New Assessment

Harari Regional Health Bureau — Institutional Self-Assessment Form

Facility Information

Basic facility details

Checklist Domains

Assessment responses

Review & Submit

Confirm and save

1Facility Identification

Facility Name *

Full official name of the health facility

Facility Type *

Select the type of health facility being assessed

Region

Pre-filled — Harari Regional Health Bureau

Zone / Woreda *

Administrative zone or woreda where facility is located

Population Served

Estimated catchment population of the facility

Assessment Date *

Date the assessment is being conducted

Assessor Name *

Full name of the person conducting the assessment

The checklist framework automatically loads based on the selected facility type:

YesFully compliant — 1 point

PartialPartially compliant — 0.5 points

NoNon-compliant — 0 points

N/ANot applicable — excluded from score

Domain Score = (Yes + 0.5×Partial) / Applicable items × 100

≥80%Compliant

50–79%Partial Compliance

<50%Non-Compliant