1-7
- Distances and times to mission/training sites:
Site Kilometers Drive Time Fly Time
a.b.c.- Type of cases referred to other hospitals:
a.b.- Name of other referral hospitals:
Name Location Phone # POC
a.b.c.Operational Issues: General Medical Site Survey Checklist
Date:
Village:
Grid:
Map sheet:
- Village leader’s name:
- Population information
a. Number of infants:b. Number of children:c. Number of adults:d. Total:- General information.
a. Description of living conditions