BUREAU VERITAS CERTIFICATION INDIA PVT. LTD

APPLICATION FORM
GREEN AND CLEAN HOSPITAL ASSESSMENT





Departments (Select Yes/No/NA)
Casualty Yes No N/A
Aneasthetics Yes No N/A
Cardialogy Yes No N/A
Critical Care Yes No N/A
ENT Yes No N/A
Geriatrics Yes No N/A
Gastroenterology Yes No N/A
General Surgery Yes No N/A
Gynaecology Yes No N/A
MATERNITY/NEONATAL/PAEDIATRIC Yes No N/A
Neurology Yes No N/A
Oncology Yes No N/A
Opthamology Yes No N/A
Orthopedics Yes No N/A
Urology Yes No N/A
Burns Unit Yes No N/A
Psychiatry Yes No N/A
Support Functions (Select Yes/No/NA)
Central Sterlization Unit Yes No N/A
Housekeeping Yes No N/A
Catering & Food Services Yes No N/A
Medical Social Work Yes No N/A
Physiotherapy Yes No N/A
Pharmacy Yes No N/A
Nutrition and Dietics Yes No N/A
Microbiology Yes No N/A
Haematology Yes No N/A
Diagnostic Imaging Yes No N/A
Medical Records Yes No N/A
Medical Maintenance and Engineering Yes No N/A
IT & Communication Yes No N/A
HR Yes No N/A
Finance Yes No N/A
Administration (Incl. Top Mgmt.) Yes No N/A
Storage & Warehousing Yes No N/A
Ambulance Services Yes No N/A




KEY PERSONNEL RESPONSIBLE
KEY PERSONNEL RESPONSIBLE NAME EMAIL CONTACT NO / MOBILE NO
INFECTION CONTROL INCHARGE
LICENSES / LEGAL COMPLIANCES
WASTE MANAGEMENT
HOSPITAL ADMINISTRATION


Manpower Details
No. of Doctors (Incl. Visiting Faculty)
Nurses
Wardboys
Canteen
Admin
Other Support Staff