Standards › ASF Health Standards V11 › Standard 4
Standard 4 (Sustainability and Climate Resilience), PDF
ASF-HS11-S04 · 1 November 2026 · 31 pages, A4. The same criteria as this page, for printing and assessors.
Where this standard applies
Standard 4 is a core standard. It applies to every facility type, except where a criterion is marked N/A for that type. The table shows each criterion by facility type.
| Criterion | Hospital | Ambulatory clinic | Primary health clinic | Long-term care | Telemedicine | Home care | Fitness and wellness | Dental clinic | Aesthetic and procedure clinic |
|---|---|---|---|---|---|---|---|---|---|
| 4.1 An Environmental Sustainability Programme Is Active | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 4.2 Environmental Impact Is Reviewed at Strategic Level | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 4.3 Staff and Patients Are Informed of Sustainability Goals | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 4.4 Sustainability Progress Is Reported to Governance | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 4.5 Procurement Considers Responsible Stewardship of Resources | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 4.6 Energy Use Is Monitored, With a Move Toward Renewable Sources | Yes | Yes | Yes | Yes | N/A | N/A | Yes | Yes | Yes |
| 4.7 A Carbon Footprint Baseline Exists | Yes | Yes | Yes | Yes | N/A | N/A | Yes | Yes | Yes |
| 4.8 The Facility Plans for Environmental and Climate Resilience | Yes | Yes | Yes | Yes | N/A | N/A | Yes | Yes | Yes |
Sustainability and Climate Resilience
A core standard. It covers the environmental sustainability programme, the leadership review of environmental impact, informing staff and patients, reporting to governance, responsible procurement, energy use, the carbon footprint baseline, and planning for climate and health emergencies.
Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
4.1
An Environmental Sustainability Programme Is Active
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The facility has a specific, documented environmental sustainability programme — covering energy use, waste reduction, and resource consumption — with tracked progress, not a general statement of environmental awareness with no measurable action behind it.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Why it matters. A facility uses energy, water and produces waste every day. A documented sustainability programme with targets turns that use into something that is measured and reduced.
How the surveyor verifies this criterion
Sample. Review the sustainability programme and its progress reports for the last 12 months.
1. A written programme exists and is approved.
Method. Read the programme and check the approval.
Evidence to show. Approved environmental sustainability programme.
Pass when. Approved, covers energy, waste and resource use, and names an owner.
2. Progress is tracked against targets.
Method. Review the progress report for the last 12 months.
Evidence to show. Sustainability progress report.
Pass when. At least two progress reports in the last 12 months with figures against targets.
3. Actions are recorded.
Method. Check the action list in the progress report.
Evidence to show. Action list.
Pass when. At least one action was taken from the last reporting cycle.
Immediate fail (any one means the criterion is not met)
- No environmental sustainability programme exists, or it has no written plan.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. An approved programme covers energy, waste and resource use and names an owner. Progress is reported against targets at least twice a year, and each report leads to at least one action.
Partial because. A programme is written, but it has no targets or no owner, or progress has been reported fewer than twice in the last 12 months.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Chief executive ISCO 1120 ASF proposal |
Carries accountability to the governing body | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
ENV-FRM-003 ENV-PLN-001 |
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
ENV-FRM-003 ENV-PLN-001 |
E-learning: who must take each course.
| E-learning course | Who must take | Who is recommended |
|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
Manager (ISCO 1342) | Chief executive (ISCO 1120) |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| ENV-FRM-003 · Sustainability Progress Report Form (record) · Quarterly report of progress against the sustainability targets. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| ENV-PLN-001 · Environmental Sustainability Programme Plan · To reduce the facility’s environmental impact through a documented, measured programme covering energy, waste and resource use. |
Chief executive (ISCO 1120) | Governing body members | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
References
- World Health Organization (2024). Safe, climate-resilient and environmentally sustainable health care facilities: an overview. Used for: Sustainable facility programme (4.1). https://news.gmj.ge/guideline/safe-climate-resilient-and-environmentally-sustainable-health-care-facilities-an-overview/
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: Sustainable facility programme (4.1). https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
4.2
Environmental Impact Is Reviewed at Strategic Level
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Facility leadership undertakes a strategic-level review of the facility's environmental impact and the sustainability of how it delivers care — not an assumption that environmental questions are someone else's concern or a problem for another department.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Why it matters. Sustainability decisions made one purchase at a time never add up to a strategy. A strategic review, held by leadership, looks at the facility's whole environmental impact and decides what to change.
How the surveyor verifies this criterion
Sample. Review the leadership environmental review for the last 12 months and the minutes where it was discussed.
1. Leadership reviews environmental impact.
Method. Read the review and check it covers energy, waste and resource use.
