Ministry of Health — Healthcare Accreditation Commission · CHAS Standards Field Test Tool

Individual Standard — Surveyor Evaluation Instrument · Batheay Referral Hospital, Kampong Cham · 6–10 April 2026

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Section 1 — Facility information

Hospital / Health Center Name *

Province *

District / Operational District

Hospital Type *

Number of Beds

Number of Staff (approx.)

Date of Field Test Visit *

Surveyor information

Surveyor Full Name *

Surveyor Profession / Title *

Surveyor's Home Hospital / Institution

Section 2 — Standards & Measurable Elements

2.1 Standard's statement

Evaluation dimensions — 1 Inadequate · 2 Needs improvement · 3 Adequate · 4 Excellent · N/A

Dimension Rating Comments

Detailed comments & recommendations

Specific wording changes recommended?

Resources the hospital would need but currently lacks?

Did hospital staff understand this standard when explained?

Yes Partially No

Recommendation

2.2 Measurable elements

Are any MEs redundant or overlapping?

Are any MEs missing that should be added?

Are the MEs appropriately sequenced?

Section 3 — Surveyor feedback

3.1 Intent of standard

Is the intent clear and appropriate for Cambodia?

YES NO — explain:

3.2 Guidance

Is the guidance clear and easy to understand?

YES NO — explain:

3.3 Surveyor process

Is the surveyor process clear and easy to follow?

YES NO — explain:

3.4 Standard scoring

Are the scoring guidelines clear and easy to apply?

YES NO — explain:

✓ Assessment submitted!