This fourth chapter of the 2018 Manual for Male Circumcision under Local Anaethesia provides guidance on the role of recordkeeping and reporting in quality assurance; standards and indicators for voluntary medical male circumcision (VMMC) programmes and services; reporting severe adverse events using guidance from the College of Surgeons of East, Central, and Southern Africa; tools used for recordkeeping and data collection; the analysis and use of indicator data for decision-making at the site level; and the use of quality improvement tools.