APS

Kayakalp Clean Hospitals Awards 2019

Checklist for Assessment( DH, SDH and CHC)

The Cleanliness Score Card

Name of Facility Level of Assessment

50.0%
Grading Improvement

Thematic Scores

A. Hospital Upkeep B. Sanitation & Hygiene E. Support Services

50 50 25

C. Waste Management D. Infection Control F. Hygiene Promotion

50 50 25

G. Beyond Hospital
Boundary

50
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t Method

A. HOSPITAL / FACILITY UPKEEP

A1 Pest & Animal Control 5

A1.1 No stray animals within the facility OB/SI Observe for the presence of stray animals 1
premises such as dogs, cats, cattle, pigs, etc. within
the premises. Also discuss with the facility
staff.

A1.2 Cattle-trap is installed at the OB Check at the entrance of facility that cattle 1
entrance trap has been provided. Also look at the
breach, if any, in the boundary wall

A1.3 Pest Control Measures are SI/RR Ask the facility administration about pest 1
implemented in the facility control measures to control rodents and
insect. Check records of engaging a
professional agency for the same

A1.4 Anti-termite Treatment of the RR/SI Check if the facility has a scheduled 1
wooden furniture and fixtures is programme for anti-termite treatment at
undertaken periodically least once in a year

A1.5 Measures for Mosquito free OB/SI /PI Check for 1

environment are in place a. Usage of Mosquito nets by the
patients b.
Availability of adequate stock of Mosquito
nets c. Wire
Mesh in windows d.
Desert Coolers (if in use) are cleaned
regularly/ oil is sprinkled
e. No water collection for mosquito
breeding within the premises

A2 Landscaping & Gardening 5

A2.1 Facility’s front area is landscaped OB Frontage of the facility has been maintained 1
with grass beds, trees, Garden, etc. and it
has an aesthetic appearance

A2.2 Green Areas/ Parks/ Open spaces OB Check that wild vegetation does not exist. 1
are well maintained Shrubs and Trees are well maintained. Over
grown branches of plants/ tree have been
trimmed regularly.
Dry leaves and green waste are removed
on daily basis.

A2.3 Internal Roads, Pathways, waiting OB Check that pathways, corridors, courtyards, 1
area, etc. are even and clean waiting area, etc. are clean and land
landscaped.

A2.4 Gardens/ green area are secured OB Barricades, fence, wire mesh, Railings, 1
with fence Gates, etc. have been provided for the
green area.

A 2.5 Provision of Herbal Garden OB/SI Check if the facility maintains a herbal 1
garden for the medicinal plants

A3 Maintenance of Open Areas 5

A3.1 There is no abandoned / dilapidated OB Check for presence of any ‘abandoned 1

building within the premises building’ within the facility premises

A3.2 No water logging in open areas OB Check for water accumulation in open areas 1
because of faulty drainage, leakage from
the pipes, etc.

A 3.3 No thoroughfare / general traffic in OB/ SI Check that the facility premises are not 1
hospital premises being used as ‘thoroughfare’ by the general
public

A3.4 Open areas are well maintained OB Check that there is no over grown shrubs, 1
weeds, grass, potholes, bumps etc. in open
areas
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A3.5 There is no unauthorised occupation OB/SI Check for hospital premises and access road 1
within the facility, nor there is have not been encroached by the vendors,
encroachment on Hospital land unauthorized shops/ occupants, etc.

A4 Hospital / Facility Appearance 5

A4.1 Walls are well-plastered and painted OB Check that wall plaster is not chipped-off 1
and the building is painted/ whitewashed in
uniform colour and Paint has not faded
away.

A4.2 Interior of patient care areas are OB Interior walls and roof of the outdoor and 1
plastered & painted indoor area are plastered and painted in
soothing colour. The Paint has not faded
away.

A4.3 Name of the hospital is prominently OB Name of the Hospital is prominently 1

displayed at the entrance displayed as per state’s policy and
convenience of beneficiaries. The name
board of the facility is well illuminated in
night

A4.4 Uniform signage system in the OB All signage's (directional & departmental) 1
Hospital are in local language and follow uniform
colour scheme.

A 4.5 No unwanted/Outdated posters OB Check, that facility’s external and internal 1

walls are not studded with irrelevant and
out dated posters, slogans, wall writings,
graffiti, etc.

A5 Infrastructure Maintenance 5

A5.1 Hospital Infrastructure is well OB No major cracks, seepage, chipped plaster 1

maintained & floors in the hospital

A5.2 Hospital has a system for periodic SI/RR Check the records for preventive 1
maintenance of infrastructure at maintenance of the building. It should be
pre-defined interval done at least annually.

A5.3 Electric wiring and Fittings are OB Check to ensure that there are no loose 1
maintained hanging wires, open or broken electricity
panels

A5.4 Hospital has intact boundary wall OB Check that there is a proper boundary wall 1
and functional gates at entry of adequate height without any breach.
Wall is painted in uniform colour

A.5.5 Hospital has adequate facility for OB Check that there is a demarcated space for 1
parking of vehicles parking of the vehicles as well as for the
Ambulances and vehicles are parked
systematically

A6 Illumination 5

A6.1 Adequate illumination in Circulation OB Check for Adequate lighting arrangements 1

Area through Natural Light or Electric Bulbs.

A6.2 Adequate illumination in Indoor OB Check for Adequate lighting arrangements 1

Areas through Natural Light or Electric Bulbs. The
illumination should be 150-300 Lux at
Nursing station and 100 Lux in the wards

A6.3 Adequate illumination in Procedure OB Check for Adequate lighting arrangements 1

Areas (Labour Room/ OT) The illumination should be 300 Lux in
procedure areas. Toilets should have at
least 100 lux light.

A6.4 Adequate illumination in front of OB Check that hospital front, entry gate and 1
hospital and access road access road are well illuminated

A6.5 Use of energy efficient bulbs OB Check that hospital uses energy efficient 1
bulb like CFL or LED for lighting purpose
within the Hospital Premises

A7 Maintenance of Furniture & Fixture 5

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A7.1 Window and doors are maintained OB Check, if Window panes are intact, and 1
provided with Grill/ Wire Meshwork. Doors
are intact and painted /varnished

A7.2 Patient Beds & Mattresses are in OB Check that Patient beds are not rusted and 1
good condition are painted. Mattresses are clean and not
torn

A7.3 Trolleys, Stretchers, Wheel Chairs, OB Check that Trolleys, Stretcher, wheel chairs 1
etc. are well maintained are intact, painted and clean. Wheels of
stretcher and wheel chair are aligned and
properly lubricated

A7.4 Furniture at the nursing station, staff OB Check the condition of furniture at nursing 1
room, administrative office are station, duty room, office, etc. The furniture
maintained is not broken, painted/polished and clean.

A7.5 There is a system of preventive SI/RR Check if hospital has an annual preventive 1
maintenance of furniture and maintenance programme for furniture and
fixtures fixtures, at least once in a year.

A8 Removal of Junk Material 5

A8.1 No junk material in patient care OB Check if unused/ condemned articles, and 1
areas outdated records are kept in the Nursing
stations, OPD clinics, wards, etc.