Evidence to show. Leadership environmental review record.
Pass when. Review done in the last 12 months, covering all three areas.
2. The review is discussed at leadership level.
Method. Check the minutes where the review was discussed.
Evidence to show. Leadership minutes.
Pass when. Discussed at a leadership meeting with a recorded decision.
3. Decisions are recorded.
Method. Check that decisions from the review have an owner.
Evidence to show. Decision log.
Pass when. At least one decision has an owner and a date.
Immediate fail (any one means the criterion is not met)
- Environmental impact is not reviewed at leadership level in the last 12 months.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. Leadership reviews the facility's environmental impact at least once a year, discusses the review at a leadership meeting, and records its decisions with an owner and a date.
Partial because. A review has been done, but it does not cover every area, or it was not discussed at leadership level, or its decisions have no owner or date.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Chief executive ISCO 1120 ASF proposal |
Carries accountability to the governing body | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
ENV-SOP-004 ENV-FRM-006 |
| Governing body members ASF proposal |
Holds the authority this criterion requires | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
— |
E-learning: who must take each course.
| E-learning course | Who must take | Who is recommended |
|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
Chief executive (ISCO 1120) | Governing body members |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| ENV-SOP-004 · Environmental Impact Review (leadership) Procedure (SOP) · To make sure leadership looks at the facility environmental impact as a whole each year and decides what to change, rather than leaving it to individual purchases or to one department. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| ENV-FRM-006 · Leadership Environmental Review Record Form (record) · Records the annual leadership review of environmental impact, with findings, actions and owners. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
References
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: Leadership review of environmental impact (4.2). https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
4.3
Staff and Patients Are Informed of Sustainability Goals
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The facility's approach to environmentally sustainable care, and its goals in this area, are communicated to staff and patients — not confined to an internal policy document nobody outside senior management ever sees.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Why it matters. Staff and patients can help a sustainability goal only if they know what it is. Communicating the goals in plain words makes the approach something people do, not something on paper.
How the surveyor verifies this criterion
Sample. Review the sustainability communication plan and the notices issued in the last 12 months. Ask 3 staff and 3 patients what the goals are.
1. Goals are communicated to staff.
Method. Check the notices and the induction material.
Evidence to show. Sustainability notice and communication record.
Pass when. Goals were communicated to staff in the last 12 months.
2. Goals are communicated to patients.
Method. Check the patient-facing notices.
Evidence to show. Patient notice (template).
Pass when. A patient-facing notice is on display or in the patient information.
3. Staff and patients can describe the goal.
Method. Ask 3 staff and 3 patients what the facility is trying to do.
Evidence to show. Interview notes.
Pass when. At least 70% of those asked describe one goal correctly.
Immediate fail (any one means the criterion is not met)
- No communication about the sustainability goals reaches staff or patients.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. The sustainability goals are sent to staff and shown to patients in plain words. Each communication is recorded, and most staff and patients who are asked can name one goal.
Partial because. The goals are communicated to staff but not to patients, or fewer than 70% of those asked can describe one goal.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Recommended Transition: Recommended Standard: Recommended |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
ENV-FRM-007 ENV-REG-001 ENV-PLN-002 |
| Secretary ISCO 3344 ASF proposal |
Front desk and records support | Humanitarian: Recommended Transition: Recommended Standard: Recommended |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
ENV-FRM-007 ENV-REG-001 ENV-PLN-002 |
E-learning: who must take each course.
| E-learning course | Who must take | Who is recommended |
|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
None | Manager (ISCO 1342), Secretary (ISCO 3344) |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| ENV-FRM-007 · Staff and Patient Sustainability Notice (template) Form (record) · Template for the plain-language notice of the facility sustainability goals for staff and patients. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| ENV-REG-001 · Sustainability Communication Record Register · Records each communication of the sustainability goals to staff and patients, and the result of any check. |
Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| ENV-PLN-002 · Sustainability Goals and Communication Plan Plan · To make sure staff and patients know the facility sustainability goals in plain words, and can help reach them. |
Chief executive (ISCO 1120) | Governing body members | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
References
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: the facility-level approach and goals for environmentally sustainable care. https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
4.4
Sustainability Progress Is Reported to Governance
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Progress against the facility's environmental sustainability goals is reported to governance on a defined schedule — not tracked informally by whoever happens to care about it, with no visibility at the level that sets institutional priorities.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Why it matters. Goals that are never reported to the people who govern the facility are easily dropped. A set reporting schedule to governance keeps progress visible and acted on.
How the surveyor verifies this criterion
Sample. Review governance minutes and the progress reports for the last 12 months.
1. Progress is reported to governance on a set schedule.
Method. Check the governance minutes for the last 12 months.
