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