A8.2 No junk material in Open Areas and OB Check, if unused/ condemned equipment, 1
corridors vehicles, etc. are kept in the corridors,
pathways, under the stairs, open areas, roof
tops, balcony, etc.

A8.3 No junk material in critical service OB Check if unused articles, and old records are 1
area kept in the Labour room, OT, Injection
room, Dressing room etc.

A8.4 Hospital has demarcated space for OB/SI Check for availability of a demarcated & 1
keeping condemned junk material secured space for collecting and storing the
junk material before its disposal

A8.5 Hospital has documented and SI/RR Check if Hospital has drafted its 1
implemented Condemnation policy condemnation policy or have got one from
the state. Check whether they are
complying with it

A9 Water Conservation 5

A9.1 Water supply is adequate in OB/SI/RR Check the quantity of water including 1
Quantity & Quality reservoir and record of its quality

A9.2 Water supply system is maintained OB Check for leaking taps, pipes, over-flowing 1
in the Hospital tanks and dysfunctional cisterns

A9.3 There is a system of periodical OB Check if staff have been assigned duty for 1
inspection for water wastage periodical inspection of leaking taps, etc.

A9.4 Hospital promotes water SI/OB Check if IEC material is displayed for water 1
conservation conservation, and staff & users are made
aware of its importance

A 9.5 Hospital has a functional rain water OB/SI Check if Hospital Infrastructure and drain 1
harvesting system system are fitted with rain water harvesting
system with sufficient storage capacity

A10 Work Place Management 5

A10.1 Staff periodically sort useful and SI/OB Ask the staff, how frequently they sort and 1
unnecessary articles at work station remove unnecessary articles from their
work place like Nursing stations, work
bench, dispensing counter in Pharmacy, etc.
Check for presence of unnecessary articles.
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t Method

A10.2 The Staff arrange the useful articles, SI/OB Check if drugs, instruments, records are not 1
records in systematic manner lying in haphazard manner and kept near to
point of use in arranged manner. The place
has been demarcated for keeping different
articles

A10.3 Staff label the articles in identifiable SI/OB Check that drugs, instruments, records, etc. 1
manner are labelled for facilitating easy
identification.

A10.4 Work stations are clean and free of SI/OB Check that nursing station, dispensing 1
dirt/dust counter, lab benches, etc. are clean and
shining

A10.5 Staff has been trained for work place SI/RR Check, if the facility staff has got any 1
management formal/hands on training for managing the
workplace (e. g.5’s’)

B Sanitation & Hygiene

B1 Cleanliness of Circulation Area 5

B1.1 No dirt/Grease/Stains in the OB Check that floors and walls of Corridors, 1

Circulation area Waiting area, stairs, roof top for any visible
or tangible dirt, grease, stains, etc.

B1.2 No Cobwebs/Bird Nest/ Dust on OB Check that roof, walls, corners of Corridors, 1
walls and roofs of corridors Waiting area, stairs, roof top for any
Cobweb, Bird Nest, etc.

B1.3 Corridors are cleaned at least twice SI/RR Ask cleaning staff about frequency of 1
in the day with wet mop cleaning in a day. Verify with Housekeeping
records

B1.4 Corridors are rigorously cleaned with SI/RR Ask the staff about cleaning schedule and 1
scrubbing / flooding once in a month activities

B1.5 Surfaces are conducive of effective OB Check if surfaces are smooth enough for 1
cleaning cleaning

B2 Cleanliness of Wards 5

B2.1 No dirt/Grease/ Stains/ Garbage in OB Check that floors and walls of indoor 1
wards department for any visible or tangible dirt,
grease, stains, etc.

B2.2 No Cobwebs/Bird Nest/ OB Check for the roof, corners of ward for any 1
Dust/Seepage on walls and roofs of Cobweb, Bird Nest, Dust etc.
wards

B2.3 Wards are cleaned at least thrice in OB Ask cleaning staff about frequency of 1
the day with wet mop cleaning in a day. Verify with Housekeeping
records

B2.4 Patient Furniture, Mattresses, OB Check for visible dirt, dust, grease etc. 1
Fixtures are without grease and dust Check if the items are wiped/dusted daily

B2.5 Floors, walls, furniture and fixture OB Ask cleaning staff about frequency of 1
are thoroughly cleaned once in a cleaning in a day. Verify with Housekeeping
week. records if available

B3 Cleanliness of Procedure Areas 5

B3.1 No dirt/Grease/ Stains/ Garbage in OB Check that floors and walls of Labour room, 1
Procedure Areas OT, Dressing room for any visible or tangible
dirt, grease, stains etc.

B3.2 No Cobwebs/Bird Nest/ Seepage in OB Check for roof, walls, corners of Labour 1
OT & Labour Room Room, OT, Dressing Room for any Cobweb,
Bird Nest, Seepage, etc.

B3.3 OT/Labour Room floors and SI/RR Ask cleaning staff about frequency of 1
procedures surfaces are cleaned at cleaning in a day. Verify with Housekeeping
least twice a day / after every records.
surgery

B3.4 OT & Labour Room Tables are OB Check that Top, side and legs of OT Tables, 1
without grease, body fluid and dust Dressing Room Tables, Labour Room Tables
for dirt, dried human tissue, body fluid etc.

B3.5 Floors, walls, furniture and fixture SI/RR Ask cleaning staff about frequency of 1
are thoroughly cleaned once in a cleaning day. Verify with Housekeeping
week. records if available.
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B4 Cleanliness of Ambulatory Area (OPD, Emergency, Lab) 5

B4.1 No dirt/Grease/Stains / Garbage in OB Check for floors and walls of OPD, 1

Ambulatory Area Emergency, Laboratory, Radiology for any
visible or tangible dirt, grease, stains, etc.

B4.2 No Cobwebs/Bird Nest/ Seepage on OB Check for roof , walls, corners of OPD, 1
walls and roofs of ambulatory area Emergency, Laboratory, Radiology for any
Cobweb, Bird Nest, Dust, Seepage, etc.

B4.3 Ambulatory Areas are cleaned at SI/RR Ask cleaning staff about frequency of 1
least thrice in the day with wet mop cleaning in a day. Verify with Housekeeping
records

B4.4 Furniture, & Fixtures are without OB/SI Observe and ask the staff about frequency 1
grease and dust and cleaned daily for cleaning

B4.5 Floors, walls, furniture and fixture SI/RR Ask staff about schedule of cleaning and 1
are thoroughly cleaned once in a verify with records
week.

B5 Cleanliness of Auxiliary Areas 5

B5.1 No dirt/Grease/ Stains/ Garbage in OB Check for the floors and walls of Pharmacy, 1
Auxiliary Area Kitchen, Laundry, Mortuary, Administrative
offices, for any visible or tangible dirt,
grease, stains, etc.

B5.2 No Cobwebs/Bird Nest/ Seepage on OB Check the roof , walls, corners of Pharmacy, 1
walls and roofs of Auxiliary Area Kitchen, Laundry, Mortuary, Administrative
offices for any Cobweb, Bird Nest, Seepage,
etc.

B5.3 Auxiliary Areas are cleaned at least SI/RR Ask cleaning staff about frequency of 1
twice in the day with wet mop cleaning in a day. Verify with Housekeeping
records.