Evidence to show. Governance minutes.
Pass when. Reported at least twice a year.
2. The report uses the agreed goals.
Method. Compare the report with the programme goals.
Evidence to show. Sustainability progress report.
Pass when. Each goal in the programme is reported on.
3. Governance responds to the report.
Method. Check the minutes for a decision or question after the report.
Evidence to show. Governance minutes.
Pass when. At least one recorded question or decision followed each report.
Immediate fail (any one means the criterion is not met)
- Sustainability progress is not reported to the governing body in the last 12 months.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. Progress against every goal in the programme is reported to the governing body at least twice a year, and the minutes record a question or a decision after each report.
Partial because. Progress is reported, but less than twice a year, or not for every goal, or the governing body does not respond to the report.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Chief executive ISCO 1120 ASF proposal |
Carries accountability to the governing body | Humanitarian: Essential Transition: Essential Standard: Essential |
Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file | ENV-SOP-005 ENV-FRM-003 |
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Essential Transition: Essential Standard: Essential |
Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file | ENV-SOP-005 ENV-FRM-003 |
E-learning: who must take each course.
No course is required for this criterion. Optional course in the GMJ Academy: Reporting Sustainability Progress to Governance (English).
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| ENV-SOP-005 · Governance Reporting of Sustainability Progress Procedure (SOP) · To make sure progress against the sustainability goals is seen, discussed and acted on by the governing body on a set schedule. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| ENV-FRM-003 · Sustainability Progress Report Form (record) · Quarterly report of progress against the sustainability targets. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
References
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: keeping progress on sustainability goals visible to those who govern the facility (4.4). https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
4.5
Procurement Considers Responsible Stewardship of Resources
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The facility's procurement and supply decisions take environmental and social responsibility into account — reducing wasteful use of supplies, considering supplier environmental practices, and reviewing single-use equipment decisions against patient and staff safety requirements — rather than treating sustainability as irrelevant to purchasing choices.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Why it matters. Purchases carry environmental and social costs: wasteful packaging, disposable products, and suppliers who exploit workers. Procurement that considers these reduces both.
How the surveyor verifies this criterion
Sample. Review the procurement policy and the supplier review records for the last 12 months. Check 5 recent purchase orders.
1. A responsible procurement policy exists.
Method. Read the policy and check its approval date.
Evidence to show. Responsible procurement policy.
Pass when. Approved and includes environmental and social criteria.
2. Suppliers are reviewed against the policy.
Method. Check the supplier review records.
Evidence to show. Supplier review record.
Pass when. At least 70% of the key suppliers were reviewed in the last 12 months.
3. Purchases reflect the policy.
Method. Check the 5 purchase orders for the criteria applied.
Evidence to show. Purchase order extract.
Pass when. At least 70% of the sampled orders show the criteria were applied or the reason is recorded.
Immediate fail (any one means the criterion is not met)
- Purchases are made with no supplier review or stewardship check.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. An approved procurement policy includes environmental and social criteria. Key suppliers are reviewed each year, and purchase orders show that the criteria were applied or why they were not.
Partial because. A policy exists, but fewer than 70% of key suppliers were reviewed in the last 12 months, or fewer than 70% of sampled orders show that the criteria were applied.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Supplier Evaluation and Purchasing (T-13) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
PRC-SOP-001 PRC-FRM-001 |
| Secretary ISCO 3344 ASF proposal |
Front desk and records support | Humanitarian: Essential Transition: Essential Standard: Essential |
Supplier Evaluation and Purchasing (T-13) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
PRC-SOP-001 PRC-FRM-001 PRC-POL-001 |
E-learning: who must take each course.
| E-learning course | Who must take | Who is recommended |
|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
None | Manager (ISCO 1342) |
| Supplier Evaluation and Purchasing (T-13) GMJ Academy: English · Georgian |
Manager (ISCO 1342), Secretary (ISCO 3344) | None |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| PRC-SOP-001 · Procurement Stewardship Review Procedure (SOP) · To give buyers a simple, repeatable way to apply the procurement policy PRC-POL-001 to each purchase. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| PRC-FRM-001 · Supplier Review Record Form (record) · Annual review of each main supplier against environmental and social criteria. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| PRC-POL-001 · Responsible Procurement Policy Policy · To make sure purchasing decisions consider environmental and social responsibility, and that no change to reduce waste compromises patient or staff safety. |
Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
References
- World Health Organization (2023). Sustainable management of radiotherapy facilities and equipment. Used for: Stewardship of equipment and procurement (4.5). https://news.gmj.ge/guideline/sustainable-management-of-radiotherapy-facilities-and-equipment-2/
4.6
Energy Use Is Monitored, With a Move Toward Renewable Sources
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The facility monitors its use of electricity, gas, and other fuel sources, and takes steps toward reducing reliance on fossil fuels where this is practically possible — not energy use left entirely unmeasured and unmanaged as a fixed, unexamined operating cost.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Not assessed (N/A) for: telemedicine, home care.
