Facility Information

 

 

 

Index

Table

Session

Field Name

Excel position or Column

Field Type

int/ float / string

Calculated Field

(specify formula/calculation)

Dependencies (Internal Sources)

Notes

Index

Table

Session

Field Name

Excel position or Column

Field Type

int/ float / string

Calculated Field

(specify formula/calculation)

Dependencies (Internal Sources)

Notes

1

Facility Information

Facility Information

Facility Name

 

 

 

 

 

2

Facility Information

Facility Information

Address

 

 

 

 

 

3

Facility Information

Facility Information

City

 

 

 

 

 

4

Facility Information

Facility Information

Postal Code

 

 

 

 

 

5

Facility Information

Facility Information

Telephone

 

 

 

 

 

6

Facility Information

Facility Information

FAX

 

 

 

 

 

7

Facility Information

Facility Information

Facility's website Address

 

 

 

 

 

8

Facility Information

Facility Information

Site ID #

 

 

 

 

 

9

Facility Information

Facility Information

Program Type 

 

 

 

 

 

10

Facility Information

Facility Information

Ownership Type

 

 

 

 

 

11

Facility Information

Facility Information

Legislation

 

 

 

 

 

12

Facility Information

Facility Information

Accreditation Body

 

 

 

 

 

13

Facility Information

Facility Information

Accreditation Date

 

 

 

 

 

14

Facility Information

Facility Information

Accreditation Expiry Date

 

 

 

 

 

15

Facility Information

Facility Information

Health Authority

 

 

 

 

 

16

Facility Information

Facility Information

Local Health Authoriy

 

 

 

 

 

17

Facility Information

Owner Information

Site ID #

 

 

 

 

 

18

Facility Information

Owner Information

Program Type 

 

 

 

 

 

19

Facility Information

Owner Information

Ownership Type

 

 

 

 

 

20

Facility Information

Owner Information

Legislation

 

 

 

 

 

21

Facility Information

Owner Information

Accreditation Body

 

 

 

 

 

22

Facility Information

Owner Information

Accreditation Date

 

 

 

 

 

23

Facility Information

Owner Information

Accreditation Expiry Date

 

 

 

 

 

24

Facility Information

Owner Information

Health Authority

 

 

 

 

 

25

Facility Information

Owner Information

Local Health Authority

 

 

 

 

 

26

Facility Information

Operator Information

Operator Name   

 

 

 

 

 

27

Facility Information

Operator Information

Address

 

 

 

 

 

28

Facility Information

Operator Information

City

 

 

 

 

 

29

Facility Information

Operator Information

Postal Code

 

 

 

 

 

30

Facility Information

Operator Information

Telephone

 

 

 

 

 

31

Facility Information

Operator Information

FAX

 

 

 

 

 

32

Facility Information

Operator Information

(Contact) Name

 

 

 

 

 

33

Facility Information

Operator Information

(Contact) Position

 

 

 

 

 

34

Facility Information

Operator Information

(Contact) Telephone

 

 

 

 

 

35

Facility Information

Operator Information

(Contact) E-mail Address

 

 

 

 

 

36

Facility Information

Preparer Contact Information

Name

 

 

 

 

 

37

Facility Information

Preparer Contact Information

Position

 

 

 

 

 

38

Facility Information

Preparer Contact Information

Telephone

 

 

 

 

 

39

Facility Information

Preparer Contact Information

E-mail Address

 

 

 

 

 

40

Facility Information

Preparer Contact Information

Fax

 

 

 

 

 

41

Facility Information

CFO or VP Finance Contact Information

Name

 

 

 

 

 

42

Facility Information

CFO or VP Finance Contact Information

Position

 

 

 

 

 

43

Facility Information

CFO or VP Finance Contact Information

Telephone

 

 

 

 

 

44

Facility Information

CFO or VP Finance Contact Information

E-mail Address

 

 

 

 

 

45

Facility Information

CFO or VP Finance Contact Information

Fax

 

 

 

 

 

46

Facility Information

Auditor's Contact Information

Audit Firm

 

 

 

 

 

47

Facility Information

Auditor's Contact Information

(Contact) Name

 

 

 

 

 

48

Facility Information

Auditor's Contact Information

(Contact) Position

 

 

 

 

 

49

Facility Information

Auditor's Contact Information

(Contact) Telephone

 

 

 

 

 

50

Facility Information

Auditor's Contact Information

(Contact) E-mail Address

 

 

 

 

Â