Safety CAQ Application

PAY ACCREDITATION FEE

    Clinical Hyperbaric Safety Certificate of Added Qualification (CAQ) — Application

    Applicant Contact

    Applicant Name

    Applicant Email

    Phone

    Facility Information

    Facility Name

    Address

    Primary Contact (Name, Title, Email, Phone)

    Chamber Type

    Scope of Services: (approved indications, average patient volume, emergency response capacity)

    Leadership & Governance

    Safety Director (Name & Credentials)

    Team Roster (attach license copies)

    Executive Sign-off (Name & Title)

    Attestation

    By signing below, I affirm the information is accurate and complete and that this facility commits to upholding ACHM safety standards.

    Signature (type full legal name)

    Date

    [acceptance* consent] I agree to the above attestation and to be contacted regarding this application.

    Application Review & Next Steps

    All submitted applications undergo a comprehensive review by the ACHM Safety Committee. During this process, applicants may be contacted to provide additional documentation or clarification as needed.

    Upon preliminary approval, the applicant will receive a Safety CAQ preparation packet via email, including the ACHM Safety Consensus Document: Safe Operations in Clinical Hyperbaric Oxygen Therapy, associated annex materials, and Safety CAQ checklists. These materials are intended to support self-assessment and preparation prior to the formal site evaluation.

    Once all required documentation has been reviewed and accepted, the facility site evaluation and Safety CAQ accreditation visit will be scheduled.