Please complete this Needs Analysis form for general lab services. Upon completion of the form click Submit button at bottom. You may also print a blank form and send it to us at:
Worldwide Lab Improvement, Inc
3607 Gembrit Circle
Kalamazoo, MI 49001
(269) 323-8407 (phone) (269) 323-2030 (fax)
A-1 Your Information
Hospital/Clinic:
Hospital/Clinic Address:
Ministry/Mission Board Name:
Your Name:
Email:
Your Phone:
City, Country:
How did you learn about WWLAB?
A-2 USA Contact Information
Ministry Name:
Contact Name:
Address:
Federal Tax ID Number:
Email:
Website:
Phone:
B-1 MISSION STATEMENT AND STATEMENT OF FAITH
WWLAB assists mission hospitals and clinics. To help us determine if your request meets this criteria, you must submit your Mission Statement and Statement of Faith.
I will submit my Mission Statement and Statement of Faith via:
REQUIRED - Please check one:
C-1 TESTING
a. What laboratory tests do you presently do?
b. What method do you use for each?
c. What is the average number of each test that you do per year?
d. What tests would you like to add? Why?
C-2 PERSONNEL
a. Who does the lab testing?
b. What training have they had?
C-3 EQUIPMENT
a. What equipment (microscope, centrifuge, chemistry analyzer, etc) do you have?
Please give the make, model number, serial number, and note if each is working.
C-4 REAGENTS AND SUPPLIES
a. How do you get your reagents and supplies?
b. What problems, if any, do you have in getting them?
c. How frequently does your mission have travelers from the US who could carry
supplies as checked baggage?
C-5 GENERAL
a. What is your greatest laboratory need right now?
(If there are several, please prioritize)
b. What is your source of electricity? What is the range of voltage?
How often is your lab without power? How long do outages last?
c. Do you have a working refrigerator with a separate freezer compartment?
Do they maintain a constant temperature?
d. How is water supplied to your laboratory? Is it reliable?
e. What is your current annual budget for laboratory equipment and supplies?
C-6 TRAVEL
a. Which international airport do you use?
b. What additional travel is necessary to reach your location?
THANK YOU! PLEASE SUBMIT YOUR SURVEY. 
| ||||||
