Guidelines on stock records for immunization programme - Path

Serial number :
Issuing office :
Issued by :
Title:
Date and signature:
Approved by :
Title:
Date and signature :
Nature of loss :
No :
Item description :
Unit size :
Quantity to be disposed of :
Remarks :
Recommendations of corrective actions and disposal :
Property Survey Board submission :
Number assigned to the report (in consecutive order)
Name of the office (store) issuing the report
Name of the person filling in the form
Title of the person filling in the form
Date and signature of the person filling in the form
Name of the person approving the information on the form
Title of the person approving the form
Date and signature of the person approving the form
Tick for place where loss has had happened (in store or in
transit) and type of loss (damaged by heat, freezing, expiry,
missing inventory or other - and explain)
Line number of items in the report
Name of the commodity
Indicate either vials, doses, pack of X
Number of units to be disposed of
Any explanation regarding the reason of disposal
Explain how the commodities will be disposed and how
further damages/losses could be prevented
List of documents attached to the report (photos, claims,
laboratory analysis, batch and expiry dates, etc.)
WHO/IVB/06.12
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