Why it matters. A facility that does not measure its energy use cannot reduce it. Monitoring electricity, gas and fuel, and taking steps away from the most polluting sources, is the first practical step.
How the surveyor verifies this criterion
Sample. Review the energy use records for the last 12 months and the reduction plan.
1. Energy use is recorded each month.
Method. Check the monthly energy use record for the last 12 months.
Evidence to show. Monthly energy use record.
Pass when. At least 10 of the last 12 months are recorded.
2. A reduction plan exists.
Method. Read the plan and check its last review date.
Evidence to show. Energy reduction and renewable options plan.
Pass when. Plan has at least one measure, an owner and a date, and was reviewed in the last 12 months.
3. Use is compared with the previous year.
Method. Compare the last 12 months with the previous year, or with the first recorded year.
Evidence to show. Energy use record.
Pass when. A comparison is recorded and the trend is reviewed by the owner.
Immediate fail (any one means the criterion is not met)
- Energy use is not monitored in the last 12 months.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. Electricity, gas and fuel use are recorded every month and compared with the previous year. A reduction plan has at least one measure with an owner and a date, and it was reviewed in the last 12 months.
Partial because. Energy use is recorded, but for fewer than 10 of the last 12 months, or it is not compared with the previous year, or the reduction plan has not been reviewed.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
ENV-SOP-006 ENV-FRM-008 ENV-PLN-003 |
E-learning: who must take each course.
| E-learning course | Who must take | Who is recommended |
|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
Manager (ISCO 1342) | None |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| ENV-SOP-006 · Energy Use Monitoring and Reduction Procedure (SOP) · To monitor the facility energy use by source, and to take concrete, safe steps away from fossil fuel reliance where practical. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| ENV-FRM-008 · Monthly Energy Use Record Form (record) · Monthly reading of energy use by source and area, with comparison to last year. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| ENV-PLN-003 · Energy Reduction and Renewable Options Plan Plan · To set and track the concrete steps to reduce energy use and fossil fuel reliance safely. |
Chief executive (ISCO 1120) | Governing body members | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
References
- Pan American Health Organization (2020). Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities. Used for: Energy use in ventilation systems (4.6). https://news.gmj.ge/guideline/recommendations-for-heating-ventilation-and-air-conditioning-in-health-care-facilities/
4.7
A Carbon Footprint Baseline Exists
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The facility has carried out an assessment of its carbon footprint — even based on a minimal dataset such as energy use alone — to establish a baseline for monitoring and reducing greenhouse gas emissions, not treating carbon impact as something too complex to ever measure.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Not assessed (N/A) for: telemedicine, home care.
Why it matters. A carbon footprint shows where a facility's greenhouse emissions come from. It does not need to be perfect; a basic baseline from energy and travel data is enough to start measuring change.
How the surveyor verifies this criterion
Sample. Review the carbon footprint baseline record and the method used.
1. A baseline assessment exists.
Method. Read the baseline record and check the date and the data used.
Evidence to show. Carbon footprint baseline record.
Pass when. Baseline is recorded with a date and a stated method.
2. The method is written down.
Method. Read the method and check it can be repeated.
Evidence to show. Baseline method (SOP).
Pass when. Method is approved and states its data sources and limits.
3. The baseline is used for monitoring.
Method. Check whether the baseline is compared with later data.
Evidence to show. Carbon footprint record.
Pass when. The baseline has been compared with at least one later period, or a plan to do so has an owner and a date.
Immediate fail (any one means the criterion is not met)
- No carbon footprint baseline exists.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. A dated carbon footprint baseline is recorded, with an approved method that states its data sources and limits. The baseline has been compared with a later period, or a plan to do so has an owner and a date.
Partial because. A baseline figure exists, but the method is not written down, or there is no later comparison and no plan to make one.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Recommended Transition: Recommended Standard: Recommended |
Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file | ENV-SOP-007 ENV-FRM-009 |
E-learning: who must take each course.
No course is required for this criterion. Optional course in the GMJ Academy: Carbon Footprint Baseline for Healthcare Facilities (English).
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| ENV-SOP-007 · Carbon Footprint Baseline Method Procedure (SOP) · To establish a dated carbon footprint baseline, using a documented method, so change can be measured over time. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| ENV-FRM-009 · Carbon Footprint Baseline Record Form (record) · Records the dated carbon footprint baseline, its method, data sources and any repeat. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
References
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: Carbon footprint and environmental baseline (4.7). https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
4.8
The Facility Plans for Environmental and Climate Resilience
Humanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The facility considers its resilience to major environmental, climate, or health emergencies that could disrupt service delivery — heatwaves, flooding, extreme storms, pandemic outbreaks — and plans a range of actions in response, not assuming such disruptions are too remote to prepare for.
