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Form · OBS-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee

Supports: Standard 12 (Obstetrics and Gynaecology), criterion 12.5, 12.9

Purpose

Records the newborn’s assessment at birth, care given, identifiers and any transfer.

How to complete

Checks

Check Entry
Time of birth and Apgar or equivalent assessment Yes
Warmth, airway and drying given Yes
Resuscitation given (yes or no) and time Yes or N/A
Newborn identifier matched to mother Yes
Transferred (yes or no) and receiving unit Yes or N/A
Recorded by and time Yes

Evidence

Reference Note
E-009 Based on the WHO recommendations on newborn health (2017).
E-006 ASF Policy Framework v1.2. Adapted.
E-009 ASF Expert Committee consensus.

Change history

Version Date What changed Approval
1.0 the date of approval First version set Expert Committee approval

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