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CIMIC Field Handbook Annex 16
Annex 16-1 Version 3.0.0
Annex 16 Rapid Health Assessments
Municipality Village MGRS Grid Ref
Agency Name ofassessor Date
Source ofinformation (give as much detail as possible – givea telephone ofsomeone in the village if possible)
1. FACILITIES
HOSPITALS
LOCATIONS/
OWNERSHIP
ROOMS/BEDS/
OCCUPANCY
SURGICAL
FACILITIES
LABORATORY
FACILITIES
STERILIZATION
FACILITIES
MEDICAL
SUPPLIES
POWER/ WATER/
WASTE DISPOSAL PERSONNEL
CLINICS/
NURSING
HOMES
LOCATIONS/
OWNERSHIP
ROOMS/BEDS/
OCCUPANCY
FACILITIES MEDICAL SUPPLIES
POWER/ WATER/
WASTE DISPOSAL PERSONNEL
MEDICAL
LABORATO-
RIES
LOCATIONS/ OWNERSHIP FACILITIES/ CAPABILITIES MEDICAL SUPPLIES PERSONNEL
2. DRUGS/SUPPLIES/EQUIPMENT
DRUGS/
SUPPLIES/
EQUIPMENT
LOCATIONS/
OWNERSHIP
TYPES
QUANTITIES/
CONDITION
SHORTFALLS
RESUPPLY CHANNELS/
CAPABILITIES
STORAGE
FACILITIES
3. PERSONNEL
PERSONNEL
LOCATIONS/ NUMBERS TYPES/ NUMBERS TRAINING SHORTFALLS
ACTION TAKEN
#
REMARKS ANDRECOMMENDATIONS

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Cfhb annex 16 rapid health assessment-vers0.1

  • 1. CIMIC Field Handbook Annex 16 Annex 16-1 Version 3.0.0 Annex 16 Rapid Health Assessments Municipality Village MGRS Grid Ref Agency Name ofassessor Date Source ofinformation (give as much detail as possible – givea telephone ofsomeone in the village if possible) 1. FACILITIES HOSPITALS LOCATIONS/ OWNERSHIP ROOMS/BEDS/ OCCUPANCY SURGICAL FACILITIES LABORATORY FACILITIES STERILIZATION FACILITIES MEDICAL SUPPLIES POWER/ WATER/ WASTE DISPOSAL PERSONNEL CLINICS/ NURSING HOMES LOCATIONS/ OWNERSHIP ROOMS/BEDS/ OCCUPANCY FACILITIES MEDICAL SUPPLIES POWER/ WATER/ WASTE DISPOSAL PERSONNEL MEDICAL LABORATO- RIES LOCATIONS/ OWNERSHIP FACILITIES/ CAPABILITIES MEDICAL SUPPLIES PERSONNEL 2. DRUGS/SUPPLIES/EQUIPMENT DRUGS/ SUPPLIES/ EQUIPMENT LOCATIONS/ OWNERSHIP TYPES QUANTITIES/ CONDITION SHORTFALLS RESUPPLY CHANNELS/ CAPABILITIES STORAGE FACILITIES 3. PERSONNEL PERSONNEL LOCATIONS/ NUMBERS TYPES/ NUMBERS TRAINING SHORTFALLS ACTION TAKEN # REMARKS ANDRECOMMENDATIONS