MRC Block Jambai Final Report

Tamil Nadu MR Campaign 2017
FORM 2.1 Target Children -PHC wise Abstract form for MR Vaccination campaign
District :_____Erode____________
S.N
o.
Name of
PHC/UPHC
HUD : _______Erode________
9
Estimated
months
MYE
children of the
to < 5
Populationarea
years
2016
(9 m to < 15
(Enumer
years)
ated)
5 to <15 years school children and number of Schools (as per school
records)
Govt
Govt. Aided
Private
No of
Schools
No of
Children
No of
Schools
No of
Children
No of
Schools
No of
Children
Out of
School
going
Total
Total
childre Target
n (5 to Children
< 15
No of
No of Children
Schools
years)
n=d+l+m
Jambai
14763
3395
459
507
108
306
11
921
1380
Mylambadi
35155
8086
1018
23
2188
84
6618
31
8890
9908
Periyapuliyur
35865
8249
1670
29
2431
60
1224
34
3715
5385
Odathurai
35475
8159
1218
21
3473
21
2520
26
6014
7232
Appakudal
23493
5403
643
13
2715
58
1034
16
3807
4450
UPHC Bhavani
42530
9782
936
3176
352
1330
18
4858
12
5794
187281
43075
5944
102
14490
683
26
13032
136
28205
12
34149
Grand Total
Note :
1 School Children means all schools located within the PHC/UPHC area
2 MPTY/Corp. School Children particulars should be provided UPHC wise

FORM 2.2- Target Children form for MR Vaccination campaign (Age /Sex wise)
District :_____Erode____________
HUD : ___Erode____________
Enumerated Children
in the area
Targeted children
(School going & Out of school)
Grand total
S. No.
Name of PHC/UPHC
9 months to < 5 yrs
5 yrs to < 10 yrs
10 yrs to < 15 yrs
Total
Total
Total
Total
Jambai
246
213
459
360
367
727
112
82
194
718
662
1380
Mylambadi
527
491
1018
2023
1893
3916
2751
2223
4974
5301
4607
9908
Periyapuliyur
870
800
1670
1220
1205
2425
734
556
1290
2824
2561
5385
Odathurai
619
599
1218
1644
1502
3146
1471
1397
2868
3734
3498
7232
Appakudal
328
315
643
682
604
1286
1269
1252
2521
2279
2171
4450
UPHC Bhavani
485
451
936
945
953
1898
1164
1796
2960
2594
3200
5794
3075
2869
5944
6874
6524
13398
7501
7306
14807
17450
16699
34149
Total
4PM
Govt.Girls
Hr.Sec.Scho
ol
7
1416
Number of Target children

(9m - <15 yrs children) in
the school
No. of vaccinators
Required
(= children/200)
C
D
E
F
G
Name of
volunteers
(ASHA, AWW,
others)
H
I
2.
M.Tamilselvi
VHN
1.Kanimozhi
1.
HW
M.Ponnulaksh 2.Maheshwari
mi VHN
AWW
2. P. Santhi
3.Puvaneshwar
VHN
i AWW
1. N.T.Mahesh
VHN
2. J.Elizabeth
SHN
1. T.R.Renuka
VHN
2. S.Vijaya
VHN
1.
R.Valarmathi
VHN
Rames
1.0E+010
h
School Nodal
Person
M
N
O
P
Q
R
S
T
157
157
1571
157
7
35
14
7
(5
Indelible Marker Pens

(1 pen per 250
benefciaries)
1. T.Umapathi
VHN
Black Plastic Bags

(2 per
site)
Red Plastic Bags

(1 bag
per 50 syringes)
Hub Cutter
(1 per vaccinator)
Reconstitution
syringe
ml) (= M)
Contact
Number
AD (0.5 ml) syringe
(Fx 1.11)
Name
Measles-Rubella
Diluent Ampoules (=
M)
Team Details
Measles-Rubella
Vaccine Vials*
(10 dose vial)
(F x 1.11)/10
Name and
designation of
Supervisor
(with mob no)
Name of
Vaccinator(s
)
8344567843
Time of vaccination
Erode
Dr.Prema MBBS
Date of vaccination
Distance from ILR point
0.5 KM
Village / Urban Locality
Name of
school
17
1
Bhavani Urban
S. No
School Planning Form -3
Block:___Bhavani__________________
PHC / UHP / Mpty._________________
HSC / Urban Area:___
Logistics requirement
MR vaccination card
(=F)
Address & Contact
No. of nearest AEFI
Management center
, 9865273240
1416
nning Form -3
HSC / Urban Area:________________________
AEFI
U
V
Form 4.1- Outreach Planning Form (Includes Regular, High Risk Area / Population)- Rural
District:___Erode__________
HUD :___Erode__________________________ Block:Bhavani
Jambai
Jambai
AWC
PERIYAVADAMALAIP
ALAYAM
PUES
Jambai
AWC
0.5
29
TAMILSEL
VI
leevavathi
98650 64687
32
45
TAMILSEL
MEENACHI
VI
9750611082
50
55
GUNALAK SHANMUGAVADIV
SHMI
U
9788487153
61
45
TAMILSEL
VI
9994850900
49
174
19
19
192
19
8 AM to 4PM
SATHYA
MOORTHINAGAR
jambai
23.02.2017
To
tal
Contact
Number of
Volunteers
(with mob no)
SARATHAMBAL
(1 bag per
50 syringes)
Name of
volunteers
(ASHA, AWW,
others)
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Name of
Vaccinato
rs
syringe
AMMANKOIL
JAMBAI
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
AWC
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Date of vaccination
20.02.201 18.02.201 11.02.201

7
7
7
ST
Name of
session
sites
Distance from ILR

point
Name of Village /
Urban Locality
Type of Area (R/HRA)
S. No
Name of Supervisor with contact no:Dr.P.Vidhyalakshmi MBBS,MO,99444
Kadaiyampatti
. of vaccinators
=( F/150)
mber of Target
children
mo to <15 yrs)
e of vaccination
e of vaccination
Name of
session
sites
tance from ILR

point
Name of Village /
Urban Locality

e of Area (R/HRA)
S. No
Jambai
Team Details
54
65
SHANTHI
SENTHAM
TAMIL
ALAI`
SARALADEVI
SELVI
64
24
25
232
KADAYAMPATTI
THIPPICHETTYPALA
YAM
PUMS
20.02.17
SERVARAYANPALAYA
M
PUES
CINNAMOLA
PALAYAM
21.02.201
7
AWC
24.02.17
SEETHAPALAYAM
AWC
25.02.17
8 AM to 4PM
18.02.201
7
GUNALAK
H
SHMI, SHN
Total
TAMIL
SELVI
Contact
Number of
Volunteers
(with mob no)
9698939823
60
9488875443
72
90955 99936
71
9488875443
27
28
26
26
258
26
K.SIVAKUMAR
R.GUNA
SARALADEVI
LAKSHMI
TAMIL
SELVI
(1 bag per
50 syringes)
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Name of
volunteers
(ASHA, AWW,
others)
Sulochana
9943715829
syringe
AWC
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
Name of
Vaccinato
rs
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Date of vaccination
Time of vaccination
Name of
session
sites
Distance from ILR

point
Name of Village /
Urban Locality
S. No
Jambai
Periyamolapalayam
109
20.02.201
7
44
21.02.2017
61
PUES
23.02.2017
34
PUES
24.02.2017
38
PERIYA
MOLAPALAYAM 1
AWC
CHINNAVADAMALAIP
ALAYAM
PUES
KARUKKUPALAYAM
PERUMAPALAYAM
Contact
Number of
Volunteers
(with mob no)
SASIKALA
9865718385
12
12
120
12
SASIKALA
9443936665
49
VALARMATHI
7502217206
68
KALAISELVI
9443936665
38
RAMYA
8870846291
42
2
SENTHAM
ALAR
8 AM to 4PM
PUPS
Name of
volunteers
(ASHA, AWW,
others)
GUNALAK
SHMI, SHN
11.02.201
7
PERIYA
MOLAPALAYAM 2
(1 bag per
50 syringes)
No. of vaccinators
=( F/150)
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Number of Target
children
(9 mo to <15 yrs)
Name of
Vaccinato
rs
syringe
Time of vaccination
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
Date of vaccination
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
Name of
session
sites
Distance from ILR

point
Name of Village /
Urban Locality
S. No
SENTHA
MALAR
GUNALAK
SHMI ,
SENTHAM
ALAR
SENTHA
MALAR
SENTHA
MALAR
8
6
MUTHUGOUNDANUR
AWC
25.02.2017
29
SENTHA
MALAR
CHANDRA
9715635350
32
SERANGADU
AWC
25.02.2017
15
GUNALAK
SHMI
KRISHNAVENI
99768 28230
17
330
37
37
366
37
12
Total
Outreach Planning Form
HUD / Corporation: Erode
(Includes Regular, High Risk Area / Population)
Block: Bhavani
PHC / UHP / Mpty : Mylambadi
HSC / Urban Area: Kannadipalayam