B5.4 Furniture & Fixtures are without OB/SI Observe and ask the staff about frequency 1
grease and dust and cleaned daily for cleaning

B5.5 Floors, walls, furniture and fixture SI/RR Ask staff about schedule of cleaning and 1
are thoroughly cleaned once in a verify with records
month

B6 Cleanliness of Toilets 5

B6.1 No dirt/Grease/Stains/ Garbage in OB Check some of the toilets randomly in 1

Toilets indoor and outdoor areas for any visible
dirt, grease, stains, water accumulation in
toilets

B6.2 No foul smell in the Toilets OB Check some of the toilets randomly in 1
indoor and outdoor areas for foul smell

B6.3 Toilets have running water and OB Ask cleaning staff to operate cistern and 1
functional cistern water taps

B6.4 Sinks and Cistern are cleaned every SI/RR Ask cleaning staff for frequency of cleaning 1
two hours or whenever required and verify it with house keeping records

B6.5 Floors of Toilets are Dry OB Check some of the toilets randomly for 1
dryness of floors and without residue water
accumulation

B7 Use of standards materials and Equipment for Cleaning 5

B7.1 Availability of Detergent Disinfectant SI/OB/RR Check for good quality Hospital cleaning 1
solution / Hospital Grade Phenyl for solution preferably a ISI mark. Composition
Cleaning purpose and concentration of solution is written on
label. Check with cleaning staff if they are
getting adequate supply. Verify the
consumption records.

B7.2 Cleaning staff uses correct SI/RR Check, if the cleaning staff is aware of 1
concentration of cleaning solution correct concentration and dilution method
for preparing cleaning solution. Ask them to
demonstrate. Verify it with the instruction
given solution bottle.
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t Method

B7.3 Availability of carbolic Acid/ SI/RR Check for adequacy of the supply. Verify 1
Bacilocid for surface cleaning in with the records of stock outs, if any
procedure areas- OT, Labour Room

B7.4 Availability of Buckets and carts for SI/RR Check if adequate numbers of Buckets and 1
Mopping carts are available. General and critical
areas should have separate bucket and
carts.

B7.5 Availability of Cleaning Equipment SI/OB Check the availability of mops, brooms, 1
collection buckets etc. as per requirement.
Hospital with a size of more than 300 beds
should have mechanized mopping machine.

B8 Use of Standard Methods Cleaning 5

B8.1 Use of Three bucket system for SI/OB Check if cleaning staff uses three bucket 1
cleaning system for cleaning. One bucket for
Cleaning solution, second for plain water
and third one for wringing the mop. Ask the
cleaning staff about the process

B8.2 Use unidirectional method and out SI/OB Ask cleaning staff to demonstrate the how 1
word mopping they apply mop on floors. It should be in
one direction without returning to the
starting point. The mop should move from
inner area to outer area of the room.

B8.3 No use of brooms in patient care SI/OB Check if brooms are stored in patient care 1
areas areas. Ask cleaning staff if they are using
brooms for sweeping in wards, OT, Labour
room. Brooms should not be used in patient
care areas.

B8.4 Use of separate mops for critical and SI/OB Check if cleaning staff is using same mop for 1
semi critical areas and procedures outer general areas and critical areas like
surfaces OT and labour room. The mops should not
be shared between critical and general
area. The clothes used for cleaning
procedure surfaces like OT Table and
Labour Room Tables should not be used for
mopping the floors.

B8.5 Disinfection and washing of mops SI/OB Check if cleaning staff disinfect, clean and 1
after every cleaning cycle dry the mop before using it for next
cleaning cycle.

B9 Monitoring of Cleanliness Activities 5

B9.1 Use of Housekeeping Checklist in OB/RR Check that Housekeeping Checklist is 1

Toilets displayed in Toilet and updated. Check
Housekeeping records if checklists are daily
updated for at least last one month

B9.2 Use of Housekeeping Checklist in OB/RR Check that Housekeeping Checklist is 1

Patient Care Areas displayed in OPD, IPD, Lab, etc. Check
Housekeeping records if checklists are daily
updated for at least last one month

B9.3 Use of Housekeeping Checklist in OB/RR Check that Housekeeping Checklist is 1

Procedure Areas displayed in Labour room, OT Dressing
room etc. Check Housekeeping records if
checklist are daily updated for at least last
one month.

B9.4 A person is designated for SI/RR Check if a staff-member from the hospital 1
monitoring of Housekeeping has been designated to monitor the
Activities housekeeping activities and verify them
with counter signature on housekeeping
checklist.
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t Method

B9.5 Monitoring of adequacy and quality SI/RR Check if there is any system of monitoring 1
of material used for cleaning that adequate concentration of disinfectant
solution is used for cleaning. Hospital
administration take feedback from cleaning
staff about efficacy of the solution and take
corrective action if it is not effective.

B10. Drainage and Sewage Management 5

B10.1 Availability of closed drainage OB Check if there is any open drain in the 1
system hospital premises. Hospital should have a
closed drainage system. If, the hospital’s
infrastructure is old and it is not possible
create closed draining system, the open
drains should properly covered.

B10.2 Gradient of Drains is conducive for OB Check that the drains have adequate slope 1
adequate for maintaining flow and there is no accumulation of water or
debris in it

B10.3 Availability of connection with OB/SI Check if Hospital sewage has proper 1
Municipal Sewage System/ or Soak connection with municipal drainage system.
Pit If access to municipal system is not
accessible, hospital should have a septic
tank with in the premises.

B10.4 No blocked/ over-flowing drains in OB Observe that the drains are not overflowing 1
the facility or blocked

B10.5 All the drains are cleaned once in a SI/RR Check with the cleaning staff about the 1
week frequency of cleaning of drains. Verify with
the records.

C Waste Management
C1 Implementation of Biomedical Waste Rules 2016 5

C1.1 The Hospital leadership is aware of SI/OB A copy of the Biomedical waste 1
Biomedical Waste Rules 2016 management rules is available at the
including key changes as facility.
amendments.

C1.2 The facility has implemented OB/SI/RR Interview the concerned personnel and 1
Biomedical Waste Rules verify following actions -
a. Change in colour scheme
b. Linkage with CWTF, if located within 75
kms OR Approval for Deep Burial pit
c. 'On-site' pre-treatment of laboratory
waste before handing over to the CTF
Operator

C1.3 The facility has started undertaking SI/RR Please check the records and interview the 1
actions for bar coding system personnel to ascertain that the hospital has
started actions for procurement of Bar
coded bags & containers

C1.4 The facility has started undertaking SI/RR Please check the records and interview the 1
actions, which are to be complied by personnel to ascertain that the hospital has
March 2019 started actions for followings -
a. Procurement of Non-chlorinated bags
b. Development of Website and uploading
of Annual Report
c. Actions for meeting emission standards
as given in BMW Rules 2016.
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C1.5 An existing committee or newly SI/RR Check the record to ensure that the 1
constituted committee for review committee has met at least at six monthly
and monitoring of BMW interval and BMW status has been reviewed
management at DH/CHC level

C2 Segregated Collection and Transportation of Biomedical Waste 5

C2.1 Segregation of BMW is done as per OB/SI Anatomical waste and soiled dressing 1
BMW management rule,2016 material are segregated in yellow bins &
bags
General and infectious waste are not mixed

C2.2 Work instructions for segregation OB Check availability of instructions for 1

and handling of Biomedical waste segregation of waste in different colour
has been displayed prominently coded bins and instructions are displayed at
point of use.