Rating: Minimum in humanitarian settings; Medium in transition and fragile settings; Must in standard settings.
Not assessed (N/A) for: telemedicine, home care.
Why it matters. Floods, heatwaves, power cuts and disease outbreaks can stop a facility from working. Thinking ahead about how the service would keep running is part of keeping patients safe.
How the surveyor verifies this criterion
Sample. Review the climate and health emergency risk assessment, the continuity plan and the test records for the last 12 months.
1. Climate and health risks are assessed.
Method. Read the risk assessment and check it covers heat, flooding and other local hazards.
Evidence to show. Climate and health emergency risk assessment.
Pass when. Assessment covers at least two local hazards and is dated within the last 2 years.
2. A continuity plan exists.
Method. Read the plan and check it links to the assessment.
Evidence to show. Climate and health emergency continuity plan.
Pass when. Plan links each hazard to a continuity action and an owner.
3. The plan is tested.
Method. Check the continuity test record for the last 12 months.
Evidence to show. Continuity test record.
Pass when. At least one test in the last 12 months with a recorded result and actions.
Immediate fail (any one means the criterion is not met)
- No climate and health emergency plan exists, or no continuity test is recorded.
Staff, training and documents
Each occupation carries its ISCO-08 code. Each row is one document: read across to see who does each step. Training evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or your own training certificate kept in the staff file.
Good practice. A risk assessment less than two years old covers at least two local hazards. The continuity plan links each hazard to an action and an owner, and the plan was tested in the last 12 months with the result and actions recorded.
Partial because. A plan exists and has been tested, but the risk assessment is more than two years old, or some hazards are not linked to an action and an owner.
Staff responsible
| Role | Why it applies | Level | Training | Documents |
|---|---|---|---|---|
| Chief executive ISCO 1120 ASF proposal |
Carries accountability to the governing body | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
FAC-SOP-003 FAC-FRM-003 FAC-PLN-002 |
| Manager ISCO 1342 ASF proposal |
Runs the facility process this criterion measures | Humanitarian: Essential Transition: Essential Standard: Essential |
Environmental Sustainability Standards for ASF Accreditation (ENV-001) Evidence: a verified micro-credential in your GMJ Academy micro-credential portfolio, or a training certificate in the staff file |
FAC-SOP-003 FAC-FRM-003 FAC-PLN-002 |
E-learning: who must take each course.
| E-learning course | Who must take | Who is recommended |
|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
Manager (ISCO 1342) | Chief executive (ISCO 1120) |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| FAC-SOP-003 · Climate and Health Emergency Risk Assessment Procedure (SOP) · To identify climate and health emergencies that could disrupt services, and to plan how the service keeps running. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| FAC-FRM-003 · Continuity Test Record Form (record) · Records each test of the climate and health emergency continuity plan, the gaps found and the actions. |
Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| FAC-PLN-002 · Climate and Health Emergency Continuity Plan Plan · To keep essential services running and patients safe during a climate or health emergency. |
Chief executive (ISCO 1120) | Governing body members | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
References
- World Health Organization (2024). Safe, climate-resilient and environmentally sustainable health care facilities: an overview. Used for: Climate-resilient facilities and continuity (4.8). https://news.gmj.ge/guideline/safe-climate-resilient-and-environmentally-sustainable-health-care-facilities-an-overview/
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: Climate and health emergency planning (4.8). https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
Role details: reporting, supervision and training
Each role links to its own terms of reference, which holds the full reporting line, supervision, training and competency record.
| Role | Reports to | Supervises | Core training |
|---|---|---|---|
| Chief executive ISCO 1120 | The board of directors. | The executive team (COO, CMO, CNO, CFO, CQO, CHRO, CIO, CSO), and the legal, data protection, compliance and communications leads. | Environmental Sustainability Standards for ASF Accreditation (ENV-001) |
| Governing body members | Shareholders or owners of the organisation. | The chief executive officer. The board chair leads the board. | Environmental Sustainability Standards for ASF Accreditation (ENV-001) |
| Manager ISCO 1342 | The chief operating officer (COO). | Biomedical engineer, maintenance supervisor, groundskeeper, space planner and waste management officer. | Environmental Sustainability Standards for ASF Accreditation (ENV-001) Supplier Evaluation and Purchasing (T-13) |
| Secretary ISCO 3344 | The head of department (per specialty). | No direct reports. | Environmental Sustainability Standards for ASF Accreditation (ENV-001) Supplier Evaluation and Purchasing (T-13) |
Who is responsible for Standard 4
Each criterion below names the positions responsible for it.