No. of vaccinators
=( F/150)
Kannadi Palayam
PUES
2 Km
20.02.17
Amman Palayam
PUES
5 Km
20.02.17
Sanar Palayam
PUES
2 Km
20.02.17
Konduretti
Palayam
PUES
1 Km
20.02.17
87
115
42
30
H
Vijaya
VHN
Umapathy
VHr
Valarmath
i Vhr
Nalini
(1 bag per
50 syringes)
Number of Target
children
(9 mo to <15 yrs)
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Time of vaccination
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
I
1.Sagunthala
2.Arukayal
3. Dhanam
1.Kanagarani
2.Lakshmi
1.Vijaya
3.Thangamani
2.Sathya
9487712413
10
10
97
10
9688971971
13
13
128
13
9965378389
47
9489481114
33
Name of
Vaccinato
rs
1.Valarmathi
3.Sumathy
syringe
Date of vaccination
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
Distance from ILR

point
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
Name of
session
sites
8 Am to 4 Pm
Name of Village /
Urban Locality
S. No
Name of Supervisor with contact no: Dr.K.Ramya 9842763233
2.Padmavathi
Senpagava 1.Sumathi
lli
2.Thangavel
35
1
9445731554
4
4
39
4
1
1
Koonakka Palayam
PUES
R
1 km
20.02.17
5
Total
309
5
35
35
344
35
5
7
* It is assumed that at least 50% of the beneficiaries of the village or confined urban area (ward or sub ward) will be covered during school vaccination in the first week of the campaign. The vac
session should be calculated/distributed subject to school based coverage. For Eg. 1. If the coverage is > 50%, plan for 50% supply of vaccine & logistics. (2) If school coverage is <50% , plan for
(3) If school coverage is not done then plan for 100% supply of vaccine & logistics
EACH VACCINATOR MUST HAVE ONE FUNCTIONAL HUB CUTTER AND INDELIBLE INK MARKER PEN EVERY DAY

HSC / Urban Area: Vaikkal Palayam
Block: Bhavani

PUES
5 Km
21.02.17
Vaikkal Palayam
PUES
4 Km
21.02.17
Nalli Palayam
PUES
8 Km
21.02.17
Chinniyam Palayam
PUES
8 Km
21.02.17
87
Nalini
60
Vijaya
VHr
106
1.Chanthra
Umapathy
2.Mallika
VHr
3.Rajathy
9715685350
12
12
118
12
46
1.Kamala
Senpagaval
2.Kalamani
li VHr
3.Manimegalai
9715012031
53
299
34
34
335
34
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
1.Thangamani
2.Ramayee
3.Maheshwari
9765487455
10
10
97
10
1.Mythily
2. Uma
3.Revathi
9715916292
67
8 Am to 4 Pm
4
Total
(1 bag per
50 syringes)
Paruvachi School
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Name of
Vaccinato
rs
syringe
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
Date of vaccination
No. of vaccinators
=( F/150)
Distance from ILR

point
Number of Target
children
(9 mo to <15 yrs)
Name of
session
sites
Time of vaccination
Name of Village /
Urban Locality
S. No
Team Details

Block: Bhavani
(1 bag per
50 syringes)
Contact
Number of
Volunteers
(with mob no)
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Name of
volunteers
(ASHA, AWW,
others)
syringe
Name of
Vaccinato
rs
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Name of
session
sites
Date of vaccination
Name of Village /
Urban Locality

Distance from ILR
point
S. No
HSC / Urban Area: Thotti Palayam
Thotti Palayam
School
PUES
Selampagoundan
Palayam
PUES
7 Km
8 Km
21.02.17
23.02.17
8 Am to 4 Pm
Total
108
R.Valarmat
hi VHr
I
1.Kalamani
2.Kamala
8883313305
12
12
120
12
9095463356
10
10
99
10
22
22
219
22
3.Tamilselvi
89
197
1.Tamilselvi
R.Valarmat
hi VHr
2.Mahalakshmi
3.Thaiyalnayagi

Block: Bhavani
HSC / Urban Area: Mylambadi
1/2 Km
23.02.17
Erusanoor
PUMS
2 Km
23.02.17
Katham Palayam
PUES
2 Km
23.02.17
95
1.Vijaya
Senpagaval
2.Manimegalai
li VHN
3.Jeya
9095463356
11
11
105
11
41
1.Sathesprabhu
Umapathy
2.Sanmugavalli
VHN
3.Vanitha
9629750802
46
64
Vijaya VHN
9789732285
71
200
23
23
222
23
3
Total
(1 bag per
50 syringes)
PUES
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Mylambadi School
Name of
Vaccinato
rs
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
1.Chitra
2.Kalamani
3.Padmini
syringe
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)
Date of vaccination
Number of Target
children
(9 mo to <15 yrs)
Distance from ILR

point
Time of vaccination
Name of
session
sites
8 Am to 4 Pm
Name of Village /
Urban Locality
Type of Area
(R/HRA)
S. No

Block: Bhavani
HSC / Urban Area: Urachikkottai
2 Km
24.02.17
Urachikottai School
PUES
6 Km
25.02.17
Jeeva Nagar
AWC
7 Km
25.02.17
107
1.Thilaga
Senpagaval
2.Sarasu
li VHN
3.Rasathi
55
Vijaya VHN
1.Meena
2.Renuka
3.Logarani
9688540663
61
65
Umapathy
VHN
1.Savithiri
2.Gomathi
3.Rajamani
9965240563
72
227
25
25
252
25
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
9056793518
12
12
119
12
3
Total
(1 bag per
50 syringes)
(5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
PUMS
Name of
Vaccinato
rs
syringe
Sangaragoundan
Palayam School
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Date of vaccination
8 Am to 4 Pm
Name of
session
sites
Distance from ILR

point
Name of Village /
Urban Locality
Type of Area
(R/HRA)
S. No

Block: Bhavani
HSC / Urban Area: K.N.Palayam

No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Date of vaccination
Name of
session sites
Distance from ILR

point
Name of Village /
Urban Locality
S. No

Team Details
Rana Nagar
AWC
10 Km
25.02.17
80
1.Indirani
Senpagaval
2.Vasanthi
li VHN
3.Santhi
9442640010
89
85
1.Uma
Vijaya VHN 2.Thangamani
3.Puvaneswari
9688225868
95
165
18
18
184
18
Total