C2.3 The facility has linkage with a CWTF OB/ RR/ SI Check record for functional linkage with a 1
Operator or has deep burial pit (with CWTF
prior approval of the prescribed In absence of such linkage, check existence
authority) of deep burial pit, which has approval of the
prescribed authority.

C2.4 Biomedical waste bins are covered OB Check that bins meant for bio medical 1
waste are covered with lids

C2.5 Transportation of biomedical waste OB/SI Check, transportation of waste from clinical 1
is done in closed container/trolley areas to storage areas is done in covered
trolleys / Bins. Trolleys used for patient
shifting should not be used for
transportation of waste.

C3 Sharp Management 5

C3.1 Disinfection of Broken / Discarded OB/SI/ RR Check if such waste is pre-treated either 1
Glassware is done as per with 1-2 % Sodium Hypochlorite (having
recommended procedure 30% residual chlorine) for 20 minutes or by
autoclaving/ microwave/ hydroclave,

C.3.2 Disinfected Glassware is stored as OB/SI/ RR Verify that all glassware is stored in a 1
per protocol given in Schedule I of puncture proof and leak proof boxes or
the BMW Rules 2016 and containers with blue coloured marking and
amendments . later sent for recycling

C3.3 The Staff uses needle cutters for OB/SI Observe that needle cutters are available at 1
cutting/burning the syringe hub every point of waste generation and also
being used

C.3.4 Sharp Waste is stored in Puncture OB/SI Check availability of Puncture & leak proof 1
proof containers container (White Translucent) at point of
use for storing needles, syringes with fixed
needles, needles from cutter/burner,
scalpel blade, etc.

C3.4 Staff is aware of needle stick injury SI/RR Ask staff immediate management of 1
Protocol and PEP is available to the exposure site; and Medical Officer knows
staff criteria for PEP.
Please check records of reporting of Needle
Stick Injury case, PEP, and follow-up

C4 Storage of Biomedical Waste 5

C4.1 Dedicated Storage facility is available OB Check if the health facility has dedicated 1
for biomedical waste and its has room for storage of Biomedical waste
biohazard symbol displayed before disposal/handing over to Common
Treatment Facility.

C4.2 The Storage facility is located away OB Look at the location and its connectivity 1
from the patient area and has through a road for CWTF vehicle to reach
connectivity of a motor able road. the storage area un-hindrance.
The storage area does not pose any threat
to patients, indoor & outdoor both.
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C4.3 The Storage facility is secured OB Check the security (Lock and key) and 1
against pilferage and reach of animal rodent proofing of the storage area
and rodents.

C4.4 No Biomedical waste is stored for SI/RR Verify that the waste is disposed / handed 1
more than 48 Hours over to CTF within 48 hour of generation.
Check the record especially during holidays

C4.5 The storage facility has hand- OB Check availability of soap, running water in 1
washing facilities for the workers vicinity of storage facility

C5 Disposal of Biomedical waste 5

C5.1 The Health Facility has adequate RR/OB/SI The Health facility within 75 KM of CTF have 1
arrangements for disposal of a valid contract with a Common Treatment
Biomedical waste facility for disposal of Bio medical waste. Or
The facility should have Deep Burial Pit and
Sharp Pit within premises of Health facility.
Such deep burial pit should approved by the
Prescribed Authority

C5.2 Recyclable waste is disposed as per OB/SI/RR Check if Recyclable waste (catheter, 1
procedure given in the BMW Rules syringes, gloves, IV tubes, Ryle's tube, etc.)
2016 is shredded / mutilated after treatment
(options
autoclaving/microwave/hydroclave) and
then sent back to registered recyclers.
Alternatively it can also be sent for energy
recovery or road construction.
Ascertain that waste is never sent for
incineration or land-fill site.

C5.3 Deep Burial Pit is constructed as per OB/RR Located away from the main building and 1
norms given in the Biomedical water source, A pit or trench should be
Waste Rules 2016 approx. two meters deep. It should be half
filled with waste, then covered with lime
within 50 cm of the surface, before filling
the rest of the pit with soil.
Secured from animals .
If waste disposed through CTF, then a deep
burial pit is not required.(Give Full
Compliance)

C5.4 Disposal of Expired or discarded OB/SI/RR Check, if there is a system of sending 1

medicine is done as per protocol discarded medicines back to manufacturer
given in Schedule I of BMW Rules or disposed by incineration.
2016

C5.5 Discarded / contaminated linen is OB/SI/RR Check that discarded linen, mattresses & 1
disposed as per procedure given in bedding contaminated with blood or body
the BMW Rules 2016 fluid is subjected to disinfection by non-
chlorinated disinfection (e.g. Hydrogen
Peroxide) followed by incineration.
Alternatively it can be shredded or
mutilated.

C6 Management Hazardous Waste 5

C6.1 The Staff is aware of Mercury Spill SI Interact with the staff to ascertain their 1
management awareness of Mercury spill management

C6.2 Availability of Mercury Spill OB Check physical availability of Mercury spill 1

Management Kit management kit, more so at the locations
functional on 24x7 basis (Emergency
Department, Ward, etc.)
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C6.3 Disposal of Radiographic Developer SI/RR Check in the Radiology Department about 1
and Fixer the procedure being followed for disposal
of Radiographic developers and fixer. It
should be handed over to an authorised
agency, not discharged in the drain

C6.4 Disposal of Disinfectant solution like SI Should not be drained in sewage untreated 1
Glutaraldehyde

C6.3 Disposal of Lab reagents SI/RR As per instructions of the manufacturer 1

C7 Solid General Waste Management 5

C7.1 Recyclable and Biodegradable OB/SI Check availability of two types of bins for 1
Wastes have segregated collection collecting Recyclables and Biodegradables -
Kerb collection point, wards, OPD, Patient
Waiting Area, Pharmacy, Office, Cafeteria

C7.2 The Facility Undertakes efforts to PI/OB Posters/ Work instructions are displayed at 1
educate patients and visitors about the locations, where two types of bins have
segregation of recyclable and been kept
biodegradable wastes

C7.3 General Waste is not mixed with OB Check bins to ascertain that such mixing 1
infected waste does not take place

C7.4 Availability of Compost Pit within the OB/SI Check availability of pit within the premises; 1
premises If a facility has linkage with municipal waste
management system for collection of
general waste, please award full compliance

C7.5 The facility has introduced OB/SI/RR/ Check, if certain innovative practices have 1
innovations in managing General PI been introduced for managing general
Waste waste e.g. Vermicomposting, Re-cycling of
papers, Waste to energy, Compost
Activators, etc.

C8 Liquid Waste Management 5

C8.1 The laboratory has a functional OB/SI/ RR A copy of such protocol should be available 1
protocol for managing discarded and staff should be aware of the same.
samples Discarded Lab samples made safe before
mixing with other waste water

C8.2 Body fluids, Secretions in suction OB/SI Check that such secretions, blood and 1
apparatus, blood and other exudates exudates are treated as per protocol
in OT, Labour room, minor OT,
Dressing room are disposed only
after treatment

C8.3 The Facility has treatment facility for OB/SI Check the availability of Separate collection 1
managing infectious liquid waste system leading to effluent treatment
system.

