APPENDIX A: Assessment Summary Sheet

Please complete this form for each separate facility visited during the assessment (circle your rating for each item).

Name of Institution: ____________________________________________________
Name of Facility: ____________________________________________________
Date of Assessment: ____________________________________________________

 

  Poor .................... Excellent
1. a) Overall functioning of the ACC 1 2 3 4 5
b) Quality of documentation 1 2 3 4 5
c) Protocol review process 1 2 3 4 5
2. Animal holding facilities maintenance 1 2 3 4 5
3. Animal care and management practice 1 2 3 4 5
4. Veterinary care program 1 2 3 4 5
5. Continuing education/training programs 1 2 3 4 5

 

Please comment if any rating(s) given is/are less than 2:

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________