Needs Collection

• Prepared by:

• Date:

  Date

• Department

• Signature

  Sign

Area Details:

• Health Network Name

• Facility Name

• Department Name

• Stakeholder Name

• Contact Email

• Contact Number

Needs Details

• Describe the need

• Category

  Select Operational Activities Projects Supplies Other

  • Operational Activities
  • Projects
  • Supplies
  • Other

• What are the primary objectives and goals for this need

• Have the funds already been secured

  Yes

  No

  N/A

• What are the most critical obstacles and risks

• Have you faced this sort of need before

  Yes

  No

  N/A

• Objectives and goals were aligned with 2028 funding plan

  Yes

  No

  N/A

• Objectives and goals will support the EHC Long Term Strategy

  Yes

  No

  N/A

• Priority

  Urgent

  Important

  Important and Urgent