date_and_time_of_visit (type: esriFieldTypeDate, alias: Date and time of visit, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
name_of_persons_collecting_info (type: esriFieldTypeString, alias: Name of person(s) collecting information, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
email_and_phone_number_of_perso (type: esriFieldTypeString, alias: Email and phone number of person collecting information , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
name_of_institution (type: esriFieldTypeString, alias: Name of institution, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
type_of_institution (type: esriFieldTypeString, alias: Type of institution , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Psychiatric Hospital: Psychiatric Hospital], [Community Mental Health Center: Community Mental Health Center])
number_of_beds (type: esriFieldTypeDouble, alias: Number of beds:, SQL Type: sqlTypeOther, nullable: true, editable: true)
number_of_residents_who_died_du (type: esriFieldTypeDouble, alias: Number of residents who died due to the crisis, SQL Type: sqlTypeOther, nullable: true, editable: true)
number_of_residents_who_are_sti (type: esriFieldTypeDouble, alias: Number of residents who are (still) physically injured due to the crisis, SQL Type: sqlTypeOther, nullable: true, editable: true)
number_of_residents_with_physic (type: esriFieldTypeDouble, alias: Number of residents with physical disabilities (pre-existing or new), SQL Type: sqlTypeOther, nullable: true, editable: true)
number_of_residents_with_intell (type: esriFieldTypeDouble, alias: Number of residents with intellectual disabilities, SQL Type: sqlTypeOther, nullable: true, editable: true)
does_the_institution_have_suffi (type: esriFieldTypeString, alias: Does the institution have sufficient staff to ensure its functioning, and quality care and treatment of residents that respects dignity and rights? Please circle the appropriate response on the 1–4 scale based on numbers of available staff., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Relatively sufficient staffi: 1. Relatively sufficient staffing], [2. Staffing limited, but able t: 2. Staffing limited, but able to cope], [3. Significant staff shortage_: 3. Significant staff shortage ], ... 1 more ...)
total_current_staff (type: esriFieldTypeDouble, alias: Total # current staff, SQL Type: sqlTypeOther, nullable: true, editable: true)
field_33 (type: esriFieldTypeDouble, alias: Total # staff before the crisis, SQL Type: sqlTypeOther, nullable: true, editable: true)
field_35 (type: esriFieldTypeDouble, alias: Total # current staff, SQL Type: sqlTypeOther, nullable: true, editable: true)
_total_staff_before_the_crisis (type: esriFieldTypeDouble, alias: Total # staff before the crisis, SQL Type: sqlTypeOther, nullable: true, editable: true)
is_there_a_need_to_evacuate_res (type: esriFieldTypeString, alias: Is there a need to evacuate residents and staff?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Already evacuated: Already evacuated], ... 1 more ...)
if_evacuation_is_necessary_but (type: esriFieldTypeString, alias: If evacuation is necessary but not yet carried out, please describe the type of support needed (e.g. development of evacuation plan, daily supplies for period of transit etc.):, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
is_the_facility_habitable_eg_wa (type: esriFieldTypeString, alias: Is the facility habitable? (e.g. walls, windows and roof intact, functioning electricity, heating etc.) , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Yes, no significant problems: 1. Yes, no significant problems], [2. Some minor problems, but abl: 2. Some minor problems, but able to cope], [3. Significant concerns (e.g. d: 3. Significant concerns (e.g. damage to building, no electricity)], ... 1 more ...)
is_there_damage_to_the_building (type: esriFieldTypeString, alias: Is there damage to the building?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
what_damage_is_there_to_the_bui (type: esriFieldTypeString, alias: What damage is there to the building?, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
is_there_a_safe_place_eg_shelte (type: esriFieldTypeString, alias: Is there a safe place? (e.g. shelter, if applicable), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know_: Don’t know ], ... 1 more ...)
is_there_sufficient_space_for_t (type: esriFieldTypeString, alias: Is there sufficient space for the number of residents (dedicated bed per resident, living spaces and rooms not too cramped)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_water_and_sanitation_facili (type: esriFieldTypeString, alias: Are water and sanitation facilities adequate? (E.g., access to clean drinking water, toilets or latrines well maintained) , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Relatively normal water supp: 1. Relatively normal water supply], [2. Water supply more limited th: 2. Water supply more limited than usual, but able to cope], [3. Significant water shortage: 3. Significant water shortage], ... 1 more ...)
