DOH-BCU-ATO-ATRevision:0204/13/2015ASSESSMENT TOOL FOR LICENSING
A BLOOD COLLECTION UNITName of Blood Colle!ion Uni!: Add"ess:N#m$e"
% &!"ee! Ba"an'a(/ )#nii*ali!(+"ovine/Ci!( Re'ionCon!a! No,/-a.
No,//-mail Add"ess: A**lia!ion fo": 0ni!ialRene1al ATO No:Da!e
0ss#ed:222222222222 /.*i"( Da!e: 222222222222GENERAL
INFORMATION:Name of O1ne" o" 0ns!i!#!ion: Name of Head of Blood
Colle!ion Uni!:Classifia!ion ao"din' !o:O1ne"s3i*: 4ove"nmen!
+"iva!e0ns!i!#!ional C3a"a!e": Hos*i!al-$ased Non
3os*i!al-$asedInstructions:(1) Encircle () i! ite" in#ic$te# is
%resent& $n# (') i! ite" in#ic$te# is $(sent) %resent (ut
non'!unction$l*(+) All ite"s ,it- (.) s-$ll (e %oste# in $
cons%icuousl/ #esi0n$te# $re$*(1) T-is tool "$/ ser2e $s $ 0ui#e
!or sel!'$ssess"ent o! t-e !$cilit/ in %re%$r$tion !or
ins%ection)"onitorin0 2isits*+a'e 1 of 13Re%u(lic o! t-e
4-ili%%inesDe%$rt"ent o! 5e$lt-5EALT5 FACILITIES AND SER6ICES
REGULATOR7 BUREAUDOH-BCU-ATO-ATRevision:0204/13/2015STANDARDS AND
RE8UIREMENTS REFERENCE FINDINGSA %%li c$ t ionD oc u"e nts5
Docu"ent$r/ re9uire"ents co"%lete (re!er to $%%lic$tion)5
Certi!ic$tes 2$li# $n# re9uire# !or"s #ul/ $cco"%lis-e#(re!er to
$%%lic$tion)678 6-8 678 6-81*MA NA GE ME NTR E 8UIR EME N TS1*1*M$
n$ 0e "e nt Res %onsi(il it
/T-eBloo#CollectionUnits-$ll(e"$n$0e#e!!ecti2el/ $n#e!!icientl/
$n#in$ccor#$nce,it-its2ision&"ission&$n#o(:ecti2es*1*1*1*T-eres-$ll(e$continuin0%ro0r$"onst$!!#e2elo%"ent
$n#
tr$inin0*1,1,1,1,+"oofof!"ainin'!3"o#'3"elevan!e"!ifia!es9memos91"i!!en
"e*o"!s9 $#d'e!a"( alloa!ions9 e!,1*1*+*T-ere s-$ll (e $ %olic/ !or
-irin0& orient$tion $n# %ro"otion !or $ll le2els o!
%ersonnel*1,1,2,1,Do#men!ed*"oed#"e/*"oesson3i"in'9o"ien!a!ionand
*"omo!ion of *e"sonnel a! all levels1*1*1*T-ere s-$ll (e $ %olic/
!or #isci%line& sus%ension& #e"otion $n# ter"in$tion o!
%ersonnel $t $ll le2els*1,1,3,1,
Do#men!ed*"oed#"e/*"oessondisi*line9s#s*ension9demo!ionand!e"mina!ionof*e"sonnela!all
levels6786-86786-86786-8+a'e + of
13DOH-BCU-ATO-ATRevision:0204/13/2015STANDARDS AND RE8UIREMENTS
REFERENCE FINDINGS1*+*M$ n%o ,erT-e Bloo# Collection Unit s-$ll
$%%oint $n# $lloc$te %ersonnel
,-o$resuit$(l/9u$li!ie#&s;ille#$n#)ortr$ine#to$ssu"et-eres%onsi(ilities&
$ut-orit/&$ccount$(ilit/&$n#!unctionso!t-e%osition*1*+*1*T-e
or0$ni*T-eres-$ll(esu!!icientnu"(ero!9u$li!ie#%-le(oto"istseit-er"e#ic$ltec-nolo0istornurse,-os-$ll,or;#urin0re"ote
or in'-ouse (loo# #on$tion*1,2,5,1,A! leas! 3 mon!3s on-!3e->o$
e.*e"iene in $lood$an of
13DOH-BCU-ATO-ATRevision:0204/13/2015STANDARDS AND RE8UIREMENTS
REFERENCE FINDINGS1*>*1*T-ere is$%%ro%ri$te stor$0e $re$)
tec-ni9ue !or!l$""$(le& co"(usti(le $n# -$