C8.4 Sullage is managed scientifically OB/SI Check that Sullage (waste water from 1
Bathrooms & Kitchen;does not contain urin
& excreta) does not stagnate (causing fly &
mosquito breeding)and is connected to
Municipal system. In absence of such
system,the facility should have soakage pit
for sullage.

C8.5 Runoff is drained into the municipal OB/SI Check availability of surface drainage 1
drain system and its connectivity and gradient
with the municipal drains for the Runoff
during rains, etc.

C9 Equipment and Supplies for Bio Medical Waste Management 5

 Assessmen
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t Method

C9.1 Availability of Bins and liners for OB/SI/ RR One set of bins and liners of appropriate 1
segregated collection of waste at size at each point of generation for
point of use Biomedical and General waste and its
supply record

C9.2 Availability of Needle/ Hub cutter OB/SI At each point of generation of sharp waste 1
and puncture proof boxes

C9.3 Availability and supply of personal OB/SI/RR Please look at availability of PPE (cap, mask, 1
protective equipment gloves, boots, goggles) for waste handlers
and its supply record

C9.4 Availability of Sodium Hypochlorite OB/SI/RR Please look at availability of Sodium 1

Solution Hypochlorite and its supply record

C9.5 Availability of trolleys for waste OB/SI Number and size would depend upon the 1
collection and transportation size of facility and waste inventory

C10 Statuary Compliances 5

C10.1 The Health Facility has a valid RR Check for availability of the authorization 1
authorization for Bio Medical waste certificate and its validity
Management from the prescribed
authority

C10.2 The Health Facility submits Annual RR Check the records that reports have been 1
report to pollution control board submitted to the prescribed authority on or
before 30th June every year.

C10.3 The Health Facility has a system of RR/SI Check following records - 1
review and monitoring of BMW a. Office order for constitution of
Management through an existing committee or its review by existing
committee or by forming a new committee - Quality Committee/ infection
committee control committee
b. Frequency of committee meetings - at
least 6 monthly
c. Minutes of meetings

C10.4 The Health facility maintains its RR Check, if the facility has its own website and 1
website and annual report is annual report under the BMW Rules 2016 is
uploaded uploaded

C10.5 The Health Facility maintains RR Check following records - 1

records, as required under the a. Yearly Health Check-up record of all
Biomedical Waste Rules 2016 handlers
b. BMW training records of all staff (once in
year training)
c. Immunisation records of all waste
handlers
d. Records of operations of Autoclave and
other equipment for last five years

D Infection Control

D1 Hand Hygiene 5

D1.1 Availability of Sink and running OB Check for washbasin with functional tap, 1
water at point of use soap and running water availability at all
points of use including nursing stations,
OPD clinics, OT, labour room etc.

D1.2 Display of Hand washing Instructions OB Check that Hand washing instructions are 1
displayed preferably at all points of use

D1.3 Adherence to 6 steps of Hand SI Ask facility staff to demonstrate 6 steps of 1

washing normal hand wash

D1.4 Availability of Alcohol Based hand SI/OB Check for availability alcohol based hand- 1
rub rub. Ask staff about its regular supply

D1.5 Staff is aware of when to hand wash SI Ask staff about the situations, when hand 1
wash is mandatory (5 moments of hand
washing).

D2 Personal Protective Equipment (PPE) 5

 Assessmen
Ref. No. Criteria Means of Verification Compliance Remarks
t Method

D2.1 Use of Gloves during procedures and SI/OB Check, if the staff uses gloves during 1
examination examination, and while conducting
procedures

D2.2 Use of Masks and Head cap SI/OB Check, if staff uses mask and head caps in 1
patient care and procedure areas

D2.3 Use of Heavy Duty Gloves and SI/OB Check, if the housekeeping staff and waste 1
gumboot by waste handlers handlers are using heavy duty gloves and
gum boots

D2.4 Use of aprons/ Lab coat by the SI/OB Check the usage of protective attire e.g. 1
clinical staff Apron by the doctor and nurses, lab coat by
the lab technicians, gown in OT, etc.

D2.5 Adequate supply of Personal SI/RR Check with staff whether they have 1
Protective Equipment (PPE) adequate supply of personal protective
equipment. Verify the records for any stock
outs.

D3 Personal Protective Practices 5

D3.1 The staff is aware of use of gloves, SI/OB Check with the staff when do they wear 1
when to use (occasion) and its type gloves, and when gloves are not required.
The Staff should also know difference
between clean & sterilized gloves and when
to use

D3.2 Correct method of wearing and SI/OB Ask the staff to demonstrate correct 1
removing gloves method of wearing and removing Gloves

D3.3 Correct Method of wearing mask SI/OB Check, if the staff knows correct method of 1
and cap wearing mask
D3.4 No re-use of disposable personal SI/OB Check that disposable gloves and mask are 1
protective equipment not re-used. Reusable Gloves and mask are
used after adequate sterilization.

D3.5 The Staff is aware of Standard SI Ask the staff about five Standard 1
Precautions Precautions
D4 Decontamination and Cleaning of Instruments 5

D4.1 Staff knows how to make Chlorine SI/OB Ask the staff how to make 1% chlorine 1
solution solution from Bleaching powder and
Hypochlorite solution

D4.2 Decontamination of operating and SI/OB Ask staff when and how they clean the 1
Surface examination table, dressing operating surfaces either by chlorine
tables etc. after every procedures solution or Disinfectant like carbolic acid

D4.3 Decontamination of instruments SI/OB Check whether instruments are 1

after use decontaminated with 0.5% chlorine solution
for 10 minutes

D4.4 Cleaning of instruments done after SI/OB Check instruments are cleaned thoroughly 1
decontamination with water and soap before sterilization

D4.5 Adequate Contact Time for SI Ask staff about the Contact time for 1
decontamination decontamination of instruments (10
Minutes)

D5 Disinfection & Sterilization of Instruments 5

D5.1 Adherence to Protocols for SI/OB Check about awareness of recommended 1

autoclaving temperature, duration and pressure for
autoclaving instruments - 121 degree C, 15
Pound Pressure for 20 Minutes (30 Minutes
if wrapped) Linen - 121 C, 15 Pound for 30
Minutes

D5.2 Adherence to Protocol for High Level SI/OB Check with the staff process about of High 1
disinfection Level disinfection using Boiling or Chlorine
solution

D5.3 Use of Signal Locks for sterilization OB/RR Check autoclaving records for use of 1
sterilization indicators (signal Loc)
 Assessmen
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t Method

D5.4 Chemical Sterilization of instruments SI/OB Check if the staff know the protocol for 1
done as per protocol sterilization of laparoscope soaking it in 2%
Glutaraldehyde solution for 10 Hours

D5.5 Sterility of autoclaved pack SI/OB Check if autoclaved instruments are kept in 1
maintained during storage the clean area. Their expiry date is
mentioned on the package. Instruments are
not used later once instrument pack has
been opened.