what_are_the_specific_reasons_f (type: esriFieldTypeString, alias: What are the specific reasons for these problems? (e.g. lack of funds to buy drinking water, contaminated water supply) , SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
is_there_access_to_clean_drinki (type: esriFieldTypeString, alias: Is there access to clean drinking water (40-60 litres per resident per day)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_toilets_in_good_working_con (type: esriFieldTypeString, alias: Are toilets in good working condition and sufficient (1 per 20 residents and separated for men, women, girls, boys and staff)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_the_bathing_and_toileting_ne (type: esriFieldTypeString, alias: Is the bathing and toileting needs of residents who are bedridden or who have impaired mobility or other physical disability accommodated? , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_hygiene_and_personal_care_s (type: esriFieldTypeString, alias: Are hygiene and personal care supplies and controls adequate? (e.g. access to soap and cleaning aids, disinfectants, grooming tools, clean facilities, bedding and clothes washed regularly etc.) , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Relatively normal hygiene: 1. Relatively normal hygiene], [2. Hygiene and personal care su: 2. Hygiene and personal care supplies are below usual standard, but able to cope], [3. Poor hygiene practices or ac: 3. Poor hygiene practices or access to needed supplies, posing a risk to health], ... 1 more ...)
are_menstrual_products_availabl (type: esriFieldTypeString, alias: Are menstrual products available for women and girls? (if applicable) , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
have_there_been_any_reported_di (type: esriFieldTypeString, alias: Have there been any reported disease outbreaks since the onset of the crisis?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
field_97 (type: esriFieldTypeString, alias: What are the specific reasons for these problems? (e.g. lack of funds to purchase hygiene supplies, lack of cleaning staff to maintain hygiene) , SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
is_food_supply_adequate_eg_do_r (type: esriFieldTypeString, alias: Is food supply adequate? (e.g. do residents receive at least two meals a day that contain adequate calories and nutritional value?) , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Adequate food supply: 1. Adequate food supply], [2. Food supply more limited tha: 2. Food supply more limited than usual, but able to cope], [3. Significant food shortage, s: 3. Significant food shortage, supply of concern ], ... 1 more ...)
field_115 (type: esriFieldTypeString, alias: What are the specific reasons for these problems? (e.g. disrupted supply chains), SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
are_there_enough_staff_to_prepa (type: esriFieldTypeString, alias: Are there enough staff to prepare food for residents?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_there_food_available_that_me (type: esriFieldTypeString, alias: Is there food available that meet residents’ cultural preferences and physical health requirements (e.g. meals for persons with diabetes), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_enough_essential_item (type: esriFieldTypeString, alias: Are there enough essential items for daily living ? (e.g. soap, toothbrushes, toothpaste, towels, mosquito nets, cutlery) , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Yes, adequate supply of item: 1. Yes, adequate supply of items], [2. Availability is more limited: 2. Availability is more limited than usual, but able to cope], [3. Limited availability / signi: 3. Limited availability / significant shortage of essential items], ... 1 more ...)
field_130 (type: esriFieldTypeString, alias: What are the specific reasons for these problems? (e.g. disrupted supply chains), SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
are_residents_who_don_t_speak_t (type: esriFieldTypeString, alias: Are residents who don’t speak the primary language used in the facility provided with translators or other support for communication?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_there_sufficient_space_for_r (type: esriFieldTypeString, alias: Is there sufficient space for rehabilitation activities (at least one room with materials and supplies)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_there_a_range_of_regularly_s (type: esriFieldTypeString, alias: Is there a range of regularly scheduled, organized activities offered in both facility and the community (if feasible) that are age appropriate?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_age_appropriate_items_for_p (type: esriFieldTypeString, alias: Are age-appropriate items for play and recreation available such as books and games?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_the_supply_of_psychotropic_m (type: esriFieldTypeString, alias: Is the supply of psychotropic medicines sufficient? , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. Sufficient medication supply: 1. Sufficient medication supply], [2. Medication supply more limit: 2. Medication supply more limited than usual, but able to cope], [3. Significant medication short: 3. Significant medication shortage, supply of concern ], ... 1 more ...)