7 Km
27.02.17
V.Mettu Palayam
School
PUES
8 Km
27.02.17
1.Murugampal
Vijaya VHN 2.Dharani
3.Sagunthala
9750052781
45
102
1.Bhuvaneswari
Senpagaval
2.Chiththayal
li VHN
3.Vijayampal
9442451682
11
11
113
11
55
1.Kondammal
2.Manju
Umapathy
3.Baby
VHN
9994907564
61
(1 bag
per 50 syringes)
PUES
Red Plastic Bags
Koolikaran Palayam
School
40
Hub Cutter
(1 per vaccinator)
27.02.17
Reconstitution
syringe
(5 ml)
(= K)
5 Km
AD (0.5 ml)
syringe
(0.5 x [(F X 1.11)
Contact Number of
Volunteers
(with mob no)
Measles-Rubella
Diluent Ampoules
(= K)
PUMS
Name of
Name of volunteers
Vaccinators (ASHA, AWW, others)
Measles-Rubella
Vaccine Vials*
(10 dose vial)
[(F X 1.11)/10]
Chinnaperichi
Palayam School
No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Team Details
Time of vaccination
8 Am to 4 Pm
Date of vaccination
Distance from ILR

point
Name of
session sites
Block: Bhavani
Name of Village /
Urban Locality
HSC / Urban Area: Varadhanallur
S. No
(1 bag
per 50 syringes)
25.02.17
Red Plastic Bags
9 Km
Hub Cutter
(1 per vaccinator)
Reconstitution
syringe
(5 ml)
(= K)
AWC
AD (0.5 ml)
syringe
(0.5 x [(F X 1.11)
K.N.Palayam CNC
Contact Number of
Volunteers
(with mob no)
Measles-Rubella
Diluent Ampoules
(= K)
Name of
Name of volunteers
Vaccinators (ASHA, AWW, others)
Measles-Rubella
Vaccine Vials*
(10 dose vial)
[(F X 1.11)/10]
No. of vaccinators
=( F/150)
Number of Target
children
(9 mo to <15 yrs)
Date of vaccination
Name of
session sites
Time of vaccination
Distance from ILR

point
Name of Village /
Urban Locality
8 Am to 4 Pm
S. No
8A
4
Sanniyasi Patty
School
PUES
9 Km
27.02.17
Total
61
258
1.Gracylatha
Vijaya VHN 2.May
3.Geetha
7502933704
68
29
29
287
29

District:___________ERODE
Block:JAMBAI
PHC : PERIYAPULIYUR
HSC :_KUTTIPALAYAM
KUTTIPALAYAM
KUTTIPALAYA
M AWC
12
20.02.17
GOUNDENPUDUR
AWC
GOUNDENPU
DUR
11
21.02.17
SIRAIMETTANPALAYA SIRAIMETTAN
M AWC
PALAYAM
23.02.17
12
24.02.17
4
NESAVALAR COLONY
SCHOOL
NESAVALAR
COLONY
SCHOOL
Total
Team Details
Name of
Contact
volunteers
Number of
(ASHA, AWW,
Volunteers
others)
(with mob
no)
I
J
124
N.UMA
AMBUJAM
M.PREMA
A.SANTHI
8526742050
13
13
138
13
31
N.UMA
S.SUDHA
MAHADEVI
GEETHA
9865203538
35
61
N.UMA
K.SAROJA SELVI
RUKKUMANI
9698514230
68
68
N.UMA
S.MYNAVATHI
VANITHA
UMA
9942989322
75
284
32
32
316
32

District: ERODE
HUD : ERODE
Block: BHAVANI
PHC : PERIYAPULIYUR
(1
Time of
vaccinati
on
Number
Name of
Vaccinato
rs
Mea
slesRub
ella
Vac
cine
Vial
Mea
s*
sles(10
Rub
dose
ella
AD
vial)
Dilu
(0.5
[(F
ent
ml)
X
Amp
syri
1.11
oule
Rec
nge
)/10
s
onst
(0.5
]
(=
Red
ituti
xK)
[(F
Plas
on
X
Hub
tic
syri
1.11
Cutt
Bag
nge
er)
s (5
(1
ml)
per
(= K)
vacc
inat
or)
Date of
vaccinati
on
of Target
children
(9No.
moofto
vaccinato
<15 yrs)
rs
=( F/150)
*1
Distance
from PHC
Name of session
site & location
8 Am to 4 Pm
Village/
Hamlets
covered
Type of
Area
(R/HRA)
S.No
Name of Supervisor with contact no:
HSC : MINNAVETTUVAMPALAYAM
Time of vaccination
Number of Target
children
(9 mo to <15 yrs)
No. of vaccinators
=( F/150)*1
133
13
21.02.17
100
N.P,MAHES VASUKI
SUSILA
WARI
LAKSHMI
9443339901
9750462276
9095784755
67
23.02.17
25
N.P,MAHES SUSILA
WARI
RAJASWARI
9750462276
9940911090
30
53
N.P,MAHES VANITHA SUNITHA

WARI
POOGOTHAI
9976968044
9965022331
9842648075
93
88
N.P,MAHES POONGDI
WARI
RUKUMANI
9942440347
9976968055
10
10
98
10
75
G.B.REYAZ DEVI
SARSU
UNNISA
KRISHANVENI
9659777427
8526097967
9715357603
83
63
RATHINNAL
G.B.REYAZ
RAJALASHMI
UNNISA
SARASUVATHI
9095252819
9442543240
9942393883
70
624
57
57
574
57
14
K.RAMANATHAPURA K.RAMANAT
M ELE.SCHOOL
HAPURAM
18KM
PONNAGARAM AWC
PONAGARAM
ENJARAM
MEDU
15KM
ERAPPANIKANOOR
ELE.SCHOOL
ERAPOPANAI
KANOOR
KURAJANVA
LASU
20KM
METTUR
ELE.SCHOOL
METTUR
18KM
AYYANVALASU
ELE.SCHOOL
AYYANVALAS
U
MANICKKAV
ALASU
20KM
PERIYAGOUNDANVAL PERIYAGOUN
ASU ELE.SCHOOL
DANVALASU
22KM
Total
Name of
Vaccinato
rs
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)

District: ERODE
HUD : ERODE
Block: BHAVANI
PHC : PERIYAPULIYUR
(1 bag
per 50
15KM
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitutio
n syringe (5
ml) (= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
KRISHANAPU
RAM
PERAYUR
M.V.PALAYAM
MIDDLE SCHOOL
8 Am to 4 Pm
13
Date of vaccination
20.02.17
13
25.02.17
9488138266
9842840564
27.02.17
1.VALLIYAMMAL
N.P,MAHES
2.THAMGAMANI
WARI
3.MANIMEGALI
28.02.17
220
28.02.17
Distance from PHC
Name of session
site & location
DR.M.A.SIRAJUDEEN 984277
Village/
Hamlets
covered
Type of Area
(R/HRA)
S.No
SENTHAPALAYAM
ELE.SCHOOL
SENTHAMPA
LAYAM
12KM
DHARMAPURI AWC
DHARMAPUR
I
13
SALANGAPALAYAM
ELE.SCHOOL
VALAYAKARA
PALAYAM
2KM
23.02.17
GOUNDANPALAYAM
AWC
GOUNDANPA
LAYAN
12KM
SENTHAPALAYAM
COLONY AWC
SENTHAPALY
AM COLONY
12KM
85
ELAZABAT DEVI
H
ALAMELU
9524157596
9695597774
94
117
PREEGTHA
ELAZABAT
DEVIKA
H
SUBASINI
9659984244
8526934423
8870206532
13
13
130
13
187
ELAZABAT RANI
SUSILA
H
SARSU
9865092088
9750462276
21
21
208
21
32
ELAZABAT ANGAMMAL
H
SAMIMAPARVEEN
9788855017
9965037156
36
50
ELAZABAT ANGAMMAL
H
SAMIMAPARVEEN
9788855017
9965037156
56
471
53
53
524
53
12
8 Am to 4 Pm
Total
Mea
slesRub
ella
Vac
cine
Vial
Mea
s*
sles(10
Rub
dose
ella
AD
vial)
Dilu
(0.5
[(F
ent
ml)
X
Amp
syri
1.11
oule
Rec
nge
)/10
s
onst
(0.5
]
(=
Red
ituti
xK)
[(F
Plas
on
X
Hub
tic
syri
1.11
Cutt
Bag
nge
er)
s (5
(1
ml)
per
(= K)
vacc
inat
or)
Time of
vaccinati
on
Number
E
of Target
children
(9No.
moofto
vaccinato
<15 yrs)
rs
=( F/150)
*1
Date of
vaccinati
on
D
20.02.17
Team Details
Name of
Contact
volunteers
Number of
(ASHA, AWW,
Volunteers
others)
(with
mob
no)
I
J
21.02.17
Name of
Vaccinato
rs
24.02.17
Name of session
site & location
25.02.17
Distance
from PHC
Village/
Hamlets
covered
Type of
Area
(R/HRA)
S.No
(1
HSC :SALANGAPALAYAM

