Facilitators' Guide Immunization Handbook for Health ... - Nccvmtc.org
Facilitators' Guide Immunization Handbook for Health ... - Nccvmtc.org
Facilitators' Guide Immunization Handbook for Health ... - Nccvmtc.org
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Handout 6: Tally Sheets<br />
REPORTING FORM OF IMMUNIZATION SESSION SITE (Tally Sheet )<br />
Name of PHC/ Sub Center Name of Village/Mohalla Date of session: Place of session<br />
Children Less than 1 year More than 1 year<br />
Vaccine Tally Total Tally Total<br />
BCG<br />
DPT1<br />
DPT2<br />
DPT3<br />
DPT-<br />
Booster<br />
OPV-0<br />
OPV1<br />
OPV2<br />
OPV3<br />
OPV-<br />
Booster<br />
Measles<br />
Vit.A 1<br />
Vit. A 2<br />
HepB1<br />
HepB2<br />
HepB3<br />
DT<br />
Male Female Male Female Male Female Male Female<br />
Women Pregnant women Others<br />
Tally Total Tally Total<br />
TT1<br />
TT2<br />
TT Booster<br />
AD SYRINGES 0. 5 ml<br />
0.1 ml<br />
DISPOSABLE SYRINGES 5 ml<br />
Issued<br />
Consumed<br />
HepB vaccine 1. ANM. :<br />
BCG VIALS 2.Superviser :<br />
DPT VIALS<br />
OPV VIALS<br />
MEASLES VIALS<br />
DT VIALS<br />
TT VIALS<br />
Signature of ANM:<br />
Names of staff<br />
20
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