Annex A. Organisational Details

Annex A. Organisational details

Organisation name: / Click here to enter text. /
What category best describes your organisation? / National organisation
☐ / International organisation
☐ / Federation
☐ / Other:
Click here to enter text.
How do you implement your programmes (tick all that apply)? / Direct assistance
☐ / With partners
☐ / Advocacy
☐
What was the budget of your organisation in 2015 (in USD)? / Click here to enter text. /
In how many countries does your organisation work? (federations: please also indicate the number of members): / Click here to enter text. /
Head office location: / City: / Click here to enter text. /
Country: / Click here to enter text. /
Are you a member of the CHS Alliance? / Yes ☐ / No☐
If so, since when? (month/year) / Click here to enter text. /
Self-assessment related information
Date of self-assessment: / From: (dd/mm/yyyy) / Click here to enter text. /
To: (dd/mm/yyyy) / Click here to enter text. /
Date of submission of your self-assessment report to the Alliance: (dd/mm/yyyy) / Click here to enter text. /
Name & email of internal lead assessor: / Click here to enter text. /
Apart from your Head Office, which country(ies) were reviewed to inform this self-assessment?
Which internal stakeholders were consulted for the self-assessment (it is sufficient to list here the total number of people consulted and their job titles)? / Click here to enter text. /
Which external stakeholders were consulted for this self-assessment? Please list for each country the number of focus group discussions and names of partners and other stakeholders consulted. / Click here to enter text. /
How many working days did you dedicate to the self-assessment as the lead assessor (excluding improvement plan and other CHS Alliance reporting requirements)? / Click here to enter text. /
Was at any point your organisation certified by HAP or People In Aid? / Yes
☐ / No
☐
Is your organisation considering to use peer reviews or external verification as an alternative to self-assessments? / Yes, peer review
☐ / Yes, external verification
☐ / No
☐ / Maybe
☐