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ANNEXURE - 5 Immunization Week Tally Sheet: Daily Report Form From Sessions Site

This document contains tally sheets for recording immunization data during an immunization week. The sheets include spaces to record the number of children and women vaccinated each day, broken down by vaccine type and dose. Staff signatures and vaccine and syringe consumption are also tracked. The forms are for recording daily data at individual sites and cluster/PHC levels to monitor progress during the immunization campaign.

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baluchandrashekar2008
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301 views2 pages

ANNEXURE - 5 Immunization Week Tally Sheet: Daily Report Form From Sessions Site

This document contains tally sheets for recording immunization data during an immunization week. The sheets include spaces to record the number of children and women vaccinated each day, broken down by vaccine type and dose. Staff signatures and vaccine and syringe consumption are also tracked. The forms are for recording daily data at individual sites and cluster/PHC levels to monitor progress during the immunization campaign.

Uploaded by

baluchandrashekar2008
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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ANNEXURE - 5 Immunization Week Tally Sheet

Daily Report form from Sessions Site


Name of the PHC: Name of Sub-Center Name of Village / Area Children Vacine Male BCG DPT1 DPT2 DPT3 DPT - Booster Hep B1 Hep B2 Hep B3 OPV 0 OPV 1 OPV 2 OPV 3 OPV - Booster Measles JE Women TT1 TT2 TT Booster Issued AD Syringes Disposable Syringes BCG Vials BCG Diluents DPT Vials OPV Vials Measles Vials Measles Diluents Heb B Vials JE Vials JE Diluents TT Vials Signature of ANM-Consumed Names of Staff 1. ANM: 2. ASHA 3. AWW 4. Volunteer Female Male Female Male Female Male Female Less than 1 Year Number for the day Cumulative Date of activity: Place of Sessions Category: A/B/C More than 1 Year Number for the day Cumulative

Pregnant Women Number for the day Cumulative

Others Number for the day

Cumulative

ANNEXURE - 6 Immunization Week Reporting Format


Daily Report form from PHC onwards at each level
Name of the State: Name of PHC / Cluster: Children Vacine Male BCG DPT1 DPT2 DPT3 DPT - Booster Hep B1 Hep B2 Hep B3 OPV 0 OPV 1 OPV 2 OPV 3 OPV - Booster Measles JE Women TT1 TT2 TT Booster Issued AD Syringes Disposable Syringes BCG Vials BCG Diluents DPT Vials OPV Vials Name and Signatures of Person In-Charge Consumed Measles Vials Measles Diluents Hep B Vials JE Vials JE Diluents TT Vials Issued Consumed Pregnant Women Number for the day Cumulative Others Number for the day Cumulative Female Male Female Male Female Male Female Less than 1 Year Number for the day Cumulative Name of the District: Date of activity: More than 1 Year Number for the day Cumulative

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