| Criterion | Positions responsible or involved | |
|---|---|---|
| 4.1 | An Environmental Sustainability Programme Is Active | Chief executive · Manager |
| 4.2 | Environmental Impact Is Reviewed at Strategic Level | Chief executive · Governing body members |
| 4.3 | Staff and Patients Are Informed of Sustainability Goals | Manager · Secretary |
| 4.4 | Sustainability Progress Is Reported to Governance | Chief executive · Manager |
| 4.5 | Procurement Considers Responsible Stewardship of Resources | Manager · Secretary |
| 4.6 | Energy Use Is Monitored, With a Move Toward Renewable Sources | Manager |
| 4.7 | A Carbon Footprint Baseline Exists | Manager |
| 4.8 | The Facility Plans for Environmental and Climate Resilience | Chief executive · Manager |
Quality oversight
The quality chain keeps this standard under review, from the governing body down to the teams that run each process.
Questions and answers
The criterion text is the authority. These answers summarise it.
Do I need to meet every criterion in Standard 4?
You must meet every criterion that applies to your facility type. Standard 4 is a core standard. Criteria 4.1 to 4.5 apply to all nine facility types. Criteria 4.6 to 4.8, on energy use, the carbon footprint baseline and climate resilience, are marked N/A for telemedicine and home care services. The table at the top of this page shows each criterion by facility type. Each criterion that applies has its own pass rule and its own immediate-fail rule, so each one must be met on its own.
What is an immediate fail?
An immediate fail is one event or finding that means a criterion is not met, even if everything else in that criterion is in place. For example, if sustainability progress has not been reported to the governing body in the last 12 months, criterion 4.4 fails outright, however good the programme itself is. Each criterion on this page lists its own immediate fail under “Immediate fail”. Facilities should read these before the survey, because they are the points on which the outcome is decided most quickly.
Which documents do I submit?
The documents are the plans, procedures, forms and policies listed under each criterion in the “Documents: who does each step” table. Records, such as the Monthly Energy Use Record (ENV-FRM-008) or the Supplier Review Record (PRC-FRM-001), are kept as working files with one entry for each month or supplier. Plans, procedures and policies are signed documents that show the version, date, owner and approver. Upload or have them ready before the survey, and check that each one covers the period stated in its criterion, usually the last 12 months. You may use your own document if it meets the same check, as long as it is clearly the same record.
We are a small facility with few resources. How much is expected?
The rating depends on your setting. Every criterion in Standard 4 is Minimum in humanitarian settings, Medium in transition and fragile settings, and Must in standard settings. The criteria are also written to be achievable: the carbon footprint baseline may rest on a minimal dataset such as energy use alone, and the move away from fossil fuels is expected only where it is practically possible. What is not accepted is a general statement of environmental awareness with no plan, no figures and no owner.
What must the sustainability programme contain?
The programme (ENV-PLN-001) must be written and approved, cover energy use, waste reduction and resource consumption, set targets and name an owner. Progress is tracked on the Sustainability Progress Report (ENV-FRM-003). The surveyor reviews the programme and the reports for the last 12 months, and looks for at least two progress reports with figures against targets and at least one action taken after the last report. If there is no programme, or no written plan, criterion 4.1 fails immediately.
What is the leadership review of environmental impact?
Once a year, facility leadership looks at the environmental impact of the facility as a whole and decides what to change, instead of leaving the question to one department. The procedure is ENV-SOP-004, and the review is recorded on the Leadership Environmental Review Record (ENV-FRM-006). The surveyor checks that a review was done in the last 12 months, that it was discussed at a leadership meeting, and that at least one decision has an owner and a date. If leadership has not reviewed environmental impact in the last 12 months, criterion 4.2 fails immediately.
How do we inform staff and patients about our goals?
The goals must reach people outside senior management, in plain words. The Sustainability Goals and Communication Plan (ENV-PLN-002) sets out how, the notice template (ENV-FRM-007) is used for staff and patients, and each communication is recorded on the Sustainability Communication Record (ENV-REG-001). A patient notice should be on display or in the patient information. On the day, the surveyor asks three staff and three patients what the goals are, and at least 70% of them should be able to describe one goal correctly.
How often must progress be reported to governance?
At least twice a year. The report must cover each goal in the programme, not a selection, and it uses the Sustainability Progress Report (ENV-FRM-003) under the governance reporting procedure (ENV-SOP-005). The surveyor reads the governing body minutes for the last 12 months and looks for a recorded question or decision after each report, because a report that is tabled and not discussed does not show that governance is following progress.
