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 City

Contact No Mobile
Website(If any) 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
General medicine Paediatrics
Gynaecology
General Surgery Intensive care Psychiatry

Orthopaedic Care Burn cure Others:

5.0 DIAGNOSTIC SERVICES

(Tick if available and mark (x) if not available)
Diagnostic X-ray Radioisotope Diagnostic
Ultra Sound/Medical
Positron Emission Tomography(PET)
Sonography
Computerized Tomography
Magnetic Resonance Imaging (MRI)
Scanner/CT- Scan

6.0 SPECIALITIES AVAILABLE

(Mention the number of doctors available against each of the speciality)
 Full Part Full Part
SPECIALITIES Time Time SPECIALITIES Time Time
a).General and Family d).Other Medical
Practice Speciality
b).General Internal
Medicine i).

c).Paediatrics ii).

7.0 SURGICAL SPECIALITY

e).Obstetrics j).General Surgery

k).Thoracic
F).Gynaecology Surgery
l).Other Surgical
g).Ophthalmology Surgery Speciality

h).Orthopaedic Surgery i).

i).Plastic Surgery ii).

8.0 OTHER SPECIALITIES

m).Anaesthesiology r).Psychiatry

n).Dermatology s).Radiology

o).Emergency Medicine i).

p).Nuclear Medicine ii).

q).Pathology iii).

9.0 SERVICE MANPOWER DETAILS

(Tick against the appropriate available in your hospital)

Radiology Services Yes No Nuclear Medicine Yes No

CT-Scan Yes No MRI Yes No

Sonography Yes No Others specialities: Yes No

 10.0 DIAGNOSTIC EQUIPMENT SURVEY & PRODUCT DETAILS
Equipment Specification X-RAY UNIT X-RAY MOBILE UNIT

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)
ULTRA
Equipment Specification MAMMOGRAPHY
SOUND
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)
Equipment Specification CT-SCAN MRI

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/N0)

11.0 DETAILS OF RADIOLOGIST

Once Again Thank You Very Much For Your
Assistance