Block: BHAVANI
HSC : THATTRAPALAYAM
Date of
vaccinati
on
Time of
vaccinati
on
Number
of Target
children
(9No.
moofto
vaccinato
<15 yrs)
rs
=( F/150)
*1
Village/
Hamlets
covered
Distance
from PHC
Name of session
site & location

Type of
Area
(R/HRA)
S.No
PHC : PERIYAPULIYUR
Name of
Vaccinato
rs
H
Team Details
Name of
Contact
volunteers
Number of
(ASHA, AWW,
Volunteers
others)
(with
mob
no)
I
J
(1
HUD : ERODE
Mea
slesRub
ella
Vac
cine
Vial
Mea
s*
sles(10
Rub
dose
ella
AD
vial)
Dilu
(0.5
[(F
ent
ml)
X
Amp
syri
1.11
oule
Rec
nge
)/10
s
onst
(0.5
]
(=
Red
ituti
xK)
[(F
Plas
on
X
Hub
tic
syri
1.11
Cutt
Bag
nge
)
er
s (5
(1
ml)
per
(= K)
vacc
inat
or)
District: ERODE
LEELAVATHI
N.SARADH
POONGODI
AMANI
VAJAYALASHMI
9715357597
23.02.17
30
LEELAVATHI
N.SARADH
SARADHA
AMANI
VADSANTHA
9715357597
33
49
RAJESWARI
N.SARADH
RAJAMMAL
AMANI
SANTHI
9698529175
50
25.02.17
50
GURUSMERRY
N.SARADH
PERAMAYEE
AMANI
ESWARI
9597772216
56
27.02.17
21
N.SARADH PAVATHAL AMASA

AMANI
AMUTHA
9976514172
26
28.02.17
20
N.SARADH PAVATHAL AMASA

AMANI
AMUTHA
9976514172
25
269
68395402526
30
30
244
30
10KM
PALAKATTUR
PALAKATTUR
11KM
MARANAIKNOOR
MARANAIKN
OOR
2KM
V.RAMANATHAPURA V.RAMANATH
M
APURAM
10KM
CHELLAKUTTIPALAY CHELLAKUT
AM
TIPALAYAM
10KM
SELAVANAGA
R
13KM
SEMBOOTHAPALAYA SELAVANAGA
M
R
6 KM
SELAVANAGAR
6
8 Am to 4 Pm
20.02.17
21.02.17
56
THATTRAPAL
AYAM
24.02.17
43
THATTRAPALAYAM
Total
N.SARADH
AMANI
LEELAVATHI RANI
9715357597
48
VAJAYALASHMI

Block:JAMBAI
PHC;PERIYAPULIYUR
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
(1 bag per
Name of
Vaccinato
rs
Team Details
MeaslesRubella
Vaccine
Vials*
(10 dose
vial)
Measles[(F X
Rubella
1.11)/10]
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitut
ion syringe
(5 ml) (= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Number of Target
children
(9 mo to <15 yrs)
No. of
vaccinators
=( F/150)*1
Time of
vaccination
Village/
Hamlets
covered
Date of
vaccination
Name of session
site & location

Distance from
PHC
S.No
Type of Area
(R/HRA)
HSC :______________VAIRAMANGALAM
10
11
2
KARATTUPALAYAM
KARATTUPAL
AYAM
KUDUCHETTI
PALAYAM
KUNDUCHETTIPALAY GACHINAGAR
AM
VAIKKALMED
U
CHINNA
PULIYUR
CHINNAPULIYUR
KARATTU
PUDUR
CHINNAPULIY
CHINNAPULIYUR
SCHOOL
UR
KARATTUPUD
UR
11
11
84
8 Am to 4 Pm
10
20.02.201
7
21.02.201
7
VAIRAMANGA
VAIRAMANGLAM AWC
LAM J J
NAGAR
23.02.201
7
25.0
24.02.201
2.20
7
17
Total
SIVAAGAMI
R.PONNAY ESWARI SARANYA
AL
R.PONNAY
AL
R,PONNAY
AL
135
R.PONNAY
AL
60
R.PONNAY
AL
357
30
48
RUTHCLARA
KAVITHA
THANGAMANI
MANGAIYARKARAS
I SELVI VIJAYA
K.SAROJA
MUNIYAMMAL
RANGANATHAN
K.SAROJA
MUNIYAMMAL
RANGANATHAN
7708276595
92
9952534587
33
9698514230
52
9698514230
14
14
148
14
9698514230
66
39
39
391
39

HUD : ERODE
Block: BHAVANI
PHC : PERIYAPULIYUR
HSC : PERIYAPULIYUR
20.02.17
POOLAPALAY
AM
3KM
POOLAPALYAM AWC
142
1.K,KAVITHA
G.B.REYAZ
2.PAVALLAL
UNNISA
3.DEVIPRIYA
8754720775
7373895871
8694223210
16
16
158
16
48
1.SUDHA
G.B.REYAZ
2.DEVIPRIYA
UNNISA
3.
8694223210
8694223210
53
(1 bag
per 50 syringes)
2KM
Hub Cutter
(1 per vaccinator)
Red Plastic Bags
Reconstitution
syringe (5 ml) (=
K)
PERIYAPULIY
PERIYAPULIYUR AWC UR;KAMARA
JNAGAR
No. of vaccinators
=( F/150)*1
Team Details
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Name of session
site & location
8 Am to 4 Pm
Date of vaccination
21.02.17
Distance from PHC
Village/
Hamlets
covered
S.No
Measles-Rubella
Vaccine Vials*
(10 dose vial)
[(F X 1.11)/10]
Measles-Rubella
Diluent
Ampoules
(= K)
AD (0.5 ml)
syringe
(0.5 x [(F X 1.11)
District: ERODE
Name of
Vaccinato
rs
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
POOLAPALAY
AM
3KM
8 Am to
POOLAPALYAM AWC
21.02.17
Total
48
190
1.SUDHA
G.B.REYAZ
2.DEVIPRIYA
UNNISA
3.
8694223210
8694223210
53
21
21
211
21

Block:JAMBAI
PHC :_ODATHURAI
HSC :_AYYAMPALAYAM
AYYAMPALAY
AM PUDUR
KUNJAMPARI
AYYAMPALAY
20.02.17
AYYAMPALAYAM
NEHSU NAGAR AWC
AM COLONY
NALLIGOUND
ANUR
COLONY
PANANKATOO
PANANKATOOR AWC
R COLONY
AYYAMPALAYAM
COLONY AWC
20.02.17
20.02.17
98
Total
89
67
254
Dr.Dhivakaran MBBS , 979134
Team Details
Name of
Vaccinato
rs
1.RANI
VHN
2. H
INDIRAGA
NDHI VHN
S.PARVAT
3.
HI VHN
C.NAGESW
VASANTHA
ARI
VHN
B.DOWLAT
BAI VHN
HI VHN
DHANAM
VHN
Name of
volunteers
(ASHA, AWW,
others)
M.VALLERMATHI
I
AWW
V.KODESWARI
AYYA
R.SUNDERAM BAL
S.SELVI AWW
AYYA
ERASUAMMAL
AYYA
A.AMBIKA AYYA
R.JOTHI VOL
S.NITHIYA VOL
Contact
Number of
Volunteers
(with mob no)
J
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
syringe (5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
No. of vaccinators
=( F/150)*1
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Date of vaccination
Village/
Hamlets
covered
8 Am to 4 Pm
Distance from PHC
Name of session
site & location
Type of Area
(R/HRA)
S.No
(1 bag per
50 syringes)
HUD : ERODE
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
District:_ERODE
11
11
109
11
10
10
99
10
74
28
28
282
28

