Standards › Standard 11 › Forms
Form · PRO-FRM-005 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 11 (Procedure Units), criterion 11.7
Purpose
Records the observed sterile technique at each injection and procedure.
How to complete
- Observe each practitioner each month.
- Record each step observed.
- Record each gap and its action.
Checks
| Check | Entry |
|---|---|
| Hand hygiene before procedure | Yes |
| Sterile field prepared | Yes |
| Single-use items used once only | Yes |
| Gloves and PPE as required | Yes |
| Gap found and action | Yes or N/A |
| Observer and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Guidelines on Hand Hygiene in Health Care (2009) and the WHO Guidelines for Safe Surgical Care (2016). |
| 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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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)