New Facility or Modality Accreditation Application Form

Please complete all fields as applicable.

Note: Stakeholders, listed below, will receive a request prior to the assessment to complete an online survey. Findings from the survey will be shared with the assessment team to inform assessment activities.

Identify the singular person who will be responsible for coordinating the assessment logistics. They will be granted access to the secure CPSA Facility Accreditation SharePoint site, and will be the primary contact throughout the accreditation process.

Check the specific imaging examination services you will be providing at the facility.

Check the specific imaging examination services your facility is already accredited for.

Check the imaging examination services your new facility will be providing, or which new imaging modality your existing facility wishes to add.

Please identify the location for each of the following types of records (documents, policies, logs, files, etc.). NOTE: A log detailing the completed staff performance evaluations should be available at each site.