National Rural Health Mission - Amravati

3b1. Data to be collected on a monthly basis at block level
Name of
Sub
Centre
Total
3b.2
Number
of girls
reached
per
month
Name of sub
centre
Total
Number
of SN
packs
Received
Total number of
ASHA
Number of
SN packs
Distributed
Balance
Packs
Amount of Incentive
paid to ASHA for SN
packs
Amount of
Incentive
paid to
ASHA
Amount of
funds
recouped
to SC
Amount of
Incentive paid to
ASHA for meeting
4. Monthly Monitoring format/Register for Sub Centre
a. Rental cost for storage arrangements (e.g. SC, rented godown)
b. Costs of transportation
Name of
Village
Total
Name of
ASHA
Number of
girls reached
per month
Number of
SN packs
Recd from
block
Number of
SN packs
sold
Balance
SN packs
Rental cost
for storage
arrangemen
ts, if any.
Costs of
transpo
rtation
Average
attendance in
monthly meeting
Amount of
Incentive paid to
ASHA
Sale of
napkins
Sunday
meeting
s
Amoun
t of
funds
recoup
ed to
SC
5. The ASHA will maintain a tracking register (Format A) of the adolescent girls in her village and submit
a monthly report to the ANM in the Format B.
Format A
Name
of Girl
Total
number
of SN
packs
sold
Jan
Sunday mtg.
attendance
number
of SN
packs
sold
Feb Mar Apr
Sunday
mtg.
attendance
number
of SN
packs
sold
Sunday mtg.
attendance
number
of SN
packs
sold
Sunday mtg.
attendance