Standards › Standard 13 › Forms
Form · MOB-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 13 (Mobile Clinic and Outreach), criterion 13.1
Purpose
Records the safety, access, privacy, infection control and facility checks for each site.
How to complete
- Complete before the first session.
- Record each failed item and its fix.
- Sign and date.
Checks
| Check | Entry |
|---|---|
| Safe ground and shelter for the unit | Yes |
| Access by road and for patients | Yes |
| Privacy for consultations | Yes |
| Hand washing and waste disposal | Yes |
| Power, water and waste facilities | Yes |
| Failed item and fix (or none) | Yes |
| Signed by outreach lead, date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the Sphere Handbook, Humanitarian Charter and Minimum Standards in Humanitarian Response (2018). |
| 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 |
E-learning for this document
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References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)