What does responsible procurement mean in practice?
It means that purchasing decisions consider environmental and social responsibility: reducing wasteful use of supplies, looking at how suppliers behave, and reviewing single-use items against patient and staff safety. No change made to reduce waste may compromise safety. The Responsible Procurement Policy (PRC-POL-001) sets the criteria, the stewardship review (PRC-SOP-001) applies them to purchases, and the Supplier Review Record (PRC-FRM-001) records the review of each main supplier. The surveyor checks five recent purchase orders. At least 70% of key suppliers should have been reviewed in the last 12 months, and at least 70% of the sampled orders should show that the criteria were applied or give the reason why not.
How should we monitor energy use?
Record the use of electricity, gas and other fuel every month on the Monthly Energy Use Record (ENV-FRM-008), and compare it with the same period in the previous year. At least 10 of the last 12 months must be recorded. The Energy Reduction and Renewable Options Plan (ENV-PLN-003) must contain at least one measure with an owner and a date, and must have been reviewed in the last 12 months. The procedure is ENV-SOP-006. If energy use has not been monitored in the last 12 months, criterion 4.6 fails immediately.
How detailed must the carbon footprint be?
It does not need to be complete. A baseline built from a minimal dataset, such as energy use alone, is accepted. What matters is that the baseline is dated, that the method is written down and approved (ENV-SOP-007), and that the method states its data sources and its limits. The baseline is recorded on the Carbon Footprint Baseline Record (ENV-FRM-009). It should then be used: compared with at least one later period, or with a plan to do so that has an owner and a date. If no baseline exists, criterion 4.7 fails immediately.
What must the climate and health emergency plan cover?
First, a risk assessment (FAC-SOP-003), dated within the last two years, that covers at least two hazards relevant to your location, such as heatwaves, flooding, storms, power cuts or disease outbreaks. Second, a continuity plan (FAC-PLN-002) that links each hazard to a continuity action and an owner. Third, at least one test of the plan in the last 12 months, recorded on the Continuity Test Record (FAC-FRM-003) with the result and the actions that followed. If there is no plan, or no test on record, criterion 4.8 fails immediately.
What do the colours mean?
Red means Must: the criterion is required in every setting, and criteria that protect life are always red. Yellow means Medium: the criterion is required, but adapted to what a transition setting can realistically do. Green means Minimum: the lowest acceptable level in a humanitarian setting, where resources are very limited. In standard settings every criterion is Must. Each criterion shows its rating for each of the three settings, so a facility can see exactly what applies to it.
Do we have to use your forms and policies?
No. Every policy, procedure, form and course on this page is a reference draft to help you meet the criterion. You can adapt it to your facility, write your own, or upload your own documents. What the assessor checks is that the standard is met and that you can show how. If you use your own document, make sure it covers the same content as the reference and that it is current, signed and dated, so that the assessor can match it to the criterion without difficulty.
What does essential or recommended training mean for my staff?
In the training tables, red means essential: the course is required for that role in that setting. Green means recommended: the course is advised for that role. Yellow means optional. Each course shows its level for humanitarian, transition and fragile, and standard settings, because the requirement can differ between them. Staff evidence is a verified micro-credential in the GMJ Academy micro-credential portfolio, or a training certificate kept in the staff file.
Do we have to use ISCO-08 codes?
The staff tables give each occupation its ISCO-08 code, so that roles can be compared between facilities and countries. You are not required to change your job titles. What matters is that each role named in the standard can be matched to the person who does that job and to the training they have had. If your titles differ, record the match in your staff file so that the assessor can follow it.
Which training do staff need?
The e-learning table under each criterion shows who must take each course and who is recommended. Two criteria, 4.4 and 4.7, name no required course; an optional academy course is shown there instead. The table is read together with the staff table, which shows the level for each setting. Each course name opens the course page in the GMJ Academy. Staff can show evidence through a verified micro-credential in the GMJ Academy micro-credential portfolio, or through a training certificate kept in the staff file.
What will the surveyor see on the day?
The surveyor works through the criteria, following the “Sample” and the checks given for each one. Most of Standard 4 is checked from records for the last 12 months: the programme and its progress reports, the leadership review and minutes, governing body minutes, supplier reviews, energy records, the carbon baseline, and the continuity plan and its test. The surveyor also checks five recent purchase orders, looks for the patient notice, and asks three staff and three patients what the sustainability goals are. The surveyor records whether each check is passed and whether any immediate-fail rule applies.
How does the surveyor choose which records to check?
Each criterion states its own sample, such as “Review the energy use records for the last 12 months and the reduction plan” or “Check 5 recent purchase orders”. The surveyor uses the sample given on the criterion rather than choosing records to suit the facility. Preparing for the survey means keeping the records for the whole period stated, organised so that any item in the sample can be produced quickly. A facility that cannot produce the sampled records loses the criterion, whatever else it has in place.