D6 Spill Management 5
D6.1 Staff is aware of how manage small SI/OB Check for adherence to protocols 1
spills

D6.2 Availability of spill management Kit SI/OB Check availability of kits 1

D6.3 Staff has been trained for spill SI/RR Check for the training records 1
management

D6.4 Spill management protocols are OB Check for display 1

displayed at points if use

D6.5 Staff is aware of management of SI/OB Check for adherence to protocol 1

large spills

D7 Isolation and Barrier Nursing 5

D7.1 Provision of Isolation ward OB Check if isolation ward is available in the 1

hospital

D7.2 Infectious patients are not mixed for OB/SI Check infectious patients are admitted in 1
general patients infectious ward only

D7.3 Maintenance of adequate bed to OB A distance of 3.5 Foot is maintained 1

bed distance in wards between two beds in wards

D7.4 Restriction of external foot wear in OB External foot wear are not allowed in labour 1
critical areas room, OT,ICU, Burn ward, SNCU, etc.

D7.5 Restriction of visitors to Isolation OB/Is Visitors are not allowed in critical areas like 1
Area OT, ICU,SNCU, Burn Ward, etc.

D8 Infection Control Program 5

D8.1 Infection Control Committee is RR/SI Check for the enabling order and minutes of 1
constituted and functional in the the meeting
Hospital

D8.2 Regular Monitoring of infection RR/SI Check, if there is any practice of daily 1
control practices monitoring of infection control practice like
hand hygiene and personal protection

D8.3 Antibiotic Policy is implemented at RR/SI Check if the hospital has documented Anti 1
the facility biotic policy and doctors are aware of it.

D8.4 Immunization of Service Providers RR/SI Hospital staff has been immunized against 1
Hepatitis B
D8.5 Regular Medical check- ups of food RR/SI Check for the records and lab investigations 1
handlers and housekeeping staff of Food handlers and housekeeping staff

D9 Hospital Acquired Infection Surveillance 5

D9.1 Regular microbiological surveillance RR/SI Check for the records of microbiological 1
of Critical areas surveillance of critical areas like OT, Labour
room, ICU, SNCU etc.

D9.2 Hospital measures Surgical Site RR/SI Check for the records 1
Infection Rates

D9.3 Hospital measures Device Related RR/SI Check for the records 1
HAI rates

D9.4 Hospital measures Blood Related RR/SI Check for the records 1
and Respiratory Tract HAI
 Assessmen
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t Method

D9.5 Hospital takes corrective Action on RR/SI Check for the records 1
occurrence of HAIs

D10 Environment Control 5

D10.1 Maintenance of positive air pressure OB/SI Check how positive pressure is maintained 1
in OT and ICU in OT

D10.2 Maintenance of air exchanges in OT OB/SI At least 15 to 20 air changes per hour 1
and ICU
D10.3 Maintenance of Layout in OT OB/SI Check for zoning of OT in protective, clean, 1
sterile and disposal zones

D10.4 Carbolization of OT and Labour OB/SI OT and Labour room are carbolized daily 1
Room

D10.5 General and patient traffic are OB/SI Check for the layout and patient traffic . 1
segregated in Hospitals There should be no criss cross between
general and patient traffic.

E SUPPORT SERVICES
E1 Laundry Services & Linen Management 5

E1.1 The facility has adequate stock RR/SI/PI Check the stock position and its turn-over 1
(including reserve) of linen during last one year in term of demand and
availability

E1.2 Bed-sheets and pillow cover are OB/SI/PI Observe the condition of linen in use in the 1
stain free and clean wards, Accident & Emergency Department,
other patient care area, etc.

E1.3 Bed-sheets and linen are changed OB/SI/PI Check, if the bedsheets and pillow cover 1
daily have been changed daily. Please interview
the patients as well.

E1.4 Soiled linen is removed, segregated SI/OB Check, how is the soiled linen handled at 1
and disinfected, as per procedure the facility. It should be removed
immediately and sluiced and disinfected
immediately

E1.5 Patients’ dress are clean and not torn PI/SI Check the patients’ dresses - its cleanliness 1
and condition

E2 Water Sanitation 5
E2.1 The facility receives adequate RR/SI/PI At least 200 litres of water per bed per day 1
quantity of water as per is available (if municipal supply). or the
requirement water is available on 24x7 basis at all points
of usage

E2.2 There is storage tank for the water RR The hospital should have capacity to store 1
and tank is cleaned periodically 48 hours water requirement Water tank is
cleaned at six monthly interval and records
are maintained.

E2.3 Drinking Water is chlorinated RR Presence of free chlorine at 0.2 ppm is 1

tested in the samples, drawn from the
potable water.

E2.4 Quality of Water is tested RR Periodically, the water is sent for 1

periodically bacteriological examination

E2.5 Water is available at all points of use OB/SI/PI Water is available for hand- washing, OT, 1
Labour Room, Wards, Patients’ toilet &
bath, waiting area.

E3 Kitchen Services 5
E3.1 Hospital kitchen is located in a OB The Hospital kitchen is functional in a 1
separate building, away from patient separate building with proper lay out.
care area and functions meticulously Cooking takes place on LPG/ PNG. No fire
wood is used. Kitchen waste is collected
separately and not mixed with the
Biomedical waste.

E3.2 The Kitchen has provision to store OB Dry ration is stored on pellet, away from 1
dry ration and fresh ration wall in closed containers. Vegetables are
separately. stored at appropriate temperature. Milk,
curd and other perishable items are stored
in the fridge, which is cleaned and
defrosted regularly.
 Assessmen
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t Method

E3.3 The Kitchen is smoke-free and fly- OB There is proper ventilation in the kitchen. 1
proofed Doors and Windows are fly-proofed. No fly
nuisance is noticed inside the kitchen.

E3.4 Staff observes meticulous personal OB Check that the Staff uses cap and kitchen 1
hygiene dress, while cooking. Nails & hair are
trimmed. All staff is not allowed to work in
kitchen. Toilet facilities are available for the
staff. Nail brush is available.

E3.5 Food to patients is distributed OB Check that adequate number of trolleys are 1
through covered trolleys and available and are in use. Look for the
patients utensils are not dented or condition of patients crockery and utensils.
chipped - off

E4 Security Services 5
E4.1 The main gate of premises, Hospital OB Check for the presence of security 1
building, wards, OT and Labour room personnel at critical locations
are secured

E4.2 The security personal are OB Check if Security personnel themselves 1

meticulously dressed and smartly observe the commensurate behaviour such
turned-out. no spitting, no chewing of tobacco, non-
smoker, etc.

E4.3 There is a robust crowd OB Crowd in OPD has waiting place, seats, etc. 1
management system. Dust bins are available and there is
adequate ventilation for the patients and
their attendants.

E4.4 Security personal reprimands OB Check, if security personnel watch 1

attendants, who found indulging behaviour of patients and their attendants,
into unhygienic behaviour - spitting, particularly in respect of hygiene,
open field urination & defecation, sanitation, etc. and take appropriate
etc. actions, as deemed.

E4.5 Un-authorised vendors are not OB/SI/PI Check, entry of vendors is controlled or not. 1
present inside the campus. Waste Unauthorised entry of rag-pickers should
storage is secured and there is no not be there.
plastic items, card board etc.