for_scores_of_3_or_4_orange_or (type: esriFieldTypeString, alias: For scores of 3 or 4 (orange or red) please note what psychotropic medicines are required and the respective quantities? , SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
are_staff_in_the_facility_train (type: esriFieldTypeString, alias: Are staff in the facility trained and licensed to prescribe and review psychotropic medication?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_expired_products_on_t (type: esriFieldTypeString, alias: Are there expired products on the shelf and are they arranged FEFO (First Expired, First Out)? (take 5 random samples), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_physical_health_care_servic (type: esriFieldTypeString, alias: Are physical health care services available to residents? (e.g. blood pressure monitoring, vaccination etc), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_any_persons_denied_access_t (type: esriFieldTypeString, alias: Are any persons denied access to facilities or treatment on the basis of economic factors or because of personal attributes or status (e.g. sex, language, religion, political or other opinion, nationality, ethnicity, disability etc.)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
what_non_pharmacological_method (type: esriFieldTypeString, alias: What non-pharmacological methods of care are available and who provides them? List all that apply, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
are_all_reasonable_efforts_made (type: esriFieldTypeString, alias: Are all reasonable efforts made to facilitate discharge so that residents can live in their communities? (e.g. avoiding long-stay institutionalisation), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_admission_and_treatment_dec (type: esriFieldTypeString, alias: Are admission and treatment decisions based on the free and informed consent of the residents?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
do_residents_have_the_right_to (type: esriFieldTypeString, alias: Do residents have the right to refuse treatment?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_there_a_personal_confidentia (type: esriFieldTypeString, alias: Is there a personal, confidential medical file for each resident?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_reports_of_any_form_o (type: esriFieldTypeString, alias: Are there reports of any form of abuse (physical, sexual, verbal), neglect or human rights violations (restraint)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [1. No reports or witnessing of: 1. No reports or witnessing of such events], [2. 1 or 2 reports or witnessing: 2. 1 or 2 reports or witnessing of such events], [3. Significant number of report: 3. Significant number of reports or witnessing of such events], ... 1 more ...)
notes_more_detail_on_what_was_r (type: esriFieldTypeString, alias: Notes (more detail on what was reported or witnessed):, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
are_there_any_reports_of_or_hav (type: esriFieldTypeString, alias: Are there any reports of, or have you witnessed, physical abuse such as beatings?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_any_reports_of_sexual (type: esriFieldTypeString, alias: Are there any reports of sexual abuse?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_any_reports_of_reside (type: esriFieldTypeString, alias: Are there any reports of residents being neglected? (e.g. not provided with adequate food), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_residents_locked_inside_the (type: esriFieldTypeString, alias: Are residents locked inside the facility without being able to go outside? (e.g. not allowed to leave the facility even when accompanied by staff family), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
field_184 (type: esriFieldTypeString, alias: Are there any reports of, or have you witnessed, verbal abuse?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_any_other_reports_of (type: esriFieldTypeString, alias: Are there any other reports of protection and human rights concerns? (e.g. coercive treatment, use of inappropriate treatment methods), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_any_residents_kept_in_isola (type: esriFieldTypeString, alias: Are any residents kept in isolation away from other residents?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_alternatives_to_seclusion_a (type: esriFieldTypeString, alias: Are alternatives to seclusion and restraint in place at the facility? (e.g. staff are trained on de-escalation techniques), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
is_electroconvulsive_therapy_on (type: esriFieldTypeString, alias: Is electroconvulsive therapy ONLY given with the free and informed consent of residents?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
electroconvulsive_therapy_is_on (type: esriFieldTypeString, alias: Electroconvulsive therapy is ONLY used with needed modifications? (e.g. with an anaesthetic and with a muscle relaxant), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
field_191 (type: esriFieldTypeString, alias: Electroconvulsive therapy is ONLY given to adults (not children)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_any_reports_of_aborti (type: esriFieldTypeString, alias: Are there any reports of abortions or sterilizations being carried out on residents without their consent?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_residents_provided_with_inf (type: esriFieldTypeString, alias: Are residents provided with information on the social, cultural, religious and leisure activity options available?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
do_staff_support_residents_in_p (type: esriFieldTypeString, alias: Do staff support residents in participating in the available social, cultural, religious and leisure activities of their choice?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
are_there_opportunities_for_soc (type: esriFieldTypeString, alias: Are there opportunities for socializing with the wider community? (e.g. visits from friends and family, community days), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Don't know: Don’t know])
Templates:
Name: New Feature
Description:
Drawing Tool: esriFeatureEditToolNone
Prototype: