ACTION PLAN FOR IMPLEMENTATION

General Objectives: 1.

2.

Component/ Area (PLAN)

Objective Strategy/ Activities (DO)

Resources needed

Time line Monitoring & Evaluation (CHECK)

Indicators (Targeted Outcome/ Accomplishment (ACT)

Locus of Responsibility/ Responsible person

1.

2.

3.

4.

5.

Prepared by: Noted by: Approved by: Date: Date: Date:

Name of Hospital/ Institution: _______________________________________________

Address: ________________________________________________________________

Contact Details: __________________________________________________________