E5 Out-sourced Services Management 5

E5.1 There is valid contract for out- RR Please check contract document of all out- 1
sourced services, like house-keeping, sourced services
BMW management, security, etc.

E5.2 The Contract has well defined RR Check the contract documents to see, 1
measurable deliverables whether the deliverables of the out-sourced
organisation have been well defined in term
of the work to be done and how it would be
verified

E5.3 The contract has penalty clause and RR/ Look for the penalty clause in the contract 1
it has been evoked in the event of SI/Intervie and how often it has been used
non- performance or sub-standard w with
performance vendor

E5.4 Services provided by the out- RR Check if Performance of the vendors have 1
sourced organisation are measured been evaluated and recorded
periodically and performance
evaluation is formally recorded.

E5.5 There is defined time-line for release RR/Intervi Check the record for the time taken in 1
of payment to the contractors for ew with releasing the payment due to the out-
the services delivered by the vendor sourced organisation
organisation.
 Assessmen
Ref. No. Criteria Means of Verification Compliance Remarks
t Method

F Hygiene Promotion

F1 Community Monitoring & Patient Participation 5

F1.1 Members of RKS and Local SI/RR At least once in month. 1

Governance bodies monitor the
cleanliness of the hospital at pre-
defined intervals

F1.2 Local NGO/ Civil Society SI Discuss with hospital administration about 1
Organizations are involved in involvement of local NGOs/Civil society
cleanliness of the hospital

F1.3 Patients are counselled on benefits PI Check with patients, if they have been 1
of Hygiene counselled for hygiene practices

F1.4 Patients are made aware of their PI/OB Ask patients about their roles& 1
responsibility of keeping the health responsibilities with regards to cleanliness.
facility clean Patient’s responsibilities should be
prominently displayed

F1.5 The Health facility has a system to SI/RR Check if there is a feedback system for the 1
take feed-back from patients and patients. Verify the records
visitors for maintaining the
cleanliness of the facility

F2 Information Education and Communication 5

F2.1 IEC regarding importance of OB Should be displayed prominently in local 1

maintaining hand hygiene is language
displayed in hospital premises

F2.2 IEC regarding Swachhata Abhiyan is OB Should be displayed prominently in local 1

displayed within the facilities’ language
premises

F2.3 IEC regarding use of toilets is OB Should be displayed prominently in local 1

displayed within hospital premises language

F2.4 IEC regarding water sanitation is OB Should be displayed prominently in local 1

displayed in the hospital premises language

F2.5 Hospital disseminates hygiene SI/OB Hygiene Kiosk, Video Messages, Leaflets, 1
messages through other innovative IEC corners etc.
manners

F3 Leadership and Team work 5

F3.1 Cleanliness and Infection control SI Check constitution of committee and its 1
committee is constituted at the functioning
facility

F3.2 Cleanliness and infection control RR/SI Verify with the records 1
committee has representation of all
cadre of staff including Group ‘D’
and cleanings staff

F3.3 Roles and responsibility of different SI/RR Ask different members about their roles 1
staff members have been assigned and responsibilities
and communicated

F3.4 Hospital leadership review the SI/RR Check about regularity of meetings and 1
progress of the cleanliness drive on monitoring activities regarding cleanliness
weekly basis drive

F3.5 Hospitals leadership identifies good SI Check with hospital administration if there 1
performing staff members and is any such good practice
departments

F4 Training and Capacity Building and Standardization 5

F4.1 Hospital conducts are training need RR Verify with the records, if training need 1
assessment regarding cleanliness assessment has been done
and infection control in hospital
 Assessmen
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t Method

F4.2 Bio medical waste Management SI/RR Verify with the training records 1
training has been provided to the
staff

F4.3 Infection control Training has been SI/RR Verify with the training records 1
provided to the staff

F4.4 Hospital has documented Standard SI/RR Check availability of SOP with the users 1
Operating procedures for Cleanliness
and Upkeep of Facility

F4.5 Hospital has documented Standard RR Check availability of SOP with respective 1
Operating procedures for Bio- users
Medical waste management and
Infection Control

F5 Staff Hygiene and Dress Code 5

F5.1 Hospital has dress code policy for all SI/RR Ask staff about the policy. Check if it is 1
cadre of staff documented
F5.2 Nursing staff adhere to designated OB Observation 1
dress code

F5.3 Support and Housekeeping staff OB Observation 1

adhere to their designated dress
code

F5.4 There is a regular monitoring of SI Check with the hospital administration 1

hygiene practices of food handlers
and housekeeping staff

F5.5 Identity cards and name plates have OB Observation 1

been provided to all staff

G Beyond Hospital Boundary

G1 Promotion of Swachhata in surrounding area 5
G1.1 Local community actively RR/SI Local community is actively involved in 1
participates during Swachhata administration of ''Swachhata Pledge''
Pakhwara (fortnight) and distribution of caps/T-shirts, badge
with cleanliness message and logos of
''Swachh Bharat Abhiyan'' and
''Kayakalp''.

G1.2 Implementation of IEC activities OB/RR/SI Advertisement in news-papers/ 1

related to ' Swachh Bharat electronic media, distribution of booklets/
Abhiyan' pamphlets, posters/wall writing for
promotion of use of toilets, hand washing,
safe drinking water and tree plantation,
etc.

G1.3 Community awareness by RR/SI Like rally, marathon, Swachhata walk, 1

organising physical activities human Chain, etc.

G1.4 Community awareness by RR/SI Like street plays/Nukar Natak/ folk 1

organising cultural programs arts/folk-music, etc.

G1.5 Community awareness through RR/SI Like essay writing/poem/slogan 1

competition and rewards writing/painting etc.

G2 Coordination with local Institutions 5

G2.1 The Facility coordinates with the SI/RR Look for evidence of collective action such 1
local Municipal corporation/ PRI as cleaning of drains, maintenance of
for improving the sanitation and parking space, orderly arrangement of
hygiene hawkers (outside the facility), rickshaw,
auto, taxi, construction & maintenance of
public toilets, improving street-lighting,
removing cattle nuisance, etc.

G2.2 The Facility has linkage with Local SI/RR Check for evidence of coordination with 1
NGOs, who work in the area of NGOs for improving sanitation and
water, sanitation and hygiene hygiene in the vicinity of the facility. Also
look at collaborative action for
maintenance of Public Conveniences, etc.
 Assessmen
Ref. No. Criteria Means of Verification Compliance Remarks
t Method

G2.3 The Facility coordinates with SI/RR Look for evidence of collective action such 1
nearby market welfare as cleaning of drains, Swachhata
associations, Resident Welfare Pakhwara, maintenance of parking space,
associations, etc. for improving & orderly arrangement of hawkers (outside
maintaining sanitation and hygiene the facility), removing cattle nuisance, etc.
in surrounding area

G2.4 The Facility coordinates with SI/RR Look for evidence of collective action such 1
nearby schools & colleges, National as cleaning of drains, Swachhata
Service Scheme, NSG (National Pakhwara, IEC Campaign, Plantations
Scouts and Guides), NCC (National drive, etc. in near vicinity of the health
Cadet Core), etc. for promotion of facility
hygiene & sanitation

G2.5 The Facility coordinates with other SI /RR Look for evidence of coordination with 1
Department for improving departments such as Education (school
sanitation and hygiene in the programs on hygiene promotions), Water
surroundings and Sanitation (making area ODF), PWD
(Repair & Maintenance), Forest
Department (Plantation Drive) etc., which
contributes strengthening towards of
hygiene & sanitation

G3 Alternative Financing and support Mechanism 5

G3.1 The Facility endeavours to attract RR/SI Look for evidence that Corporate 1
support under the Corporate organisations have supported health
social responsibility & initiative facilities in its cleanliness drive

G3.2 The Facility endeavours to attract RR/SI Look for evidence that philanthropic 1
support from Philanthropic organizations including religious bodies,
Organisations trusts, NGOs, Rotary clubs, Lion club, etc.
have supported the health facility in its
cleanliness efforts.