Block:Jambai
PHC : Odathurai
HSC :__Bommanpatti
Thenkattupal
ayam
21.02.17
18
Name of
Vaccinato
rs
H
Parvathi
Team Details
Name of
Contact
volunteers
Number of
(ASHA, AWW,
Volunteers
others)
(with
mob
no)
I
J
Mea
slesRub
ella
Vac
cine
Vial
Mea
s*
sles(10
Rub
dose
ella
AD
vial)
Dilu
(0.5
[(F
ent
ml)
X
Amp
syri
1.11
oule
Rec
nge
)/10
s
onst
(0.5
]
(=
Red
ituti
xK)
[(F
Plas
on
X
Hub
tic
syri
1.11
Cutt
Bag
nge
er)
s (5
(1
ml)
per
(= K)
vacc
inat
or)
of Target
children
(9No.
moofto
vaccinato
<15 yrs)
rs
=( F/150)
*1
Time of
vaccinati
on
Number
Thnkattupalayam
Date of
vaccinati
on
Village/
Hamlets
covered
Distance
from PHC
Name of session
site & location
Type of
Area
(R/HRA)
S.No
1. Rajamani AWW
2. Eswari
Teacher
9629936296
9842082214
20
(1
District:___________Erode
Thenkattupal
ayam
21.02.17
18
Bomman patti
Bomman
patti
21.02.17
46
Sambala kadu
Sambalak
adu
21.02.17
56
North Street
North Street
21.02.17
Bommanpatti Road
B.Road
8 Am to 4 Pm
Thnkattupalayam
20
1. Jothimani
Vasanthab
2. Selvi
ai
3. Krishnaveni
9659575484
9659575484
9942851024
51
Dhanam 1. Jothimani
Indiragand 2. Shammala
hi
9942924079
9942924079
62
55
1. Pankachajam
K.Rani
AWW
B.Dowlath
2. Kamaleswari
9715542467
9715542467
61
49
9629936296
9788870914
54
224
24
24
248
24
21.02.17
Total
1. Rajamani AWW
2. Eswari
Teacher
9629936296
9842082214
Parvathi
C.Nageswar Rajamani
i
Santhi

Block:Jambai
PHC : Odathurai
HSC :__K.PUDUR
Date of
vaccinati
on
Time of
vaccinati
on
Number
K.Pudur AWC
12
23.02.17
K.Pudur AWC
11
23.02.17
Kavinda padi AWC
11
23.02.17
K.Pudur AWC
12
23.02.17
Name of
Vaccinato
rs
H
Team Details
Name of
Contact
volunteers
Number of
(ASHA, AWW,
Volunteers
others)
(with
mob
no)
I
J
Mea
slesRub
ella
Vac
cine
Vial
Mea
s*
sles(10
Rub
dose
ella
AD
vial)
Dilu
(0.5
[(F
ent
ml)
X
Amp
syri
1.11
oule
Rec
nge
)/10
s
onst
(0.5
]
(=
Red
ituti
xK)
[(F
Plas
on
X
Hub
tic
syri
1.11
Cutt
Bag
nge
er)
s (5
(1
ml)
per
(= K)
vacc
inat
or)
Distance
from PHC
Name of session
site & location
of Target
children
(9No.
moofto
vaccinato
<15 yrs)
rs
=( F/150)
*1
Village/
Hamlets
covered
Type of
Area
(R/HRA)
S.No
30
K.Rani
P.Kamadhenu
Thenmozhi Saranya
9976258022
33
30
Dhanam
Dowlath
N.Madeshwari
Deivanai
Yuvasri
9750650327
33
46
P.Valarmathi
C.Nageswar
Parameswari
i T.Indira
Janani
8012181006
51
37
Vasanthab G.Eyasumani Rani

ai Parvathi
Vaishnavi
9952516085
41
8 Am to 4 Pm
(1
District:___________Erode
Total
143
15
15
159
20

Block:__________JAMBAI
PHC :___________ODATHURAI
HSC :______________L.M.PALAPPALAYAM
SURIYAMPALAYAM
PUE SCHOOL
Time of
vaccination
Number of
Target children
(9 mo to <15
yrs)of
No.
SURIYAMPAL
AYAM
PALAPPALAYAM PUE PALAPPALAY

SCHOOL
AM
PATTAIKALIP
ALAYAM,RAN
PATTAIKALIPALAYA GANKATTTU
M PUE SCHOOL
R
,RANGANKAT
TURCOLONY
KOOOTADAIPALAYA KOOOTADAIP
MPUE SCHOOL
ALAYAM
24.02.17
41
24.02.17
126
24.02.17
50
24.02.17
71
PERIYA
L.M.PALAPPALAYAM VADAMALAIP
ALAYAM
24.02.17
30
SELLAKUMARAPALA SELLAKUMA
YAM PUE SCHOOL
RAPALAYAM
24.02.17
35
Name of
Vaccinato
rs
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
9994501881
46
7502217206
14
14
140
14
9597608172
56
9965249489
8675682924
79
9787591510
33
9524440345
39
MAHESWAEI AWW
S.PARVAT
SUELLA
HI VHN
AYYA
T.INDRAG POONGODAI
AWW
ANIKURABVAVOL
ANDHIVHN
VALERMATHI
AYYA
C.NAGESW MOHANAMBAL
C.VIYAYA AWW
ARI VHN
AYYA
P.SHANAM
KALIAMMALAYYA
VHN
JAYANTHI
MARAGATHAMAY
VOL
S.VASANT
YA
HA BAI SEENGEETHA VOL
VHN
POONGADAI
AWW
K.RANI
VHN
POONGADAI AWW
B.DOWLAT
GANDHIMATHI
H
syringe
(0.5 x [(F X
Reconstit
1.11)
ution
syringe (5
Hub
ml) (= K)
Cutter
Red
(1 per
Plastic
vaccinator
Bags
)
Date of
vaccination
Team Details
vaccinators
=( F/150)*1
Distance from
PHC
8 Am to 4 Pm
Name of session
site & location
Village/
Hamlets
covered
Type of Area
(R/HRA)
S.No
(1 bag
HUD :________________ERODE_____________
MeaslesRubella
Vaccine
Vials*
(10 dose
vial)
Measles[(F X
Rubella
1.11)/10]
Diluent
Ampoules
AD (0.5
(=
K)
ml)
District:_ERODE
Total
353
40
40
392
40

District:____ERODE
Block:____JAMBAI
PHC;ODATHURAI
HSC :_______NEHRU NAGAR
THAMBAINAGAR
THAMBAINA
GAR
12
25.02.2017
NAVALERNAGAR
NAVALERNA
GAR
12
25.02.2017
95
1.K.RANI
2.C.NAGES
WARI VHN
RAMATHAL
K.NAGAAMMAL
M.SUMUTHI
9688370274
9688164701 .
9976655869
11
11
105
73
B.DOWLAT
H VHN
S.PARVATH
I VHN
K.PONNUMANI
S.GOMATHI
9865617286
9842725143
81
53
VASANTHA
BAI VHN
C.DIVA
T.RASAAMMAL
9787909616
9659677145
59
221
25
25
245
10
Total
(2 per
site)
Black
Plastic
(1 bag
per
Bags
50 syringes)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
25.02.2017
syringe
(0.5 x [(F X
1.11)
Reconstitution
syringe (5 ml)
(= K)
12
GANDHIPUR
AM AWC
Name of
volunteer Contact Number
s (ASHA,
of Volunteers
AWW,
(with mob no)
others)
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
1.11)/10]
MeaslesRubella
Diluent
Ampoules
K) ml)
AD (=
(0.5
GANDHIPURAM
AWC

