SELF AUDIT 0 = No / not implemented STANDARD 1: Governance and commitment 1 = Less than half implemented The healthcare organisation has clear and strong leadership to systematically implement a tobacco-free policy 2 = More than half implemented 3 = Yes / Fully implemented REFLECTION PRIORITIES Summary of current situation Summarize the actions flowing from (Please describe the current situation for each IMPLEMENTATION CRITERIA 0 1 2 3 the audit process for each criterion implementation criteria. This will provide a context (These will inform a more detailed for your planned actions for the next 12 months) planning process) The healthcare organisation has Policy documents of the clear policy documents towards healthcare organisation show the implementation of all the commitment to implement all Global Standards. Global Standards. The healthcare organisation The healthcare organisation prohibits the acceptance of any prohibits the acceptance of sponsorship or funding from the tobacco industry sponsorship tobacco industry, as well as the and funding. sale of their products and The healthcare organisation associated devices/ prohibits the sale of tobacco products and associated devices/e-cigarettes. The healthcare organisation A senior manager has identifies clear accountability responsibility for the for all levels and aspects of implementation of the policy implementation. tobacco-free policy. Accountability is assigned at all levels and for all aspects of policy implementation. The healthcare organisation’s Staff employment documents staff employment documents require staff commitment to (including subcontracts and the healthcare organisation’s documents with other agencies tobacco-free policy. that work within the healthcare Subcontractor documents organisation) require require staff adherence to the commitment by all staff to the healthcare organisation’s organisation’s tobacco-free tobacco-free policy. policy.
STANDARD 1: Governance and commitment The healthcare organisation has clear and strong leadership to systematically implement a tobacco-free policy SELF AUDIT 0 = No / not implemented 1 = Less than half implemented 2 = More than half implemented 3 = Yes / Fully implemented IMPLEMENTATION CRITERIA REFLECTION Summary of current situation (Please describe the current situation for each implementation criteria. This will provide a context for your planned actions for the next 12 months) 0 1 2 3 PRIORITIES Summarize the actions flowing from the audit process for each criterion (These will inform a more detailed planning process) The healthcare organisation has clear policy documents towards the implementation of all the Global Standards. Policy documents of the healthcare organisation show commitment to implement all Global Standards. The healthcare organisation prohibits the acceptance of any sponsorship or funding from the tobacco industry, as well as the sale of their products and associated devices/ The healthcare organisation prohibits the acceptance of tobacco industry sponsorship and funding. The healthcare organisation prohibits the sale of tobacco products and associated devices/e-cigarettes. The healthcare organisation identifies clear accountability for all levels and aspects of policy implementation. A senior manager has responsibility for the implementation of the tobacco-free policy. Accountability is assigned at all levels and for all aspects of policy implementation. The healthcare organisation’s staff employment documents (including subcontracts and documents with other agencies that work within the healthcare organisation) require commitment by all staff to the organisation’s tobacco-free policy. Staff employment documents require staff commitment to the healthcare organisation’s tobacco-free policy. Subcontractor documents require staff adherence to the healthcare organisation’s tobacco-free policy.
global-network-standards-self-audit-template-english-020118-wfiqleqxxfgz.docx