G3.3 The Facility endeavours to attract RR/SI Look for evidence that local leaders such 1
support from the local support as MPs, MLAs, Municipal counsellors,
Panchayat members, individual
donations, etc. have supported the health
facility in its cleanliness drive efforts
either in cash or in kind.

G3.4 The facility engages the local RR/SI Look for evidence that the facility has 1
Community for reducing engaged in reducing household level
household pollutions in the vicinity pollution in near vicinity of the health
facility – Presence of community bins for
segregated collection of general
(biodegradable & recyclable), Roll-out of
PM Ujjwala Scheme in nearby slum, etc.

G3.5 Facility coordinate with local RR/SI Look for evidence that local 1
school/ college School/College has implemented ‘Swachh
Bharat-Swachh Vidyalaya’ initiative
through coordinated efforts

G4 Leadership & Governance in Surrounding area 5

G4.1 Surrounding area is declared Open SI/RR Check district/ward/block is declared 1
Defecation Free ODF

G4.2 A person is designated to supervise SI/RR Person may be regular/contractual or 1

and monitor activities related to voluntary. Full time or Part time.
cleanliness, sanitation and hygiene
in surrounding area

G4.3 Promotion of water conservation OB Self-closing taps in drinking water area 1

are in use; Evidence of IEC on water
conservation

G4.4 Measure to control air pollution in OB/PI Check for any poisonous pollutant 1
surrounding area emitting establishments, chimneys, etc. in
near vicinity

G4.5 Measure to control noise pollution OB/PI Check for presence of noise causing 1
in Surrounding area factories, highway, etc. in the vicinity of
the facility and installation of noise
reduction measure

G5 Approach Road to Health facility 5

 Assessmen
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t Method

G5.1 On the way signage's are available OB Check for directional signage with name 1
of the facility on the approach road.

G5.2 No unauthorised encroachments OB/SI Check for any unauthorised 1

alongside of approach road encroachment/vendors/ shops alongside
the approach road.

G5.3 Approach roads are even and free OB/SI Check that approach roads are clean and 1
from pot-holes free from pot-holes, water stagnation

G5.4 Approach roads are wide enough OB/SI/PI Free to-and-fro movements of 1
for smooth traffic flow ambulances and other hospital vehicles

G5.5 Functional street lights are OB/SI Check for street lights and their 1
available along the approach road functionality. Trees or other buildings
should not be blocking the lights.

G6 Cleanliness of Surrounding areas 5

G6.1 Area around the Facility is clean, OB Check for any litter/garbage/refuse in the 1
neat & tidy surrounding area

G6.2 No water logging in surrounding OB Check for evidences of water 1

area. accumulation or any potential mosquito
breeding place

G6.3 All drains and sewer are covered. OB Check for open manhole and overflowing 1
drains.

G6.4 Footpaths and pavements are clean OB Check for dust, garbage, outgrown weeds, 1
moss on footpaths and pavements.

G6.5 Exterior of hospital boundary wall OB Exterior of boundary wall is clean and of 1
is painted and maintained uniformed colour. No unwanted posters
on exterior of hospital boundary wall.

G7 Public Amenities in Surrounding Area 5

G7.1 Availability of Public toilets in OB Check for separate toilets for male and 1
surrounding Area female and they are conveniently located
and clean.

G7.2 Availability of urinals in OB Check that urinals are conveniently 1

surrounding area located and they are clean

G7.3 Public toilets & urinal in OB Check for regular water supply, dry floor 1
surrounding areas are clean and no foul smell from toilets.

G7.4 Presence of safe drinking water OB Check for its presence & functionality and 1
facility outside the health facility safety & potability of water.

G7.5 Availability of adequate parking OB/SI Check for parking stand for auto/ 1
stand rickshaw/taxi etc., and they are not
parked haphazardly.

G8 Aesthetics of Surrounding area 5

G8.1 Parks and green areas in the OB/SI Check that there no wild vegetation & 1
surrounding area are well growth in the surroundings. Shrubs and
maintained trees are well maintained. Dry leaves and
green waste are removed regularly.

G8.2 There are no stray animals in OB/SI Observe for the presence of stray animals 1
surrounding area such as pigs, dogs, cattle, etc.

G8.3 Illumination in surrounding area OB Check that hospital front, approach road 1
and surrounding area are well illuminated
with street lights

G8.4 No unwanted/broken/ torn / loose OB Check that hospital surrounding are not 1
hanging posters/ billboards. studded with irrelevant and out dated
posters, slogans, wall writings, graffiti, etc.

G8.5 No loose hanging wires in and OB Check for any loose hanging wires 1
around the bill-boards, electric
poles, etc
 Assessmen
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t Method

G9 General Waste Management in surrounding 5

G9.1 Availability of bins for general OB Check availability adequate number of 1
recyclable and biodegradable bins for Biodegradable and recyclable
wastes general waste in the nearby market

G9.2 Segregation of general waste is OB Check content of recyclable and 1

done Biodegradable bins to ascertain their
usage

G5.3 Availability of Garbage Storage OB Garbage storage area is away from 1

area residential/commercial areas and is
covered/fenced. It is not causing public
nuisance.

G5.4 Daily collections of general waste OB/SI Municipal corporation vehicles pick up 1
by Municipal corporation garbage from the storage area on daily
basis. Look for piling of garbage.

G5.5 Innovations in managing general OB/SI Check, if certain innovative practices have 1
waste been introduced for managing general
waste e.g. Vermicomposting, Re-cycling of
papers, Waste to energy, Compost
Activators, etc.

G10 Maintenance of Surrounding Area 5

G10.1 Surrounding areas are well OB Check that there is no over grown shrubs, 1
maintained weeds, grass, potholes, bumps etc. in
surrounding areas

G10.2 Vector control measures are taken RR/SI Regular fogging, DDT Spray, Gambusia 1
for disease prevention. (mosquito fish) in ponds and other water
bodies.

G10.3 Regular cleaning of drains RR/SI At least twice in a year and before onset of 1
monsoon.

G10.4 Regular repairs and maintained of OB/SI/RR Check when was the last repair done, 1
roads, footpaths and pavements details of the repair and current condition
of the road- pot-holes, broken footpath
etc.

G10.5 Periodic cleaning of dust bins and OB/SI/RR Check for condition of dust bins 1
garbage storage area (breakage, foul smell) and garbage
storage area (covered, no stray animals)