 1 Trained Doctor and 1 2
Nurse in the Animal Bite
Management
7.2.3 Logistics Management PHO/DOH/Hospital 2
Procurement
7.2.4 Information Management HEPO of the Center. 2

7.2.5 Financial Management Willen Bitong- Accountant 2

of AMH
Availability of fund,
procurement of Vaccine
and supply
TOTAL RATING 12

Rating Scale

0 – Non Compliant
1 – Incomplete
2 – Complete

REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff)

Goal: The ABTC/ABC Provides quality services with competent manpower to its patient

Standard 7: The ABTC/ABC has complete manpower complement performing assigned tasks.

DOH-RO3-LHSD-WI-19-00- Form1 Rev.0

OVERALL RATING AND SUMMARY PER GOAL

TOTAL
GOAL MAXIMUM RATING
ABTC RATING ASSESORS
1 8 8
2 8 8
3 8 8
4 8 8
5 10 10
6 8 8
7 12 12
TOTAL 62 62

RATER
REMARKS BY THE CERTIFIERS’ TEAM

(To be completed if and when there are disparities with the information provided by the facility staff) The

decision of the CHD certifying team shall remain FINAL and OFFICIAL
The certification of the facility shall be valid for period of two (2) years but can be revoked at any point in
time if for three (3) consecutive occasions seem to be not adhering to the standards.

DOH-RO3-LHSD-WI-19-00- Form1 Rev.0