Block: JAMBAI
ccinators
50)*1
of Target
ren
<15 yrs)
accination
Village/
PHC : ODATHURAI
ccination
Name of session
from PHC
HSC :________________________
VELAMPALAYAM
ea (R/HRA)
No. of vaccinators
=( F/150)*1
Number of Target
children
(9 mo to <15 yrs)
Logistics
requirement
Time of vaccination
8AM TO 4PM
Date of vaccination
Village/
Hamlets
covered
Distance from PHC
Name of session
site & location
S.No
Name of Supervisor with contact no: Dr.Dhivakaran MBBS
Team Details
17
27.02.17
PERUMAMPA
LAYAM
PERUMAM PALAYAM
MIDDLE
SCHOOL
12
27.02.17
MANIYAM PALAYAM
MANIYAM
PALAYAM
ELEMENTAR
Y SCHOOL
11
27.02.17
AVARANKATTUR
ANGAVADI CENTRE
AVARANKAT
TUR COLONY
ANGAVADI
CENTRE
11
172
158
19
H
T.INDIRA
GANDHI
VHN
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
A.JAYALAKSHMI
AWW
M.SUMATHI
984262870
19
19
190
19
9698054110
18
18
175
18
A.K.PUSH
PAKARTHI
9488440324
21
R.BABY
9688468112
80
47
47
466
47
P.DHANAM
-VHN
B.DOWLAT P.KAMALEESWARI
H
AWW
P.POOVATHAL
S.PARVATH
I
S.VASANT
HABAI
VHN
(1 bag per
50 syringes)
VELAMPALAYAM
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
syringe (5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
VELAMPALAY
AM SCHOOL
Name of
Vaccinato
rs
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)*1
Date of vaccination
Number of Target
children
(9 mo to <15 yrs)
Distance from PHC
Time of vaccination
Type of Area (R/HRA
Name of session
site & location
8AMTO4PM
Village/
Hamlets
covered
S.No
C.NAGESW
ARI VHN
28.02.17
Total
72
421
K.RANI
VHN

Block:BHAVANI
PHC :________ODATHURAI_____________________
HSC :______________ODATHURAI
05KM
28/02/2017
48
Diluent
Ampoules
AD (=
(0.5
K) ml)
syringe
(0.5 x [(F X
1.11)
Reconstitution
syringe (5 ml)
(= K)
Hub Cutter
(1 per
Red Plastic
vaccinator)
Bags
Odathurai ,
Team Details
MeaslesRubella
Vaccine Vials*
(10 dose vial)
[(F X
Measles1.11)/10]
Rubella
No. of vaccinators
=( F/150)*1
Number of Target
children
(9 mo to <15 yrs)
Time of vaccination
Date of vaccination
AWC ODATHURAI
Village/
Hamlets
covered
Distance from PHC
Name of session
site & location
Type of Area
(R/HRA)
S.No
(1 bag per
50 syringes)
Name of
Vaccinato
rs
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
9688713343
54
S.VASANT
HABAI,S.P SHANTHI
ARVATHI
AWC ODATHURAI
Odathurai ,
Odathurai colony
AWC
Odathurai
colony
05KM
28/02/2017
48
Komarapalay
Nanjagoundenpalaya
am,indra
m AWC
nagar,marrap
palayam
0.5KM 28/02/2017
100mtr 28/02/2017
8 Am to 4 Pm
Total
S.VASANT
HABAI,S.P SHANTHI
ARVATHI
31
C.Nageswar
i,P.Dhanam
ESWARI
,T.Indragan
thi
49
B.Dowlath,
S,RUKMANI
Rani
128
9688713343
54
9750266715
35
9578227551
55
15
15
144
15

Outreach Planning Form (Includes Regular, High Risk Area / Population)
Jambai________
(5 ml)
Red Plastic Bags

(1 bag per 50 syringes)
AD (0.5 ml) syringe

(0.5 x [(F X 1.11)
No. of vaccinators
=( F/150)
Contact
Name
Name of
Number of
of
volunteers
Volunteers
Vaccina (ASHA, AWW,
(with mob
tors
others)
no)
Measles-Rubella Diluent Ampoules

(= K)

(9 mo to <15 yrs)
Measles-Rubella Vaccine Vials*

(10 dose vial)
[(F X 1.11)/10]
Time of vaccination
Date of vaccination
Distance from ILR point
Name of
Name of
S.
Village / Urban session
No
Locality
sites
Team Details
Dr. P.Dhanalakshm
Reconstitution syringe
(= K)
HSC / Urban Area:__A.Pudapalayam_____________
PHC / UHP / Mpty.___Appakudal________
Hub Cutter
(1 per vaccinator)
Block:_
Periyakalliyur
Periyakal
liyur
Kovil
9km 20.02.17
12
km
21.02.17
14
km
23.01.17
Total
8 Am to 4 Pm
A
A
Karattup
Karattupalaya
alayam
m
School
Sukkanai
Sukkanaiganur
ganur
AWC
58
P
Devaki
Santhi
Lakshmi
90
P
Santhi
14
Total
162
P
Santhi
9578350941
64
9715537401
10
10
100
10
9715537402
16
19
19
180
19
Thilagathy
Mariammal
Thilagathy
Mariammal

Outreach Planning Form (Includes Regular, High Risk Area / Population)
Block:_________Jambai ______ PHC / UHP / Mpty._______Appakudal____________________
No. of vaccinators
=( F/150)
9km 25.02.17
7km 27.02.18
10km 28.02.19
Team Details
Name of
Name of
Contact Number
Vaccinator volunteers (ASHA,
of Volunteers
s
AWW, others)
(with mob no)
82
P
Santhi
66
P
Santhi
58
P
Rajeswari
Santhi Saraswarthy
Cell No 99
(1 bag per 50
syringes)
Number of Target
children
(9 mo to <15 yrs)
Dr. P.Dhanalakshmi
Measles-Rubella
Vaccine Vials*
(10 dose vial)
[(F X 1.11)/10]
Measles-Rubella
Diluent
Ampoules
(= K)
AD (0.5 ml)
syringe
(0.5 x [(F X 1.11)
Reconstitution
syringe
(5 ml)
(= K)
Hub Cutter
(1 per
vaccinator)
Red Plastic
Time of vaccination
8 Am to 4 Pm
Appakud
A
al
Appakudal
Murugan
Murugan Kovil
Kovil
street
street
Kamarajc
AWC
Kamarajcolony olony
AWC
Kamanai
Kamanaiganpal
ganpalay
A
Name of
session sites
Date of vaccination
Name of Village /
Urban Locality
Distance from ILR

