HC-FRM-010: Supervisory visit record

Standards › Standard 29 › Forms

Form · HC-FRM-010 · Version 1.0 · Approved by the ASF Expert Committee

Supports: 29.28

Purpose

Records each supervisory visit with objective, measurable observations that another reviewer can compare.

How to complete

• Record the visit date and who was present.
• Record measured observations, not general statements.
• Record the change to the care plan, if any.

Checks

Check	Entry
Visit date and present (supervisor, caregiver)	Yes
Measured observations (score, count, time)	Yes
Care observed directly (yes or no)	Yes
Change to care plan (yes or no)	Yes

Evidence

Reference	Note
E-006	ASF Policy Framework v1.2. Adapted.
E-009	ASF Expert Committee consensus.

Change history

Version	Date	What changed	Approval
1.0	—	Initial release	Approved by the ASF Expert Committee

E-learning for this document

• Governance & Staffing for Home-Based Care (HC-07)

References

• Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
• Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 29. (E-009)