Health Evaluation Template

Health evaluation template serves as a framework of health evaluation report. It is a necessary means of judging the existing health circumstances so that the sate or private officials can take up the responsibility of changing them in the positive direction. Hence, it must be formulated unmistakably under strict supervision.

Sample Health Evaluation Template

Nature of health evaluated: _____________________________ [Mention the location of the population being evaluated and the nature of health whether it is physical or psychological]

Health evaluation commissioned by: ______________________________ [Mention the organization or company commissioning the health evaluation]

Date of submission of report: _________________________ [Mention the correct appropriate date]

Health evaluation conducted by: ____________________________________ [Provide the name of the organization or department conducting it. Mention the names of chief members and the team leader]

Purpose of health evaluation:

  • Purpose 1: _________________________________
  • Purpose 2: _________________________________
  • Purpose 3: _________________________________ [Incorporate the benefits that will be achieved through this health evaluation]

Techniques used for health evaluation:

  • Technique 1: ___________________________
  • Technique 2: ___________________________
  • Technique 3: ____________________________ [Mention the methods of evaluation]

Factors considered in health evaluation:


  • Health habits and behaviours: ________________________________
  • Vaccinations administered to children: _________________________
  • Exposure to media: __________________________________
  • State of medical equipments: __________________________________
  • Cleanliness and hygiene: ___________________________________
  • Past occurrences of illnesses : ______________________________
  • Present health status: ____________________________ [Mention how each of these factors affected the health evaluation]

Health evaluation report compiled by: _____________________________ [Provide the relevant details of the people in charge of it]

For more information please contact: _______________________________ [Provide valid contact detail]

Download Health Evaluation Template

Category: Health Evaluation

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