NABH-VA-HOPE-I&C-ASSESSOR

DECLARATION OF IMPARTIALITY,
CONFIDENTIALITY AND
INTEGRITY FOR VIRTUAL ONSITE
ASSESSMENT FOR ASSESSOR
(HOPE)

Issue No. 2 Issue Date: 10/ 20 Page 1 of 2

 Declaration of Impartiality, Confidentiality and Integrity for Virtual
Onsite Assessment for Assessor - NABH-VA-HOPE-I&C-ASSESSOR

NABH-I&C

DECLARATION OF IMPARTIALITY, CONFIDENTIALITY & INTEGRITY

(to be filled in by each Assessor for conducting Virtual Onsite Assessment)

Name Assessor ID :

Designation

Organization

Address

Capacity Assessor

I ______________________________________________________________, hereby
declare that

i. I will not offer any consultancy, guidance, supervision or other services to the hospital/ SHCO in
any way.

ii. I will not accept the application for virtual onsite assessment if there is any conflict of interest
with the hospital/ SHCO e.g. if I am an ex-employee of the health care organization or am
related to any person of the management of the health care organization.

iii. I will declare to the Board my and/ or my immediate family’s association with any of the
organization that can affect the impartiality of the assessment process. I shall also keep the
Board informed about changes in the status of my association with the organization before
every assignment.

iv. I understand that I will be given access to various documents of the hospital/ SHCO and other
related information by NABH. I undertake to maintain strict confidentiality of the information
acquired in course of discharge of my responsibility and shall not disclose to any person other
than that required by NABH and will not store any data of the concerned hospital on my system.

v. I understand that the remuneration for the Virtual onsite assessment is Rs 5000/- for one
application (including fee for the new assessment and it’s reviews also).

I have gone through the contents mentioned above and have fully understood the clauses and shall
abide by the same. I understand that failure to abide by any or all of the mentioned conditions may lead
not only to my permanent debarment as a NABH assessor but legal action as per rules may also be
initiated against me.

Date: Place: Signature:

Issue No. 2 Issue Date: 10/ 20 Page 2 of 2

NATIONAL ACCREDITATION BOARD FOR HOSPITALS
& HEALTHCARE PROVIDERS (NABH)
Quality Council of India
5th Floor, ITPI Building; 4 A, Ring Road, IP Estate
New Delhi - 110 002, India
Tel/ Fax: 91-11- 42600600
Website: www.nabh.co
E-Mail: helpdesk@nabh.co