ST.

JOSEPH COLLEGE OF ENGINEERING AND TECHNOLOGY
Post Box No.11007, Dar es salaam, Tanzania.
Questionnaire Towards Identification of Diagnostic Equipment Standards in Tanzania

1.0 GENERAL INFORMATION
Name of the Institution Address of the Institution Region Contact No Website(If any) City Mobile E-Mail Id

2.0 ADMINISTRATION DETAILS
Name of the Head of the Institution E-Mail Id: Mobile No

3.0 OWNERSHIP TYPE
(Tick against the appropriate box)

Government

Private

NGO/CBO

Others

4.0 SERVICES AND FACILITIES
(Fill in the boxes with numbers to indicate beds in each dept) Obstetrics and Gynaecology General Surgery Orthopaedic Care General medicine Intensive care Burn cure Paediatrics Psychiatry
Others:

5.0 DIAGNOSTIC SERVICES
(Tick if available and mark (x) if not available)

Diagnostic X-ray Ultra Sound/Medical Sonography Computerized Tomography Scanner/CT- Scan

Radioisotope Diagnostic Positron Emission Tomography(PET) Magnetic Resonance Imaging (MRI)

(Mention the number of doctors available against each of the speciality)

6.0 SPECIALITIES AVAILABLE

SPECIALITIES a).General and Family Practice b).General Internal Medicine c).Paediatrics

Full Time

Part Time

SPECIALITIES d).Other Medical Speciality i). ii).

Full Time

Part Time

7.0 SURGICAL SPECIALITY

e).Obstetrics F).Gynaecology g).Ophthalmology Surgery h).Orthopaedic Surgery i).Plastic Surgery

j).General Surgery k).Thoracic Surgery l).Other Surgical Speciality i). ii).

8.0 OTHER SPECIALITIES

m).Anaesthesiology n).Dermatology o).Emergency Medicine p).Nuclear Medicine q).Pathology

r).Psychiatry s).Radiology i). ii). iii).

9.0 SERVICE MANPOWER DETAILS
(Tick against the appropriate available in your hospital)

Radiology Services CT-Scan Sonography

Yes Yes Yes

No No No

Nuclear Medicine MRI Others specialities:

Yes Yes Yes

No No No

10.0 DIAGNOSTIC EQUIPMENT SURVEY & PRODUCT DETAILS
Equipment Specification Conventional Type Digital Type Name of the Manufacturer Model No Brand Name Estimation Number of Procedure Performing Annually Installation date (DD/MM/YY): Date of last service (DD/MM/YY) Date of next service (DD/MM/YY)
Service Engineer available in Local(Yes/No)

X-RAY UNIT

X-RAY MOBILE UNIT

Equipment Specification Conventional Type Digital Type Name of the Manufacturer Model No Brand Name Estimation Number of Procedure Performing Annually Installation date
(DD/MM/YY): (DD/MM/YY) (DD/MM/YY)

MAMMOGRAPHY

ULTRA SOUND

Date of last service

Date of next service

Service Engineer available in Local(Yes/No)

Equipment Specification Conventional Type Digital Type Name of the Manufacturer Model No Brand Name Estimation Number of Procedure Performing Annually Installation date
(DD/MM/YY) (DD/MM/YY) (DD/MM/YY)

CT-SCAN

MRI

Date of last service

Date of next service

Service Engineer available in Local(Yes/N0)

11.0 DETAILS OF RADIOLOGIST

Once Again Thank You Very Much For Your Assistance