point
S. No
Type of Area
(R/HRA)
HSC / Urban Area:____Appakudal____________________
Bags
HUD / Corporation:____Erode_________________________
Pankajam
Lakshmi
8615836325
91
Pankajam
Lakshmi
8615836325
73
8526933624
64
8A
R
10km 28.02.19
Total
58
206
P
Rajeswari
Santhi Saraswarthy
8526933624
64
22
22
228
17
FORM
PHC / UHP / Mpty._______Appakudal________
HSC : Punnam
(9 mo to <15 yrs)
No. of vaccinators
=( F/150)*1
1.Pandiyan
M.Ponnula
2.Vinotnkumar
kshmi VHN
9578185638
43
1.Latha
Dharani SN 2.Pathmavathi
3.
9750378399
72
85
1.Kalaiselvi
P.Vasantha
2.Selvi
SHN
3.
9865424316
10
10
94
10
1.Pandiyan
M.Ponnula
2.Vinotnkumar
kshmi VHN
9578185638
12
10
1.Pandiyan
M.Ponnula
2.Vinotnkumar
kshmi VHN
9578185638
12
208
24
24
233
24
Mariyamman Kovil,
Purasakattur
Purasakattur
12
39
Chinnamettur- Ele.
School
Chinnamettu
r
15
65
Velamara thur School Velamarathur
15
Vinayakar kovilParuvachi Kattur
Paruvachi
Kattur
21.02.17
Ayyammal housePuduPerumal kovil
PuduPerumal
kovil
10
Total
61
Total
23.02.17
8 Am to 4 Pm
Hub Cutter
(1 per vaccinator)
Red Plastic Bags
Reconstitution
syringe (5 ml) (=
K)
Team Details
Measles-Rubella
Vaccine Vials*
(10 dose vial)
[(F X 1.11)/10]
Measles-Rubella
Diluent
Ampoules
(= K)
AD (0.5 ml)
syringe
(0.5 x [(F X 1.11)
Time of vaccination
Date of vaccination
20.02.17
20.02.17
Name of
Vaccinato
rs
20.02.17
Village/
Hamlets
covered
Distance from PHC
Name of session
site & location
S.No
Name of Supervisor with contact no:Dr.P.Dhanalakshmi MBBS,MO,994240
(1 bag
per 50 syringes)
Kamanai
Kamanaiganpal
ganpalay
ayam
am AWC
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
FORM - 4
Form 4.1- Outreach Planning Form (Includes Regular, High Risk Area / Population)-Rural
HUD :___Erode__Block:____Bhavani____ PHC / UHP / Mpty._______Appakudal_______
HSC : Thalavaipettai
5 KM
Kattur AWC
Kattur,Chinn
anaickanur
8 KM
Malliyur AWC
Malliyur
8KM
Oricherry AWC
Oricherry
7KM
Total
No. of vaccinators
=( F/150)*1
Thalavaipetta
i
Number of Target
children
(9 mo to <15 yrs)
Thalavaipettai
-Ele.school
Time of vaccination
Name of
Vaccinato
rs
122
1.Pappa
P.Vasantha
2.Shiyamala
SHN
3.
9788487153
13
13
135
13
22
M.Ponnula 1.Vaitha
kshmi VHN
9578007426
24
M.Ponnula 1.Vaitha
kshmi VHN
9578007426
10
94
M.Ponnula
1.Dhana
kshmi VHN
8015829086
10
10
104
10
247
26
26
273
26
8 Am to 4 Pm
Total
Jambai
Mylambadi
Periyapuliyur
Odathurai
Appakudal
UPHC
Bhavani
736
1655
2195
1744
823
Team Details
Contact
Number of
Volunteers
(with mob no)
(1 bag
syringe
(0.5 x [(F X
Reconstitu
1.11)
tion
syringe (5
Hub
ml) (= K)
Cutter
Red
(1 per
Plastic
vaccinator
Bags
)
Name of
volunteers
(ASHA, AWW,
others)
MeaslesRubella
Vaccine
Vials*
(10 dose
vial)
Measles[(F X
Rubella
1.11)/10]
Diluent
Ampoules
AD (0.5
(=
K)
ml)
Date of vaccination
D
23.02.17
25.02.17
27.02.17
28.02.17
Village/
Hamlets
covered
Distance from PHC
Name of session
site & location
S.No
Name of Supervisor with contact no:Dr.P.Dhanalakshmi MBBS,MO,994240
No. of vaccinators
=( F/150)*1
Measles-Rubella Vaccine Vials*

(10 dose vial)
[(F X 1.11)/10]
Measles-Rubella Diluent Ampoules

(= K)
AD (0.5 ml) syringe

(0.5 x [(F X 1.11)
Reconstitution syringe (5 ml) (= K)
Hub Cutter
(1 per vaccinator)
184
20
20
204
20
243
27
27
270
27
3 Molapalay
309
35
35
344
35
736
14
82
82
818
82
14
21
162
19
19
180
19
206
22
22
228
22
208
24
24
233
24
247
26
26
273
26
823
15
91
91
914
91
15
22
309
35
35
344
35
165
18
18
184
18
200
23
23
222
23
197
22
22
219
22
227
25
25
252
25
299
34
34
335
34
258
29
29
287
29
1655
23
186
186
1843
186
23
37
284
32
32
316
32
624
57
57
574
57
14
190
21
21
211
21
471
53
53
524
53
12
269
30
30
244
30
357
39
39
391
39
A.Pudupa
4 layam
Appakud
5 al
6 Punnam
Thalavaip
7 ettai
Total
Kannadip
Kuruppu
1 alayam
naickenp
2 alayam
Mylamba
3 di
Thottipal
4 ayam
Uratchiko
5 ttai
Vaikalpal
6 ayam
Varadhan
7 allur
Total
1
2
3
4
5
6
Kuttipala
Minnavet
yam
tuvapalay
am
Periyapul
iyur
Salangap
alayam
Thattarp
alayam
Vairaman
galam
Name of
Vaccinato
rs
Name of
volunteers
(ASHA, AWW,
others)
Contact
Number of
Volunteers
(with mob no)
68395402526
Red Plastic Bags

(1 bag per 50 syringes)