What if we do not have the written protocol yet?
A criterion cannot be met on the basis of an unwritten or informal arrangement, because the assessor needs something to check against. If a protocol does not yet exist, write one before the survey, using the reference draft or your own version, and make sure it is signed, dated and in use. Staff must be able to explain it in practice.
Where can I get the full text?
The full text of each criterion, with its rating, why it matters, the assessor checks, the immediate-fail rule and the documents, is on this page. A PDF with the same criteria, for printing and for assessors, can be downloaded from the box at the top of this page. The questions and answers on this page summarise the criteria, and if they ever differ, the criterion text is the authority.
Who can I ask about this standard?
For questions about this standard, contact Accréditation Sans Frontières through the Contact page of this website. Please give the standard number and the criterion (for example 4.6) so that your question can be answered against the right text.
E-learning by standard
These are the GMJ Academy courses named in the criteria of this standard. Each course name opens the course page in the academy. Where a course is published in English and in Georgian, both versions are linked. Evidence of completion is a verified micro-credential in the GMJ Academy micro-credential portfolio, or a training certificate in the staff file.
| E-learning course | Who must take | Who is recommended | Criteria |
|---|---|---|---|
| Environmental Sustainability Standards for ASF Accreditation (ENV-001) GMJ Academy: English · Georgian |
Manager (ISCO 1342), Chief executive (ISCO 1120) | Governing body members, Secretary (ISCO 3344) | 4.1, 4.2, 4.3, 4.5, 4.6, 4.8 |
| Supplier Evaluation and Purchasing (T-13) GMJ Academy: English · Georgian |
Manager (ISCO 1342), Secretary (ISCO 3344) | None | 4.5 |
Related courses in the GMJ Academy
These courses cover the same subjects in more depth or for a specific type of facility. They are optional. They are not required by the criteria.
| Course | Subject | Criteria |
|---|---|---|
| Sustainable Care in the Laboratory Setting (LAB-11) GMJ Academy: English · Georgian |
Sustainable care for your type of service | 4.1 |
| Sustainable Care: ASF Accreditation Training (MT-09) GMJ Academy: English · Georgian |
Sustainable care for your type of service | 4.1 |
| Sustainable Care in Fitness and Wellness Settings (FIT-11) GMJ Academy: English · Georgian |
Sustainable care for your type of service | 4.1 |
| მდგრადი დახმარება ტელემედიცინაში (TELE-09) GMJ Academy: Georgian |
Sustainable care for your type of service | 4.1 |
| Healthcare Waste Management (PS-08) GMJ Academy: English · Georgian |
Waste reduction and safe waste handling | 4.1 |
| Management Review: Inputs, Outputs, and Real Decisions (T-05) GMJ Academy: English · Georgian |
Leadership and management review | 4.2 |
| Reporting Sustainability Progress to Governance (SUS-01) GMJ Academy: English |
Reporting sustainability progress to governance | 4.4 |
| Carbon Footprint Baseline for Healthcare Facilities (SUS-02) GMJ Academy: English |
Carbon footprint baseline | 4.7 |
| Environmental and Climate Resilience Planning (SUS-03) GMJ Academy: English |
Climate resilience and emergency planning | 4.8 |
| Emergency Preparedness and Fire Safety (T-10) GMJ Academy: English · Georgian |
Climate resilience and emergency planning | 4.8 |
Back to ASF Health Standards V11 · Standards Map · E-learning by standard · References
References and guidelines for this standard
The guidelines and references cited in the criteria above are listed here. Each link opens the full text.
- World Health Organization (2024). Safe, climate-resilient and environmentally sustainable health care facilities: an overview. Used for: Sustainable facility programme (4.1). https://news.gmj.ge/guideline/safe-climate-resilient-and-environmentally-sustainable-health-care-facilities-an-overview/
- World Health Organization (2020). Guidance for climate-resilient and environmentally sustainable health care facilities. Used for: Sustainable facility programme (4.1). https://news.gmj.ge/guideline/guidance-for-climate-resilient-and-environmentally-sustainable-health-care-facilities/
- World Health Organization (2023). Sustainable management of radiotherapy facilities and equipment. Used for: Stewardship of equipment and procurement (4.5). https://news.gmj.ge/guideline/sustainable-management-of-radiotherapy-facilities-and-equipment-2/
- Pan American Health Organization (2020). Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities. Used for: Energy use in ventilation systems (4.6). https://news.gmj.ge/guideline/recommendations-for-heating-ventilation-and-air-conditioning-in-health-care-facilities/