Refresher Training for Frontline Health Workers in Expanded ... - RHO

Monthly Health Facility EPI Vaccination Reporting Form (Revised 1994 EC)
Region/Zone _________________________ Woreda ___________________
Page 1
Health
Facility_________________ Month__________ Year_________
EPI Vaccination Given
No. of
vaccination sites DPT Polio (OPV)
BCG Measles 1 2 3 0 1 2 3
Fully
vaccinated
Vit. A capsule
given
No. Kebele Static
Out
reach
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
0 to
11
12 to
23
76