Self Assessment Form
Self Assessment Form
Self Assessment Form
Certification Standards
Major Requirements: YES NO
Goal: The Animal Bite Treatment Center provides a safe and effective physical environment to its staff and patient.
Standard 1: The Animal Bite and Treatment Center is easily located and patients have convenient and safe access to the center.
Rating Scale:
0 – Non Compliant
1-Incomplete
2-complete
Certification Standard
Survey Item Criterion PART 1 PART II
Evidence v]by ABTC Rating Surveyor’s Comments
Progress and
Achievements
GOAL The Animal Bite Treatment Center Provides a safe and effective physical environment to its staff and patients
2 The ABTC provides facilities for the comfort and privacy of its patients and staff
Goal: The Animal Bite Treatment Center provides a safe and effective physical environment to its staff and patient
Standard 2: The ABTC center is provides privacy and comfort of its patient and staff.
Self-Assessment Form
Rating Scale:
0 – Non Compliant
1-Incomplete
2- Complete
Certification Standard
Survey Item Criterion PART 1 PART II
Evidence v]by ABTC Rating Surveyor’s Comments Survey Team Rating
Progress and
Achievements
GOAL The Animal Bite Treatment Center Provides a safe and effective physical environment to its staff and patients
3 The ABTC is easily located and patients have convenient and safe access to the center
Goal: The Animal Bite Treatment Center provides a safe and effective physical environment to its staff and patient
Standard 2: The ABTC is easily located and patients have convenient and safe access to the center
Self-Assessment Form
Rating Scale:
0 – Non Compliant
1-Incomplete
2- Complete
Certification Standard
Survey Item Criterion PART 1 PART II
Evidence by Progress ABTC Rating Surveyor’s Comments Survey Team Rating
and Achievements
GOAL The Animal Bite Treatment Center Provides a safe and effective physical environment to its staff and patients
4 All patients have continues access to accurate and reliable Animal bite exposure management and treatment.
Rating Scale:
0 – Non Compliant
1-Incomplete
2- Complete
THE DOH/CHD Certification Self-Assessment and Survey Tool
Goal: patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard 4: all patients have continuous access to accurate and reliable Animal bite exposures management and treatment.
Rating Scale:
0 – Non Compliant
1-Incomplete
2- Complete
Self-Assessment Form
Certification Standard
Survey Item Criterion PART 1 PART II
Evidence v]by ABTC Rating Surveyor’s Comments Survey Team Rating
Progress and
Achievements
GOAL The Animal Bite Treatment Center Provides a safe and effective physical environment to its staff and patients
5 A comprehensive management approach is developed and followed for all patients.
Rating Scale:
0 – Non Compliant
1-Incomplete
2- Complete
The DOH/CHD Certification Self-Assessment and Survey Tool
OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(TO be completed by the survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the Animal Bite and Treatment Center.)
Goal: Patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard: A comprehensive management approach is developed and followed for all patients.
Rating Scale:
0 Non-Compliant
1 – incomplete
2- complete
Self-Assessment Form
Certification Standard
Survey Item Criterion PART 1 PART II
Evidence v]by ABTC Rating Surveyor’s Comments Survey Team Rating
Progress and
Achievements
GOAL The Animal Bite Treatment Center Provides a safe and effective physical environment to its staff and patients
6 The ABTC maintains an updated reports and records of all Animal Bite Patients.
OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(TO be completed by the survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the Animal Bite and Treatment Center.)
Goal: Patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard: The ABTC maintains an updated reports and records of all animal bite patients.
Rating Scale:
0 – Non compliant
1 – Incomplete
2 – complete
OVERALL RATING AND SUMMARY PER GOAL
___________________________ ______________________
RATER RATER
Rating Scale:
0 – Non compliant
1 – Incomplete
2 - complete