(9 mo to <15 yrs)
Total
1 Jambai
Kadaiyam
2 patti
Time of vaccination
Village/
Hamlets
covered
Date of vaccination
Name of session
site & location
Distance from PHC
S.No
Team Details
Total
1
2
3
4
5
6
7
232
232
2260
232
30
52
28
28
282
28
224
24
24
248
24
143
15
15
159
15
353
40
40
392
40
221
25
25
245
25
128
15
15
144
15
421
47
47
466
47
10
1744
44
194
194
1936
194
31
43
7153
126
68395402526
785
785
7771
785
113
175
Kavery N
450
50
50
502
50
Man
251
26
26
301
26
Kamaraj
204
13
13
226
13
Ayyampal
ayam
Bomman
Kavunda
patti
padipudu
r
L.M.Pala
palayam
Nehrunag
ar
Odathura
i
Velampal
ayam
Total
Palanipu
2195
30
254
68395402526
345
34
34
395
34
1250
19
123
123
1424
123
16
22
8403
145
68395402526
908
908
9195
908
129
197
736
1655
2195
1744
823
1250
8403
14
23
30
44
15
19
145
0
0
0
0
0
0
0
0
0
0
0
0
DATE/PHC
0
0
0
0
68395402526
0
0
0
68395402526
Jambai
82
186
232
194
91
123
908
Mylambadi
82
818
186
1843
232
2260
194 1935.7
91
914
123
1424
908 9194.7
82
186
232
194
91
123
908
14
23
30
31
15
16
129
Periyapuliy Odathurai Appakudal UPHC
21
37
52
43
22
22
197
Total
20.02.17
228
309
698
254
247
268
2004
21.02.17
237
407
382
224
99
182
1531
23.02.17
61
289
351
143
146
251
1241
24.02.17
58
107
284
353
151
953
108
285
213
221
104
27.02.17
29
258
109
421
75
892
28.02.17
15
158
128
152
453
736
1655
2195
1744
823
Total
398
1329
25.02.17
1250
8403
Q
R
S
2
1
29
2
1
45
2
1
55
2
1
45
8
4
174
MO,PHC,JAMBAI 04256 249277
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
n)- Rural
ai
Vidhyalakshmi MBBS,MO,9944487052
AEFI
n)- Rural
ai
AEFI
2
1
54
2
1
65
2
1
64
2
1
24
2
1
25
10
5
232
Q
R
S
2
1
109
2
1
44
2
1
61
2
1
34
2
1
38
MO,PHC,JAMBAI 04256
249277
MO,PHC,JAMBAI 04256 249277
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
Q
T
n)- Rural
ai
AEFI
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
29
15
14
330
MO,PHC,JA
lation)
y : Mylambadi
87
115
42
30
35
PHC Mylambadi
04256237077
Black Plastic
Bags
Q
Address &
Contact No. of
nearest AEFI
Management
center
AEFI
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
7
5
309
t week of the campaign. The vaccine and other logistics for outreach
chool coverage is <50% , plan for 75% supply of Vaccine & logistics
lation)
y : Mylambadi
R
S
2
1
87
2
1
60
2
1
106
1
1
46
7
4
299
PHC Mylambadi
04256237077
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
AEFI
lation)
y : Mylambadi
AEFI
2
1
108
2
1
89
4
2
197
Q
R
S
2
1
95
1
1
41
2
1
64
5
3
200
PHC Mylambadi
04256237077
PHC Mylambadi
04256237077
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
Q
T
lation)
y : Mylambadi
AEFI
Q
R
2
S
1
1
55
2
1
65
5
3
227
PHC Mylambadi
04256237077
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
lation)
y : Mylambadi
AEFI
107
lation)
y : Mylambadi
AEFI
1
40
2
1
102
1
1
55
04256237077
C Mylambadi
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
MR vaccination
card (=F)
Q
Indelible Marker
Pens (1 pen per
250 beneficiaries)
site)
Black Plastic Bags
Address &
Contact No. of
nearest AEFI
Management
center
R
S
T
2
1
80
2
1
85
4
2
165
PHC Mylambadi
04256237077
MR vaccination
card (=F)
(2 per
Indelible Marker
Pens (1 pen per
250 beneficiaries)
site)
Black Plastic Bags
lation)
y : Mylambadi
AEFI
R
S
T
n)- Rural
APULIYUR
Q
R
S
T
2
1
124
1
1
31
1
1
61
1
1
68
MO,PHC,Periyapuliyur0424-2534720
Blac
k
Plas
tic
Inde
Bag
lible
s
Mar
ker
Pen
s (1
Add
pen
ress
MR
per
(2
&
vacc
250
per
Con
inat
ben
site)
tact
ion
efici
No.
card
arie
of
(=F)
s)
near
est
AEF
I
Man
age
men
t
cent
er
1
61
6
4
258
PHC Mylamba
n)- Rural
: PERIYAPULIYUR
AEFI
Management
Center
details
5
4
284
n)- Rural
APULIYUR
Q
R
S
2
1
220
2
1
100
2
1
25
2
1
53
2
1
88
2
1
75
2
1
63
14
7
624
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens
(1 pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
AEFI
Management
Center
details
Blac
k
Plas
tic
Inde
Bag
lible
s
Mar
ker
Pen
s (1
Add
pen
ress
MR
per
(2
&
vacc
250
per
Con
inat
ben
site)
tact
ion
efici
No.
card
arie
of
(=F)
s)
near
est
AEF
I
Man
age
men
t
cent
er
Q
R
S
2
1
85
2
1
117
2
1
187
1
1
32
1
1
50
8
5
471
Q
R
S
Blac
k
Plas
tic
Inde
Bag
lible
s
Mar
ker
Pen
s (1
Add
pen
ress
MR
per
(2
&
vacc
250
per
Con
inat
ben
site)
tact
ion
efici
No.
card
arie
of
(=F)
s)
near
est
AEF
I
Man
age
men
t
cent
er
AEFI
Management
Center
details
T
n)- Rural
APULIYUR
AEFI
Management
Center
details
Indelible
(2 per
Marker
site)
Pens
(1 pen
per 250
beneficiarie
MR
s)
vaccination
card (=F)
Address &
Contact No.
of nearest
AEFI
Managemen
t center
Black
Plastic Bags
1
43
2
1
56
2
1
30
2
1
49
1
1
50
2
1
21
2
1
20
13
7
269
n)- Rural
PULIYUR
AEFI
Management
Center
details
MR vaccination
card (=F)
Address &
Contact No. of
nearest AEFI
Management
center
2
1
84
2
1
30
2
1
48
2
1
135
2
1
60
10
5
357
Q
R
S
T
2
1
142
2
1
48
MO,PHC,Periyapuliyur
0424-2534720
(2 per site)
Indelible
Marker
Pens (1 pen per
250
beneficiaries)
Black Plastic
Bags
Q
T
n)- Rural
APULIYUR
AEFI
Management
Center
details
4
2
190
Q
R
S
2
1
98
2
1
89
2
1
67
6
3
254
Q
R
S
1
1
18
MO,PHC,Periy
0424-253
48
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
266190
Blac
k
Plas
tic
Inde
Bag
lible
s
Mar
ker
Pen
s (1
Add
pen
ress
MR
per
(2
&
vacc
250
per
Con
inat
ben
site)
tact
ion
efici
No.
card
arie
of
(=F)
s)
near
est
AEF
I
Man
age
men
t
cent
er
n)- Rural
THURAI
AEFI
Management
Center
details
MO,PHC
ODATHURAI
04285-266190
n)- Rural
athurai
AEFI
Management
Center
details
18
2
1
46
2
1
56
2
1
55
2
1
49
9
5
224
Q
R
S
2
1
30
2
1
30
2
1
46
2
1
37
MO,PHC ODATHURAI 04285-266190
Blac
k
Plas
tic
Inde
Bag
lible
s
Mar
ker
Pen
s (1
Add
pen
ress
MR
per
(2
&
vacc
250
per
Con
inat
ben
site)
tact
ion
efici
No.
card
arie
of
(=F)
s)
near
est
AEF
I
Man
age
men
t
cent
er
n)- Rural
athurai
AEFI
Management
Center
details
Q
R
S
1
1
41
2
1
126
1
1
50
1
1
71
1
1
30
1
1
35
n
card (=F)
Address
&
Contact
No. of
nearest
AEFI
Manageme
nt center
Indelible
Marker
(2 per
Pens
(1
site)
pen
per
250
beneficiari
MR
es)
vaccinatio
Black
Plastic
Bags
8
143
n)- Rural
AEFI
Management
Center
details
353
tion)- Rural
PHC;ODATHURAI
95
73
53
221
MO,PHC
ODATHU
RAI
04285266190
Contact No. of
nearest AEFI
Management
center
S
MO,PHC ODATHURAI 04285266190
AEFI
AEFI
Manage
Management
ment
Center
Center
details
details
Contact No. of
nearest AEFI
Management
center &
Address
Indelible
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)&
Address
n)- Rural
AEFI
Management
Center
details
Q
R
S
T
2
1
48
285266190
2
1
172
2
1
158
2
1
19
2
1
72
8
4
421
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
Q
T
n)- Rural
I_____________________
AEFI
Management
Center
details
Address &
Contact No. of
nearest AEFI
Management
center
(2 per
Indelible
site)
Marker Pens (1
pen per 250
beneficiaries)
MR
vaccination
card (=F)
Black Plastic
Bags
Address & Contact No. of nearest AEFI

Management center
Q
MR vaccination card (=F)
(2 per site)
Dr. P.Dhanalakshmi
Indelible Marker Pens (1 pen per 250

beneficiaries)
Black Plastic Bags
t no:
1
48
2
1
31
2
1
49
6
3
128
MO,PHC Odathurai 04285266190
FORM - 4
ation)
_Appakudal________
Cell No 9942403125
AEFI
R
S
T
MR vaccination
card (=F)
Address &
Contact No. of
nearest AEFI
Management
center
58
2
1
90
2
1
14
6
3
162
MO,PHC Appakudal 04256-246108
Q
R
S
T
2
1
82
2
1
66
2
1
58
HC Appakudal 04256246108
(2 per site)
Indelible Marker
Pens (1 pen per
250
beneficiaries)
Black Plastic
Bags
r. P.Dhanalakshmi
FORM - 4
akudal______________________
Population)
Cell No 9942403125
AEFI
FORM - 4
MR vaccination
card (=F)
Address &
Contact No. of
nearest AEFI
Management
center
58
6
3
206
MO,PHC App
246
Q
R
S
T
2
1
39
2
1
65
2
1
85
2
1
9
2
1
10
10
5
208
(2 per site)
Indelible
Marker
Pens (1 pen per
250
beneficiaries)
Black Plastic
Bags
n)- Rural
2
FORM - 4
__Appakudal________
Dhanalakshmi MBBS,MO,9942403125
AEFI
Management
Center
details
Q
R
S
2
1
122
2
1
22
2
1
9
2
1
94
8
4
247
n
card (=F)
Address
&
Contact
No. of
nearest
AEFI
Manageme
nt center
Indelible
Marker
(2 per
Pens
(1
site)
pen
per
250
beneficiari
MR
es)
vaccinatio
Black
Plastic
Bags
Population)-Rural
___Appakudal________
Dhanalakshmi MBBS,MO,9942403125
AEFI
Management
Center
details
MR vaccination card (=F)
184
10
243
309
25
14
736
162
206
10
208
247
30
15
823
309
165
200
197
227
299
258
38
24
1655
Black Plastic Bags
(2 per site)
Indelible Marker Pens (1 pen per

250 beneficiaries)
284
14
624
190
471
13
269
10
357
Address & Contact No. of nearest

AEFI Management center
AEFI
Management
Center
details
54
30
2195
254
224
143
353
221
128
421
49
31
1744
196
114
7153
450
251
204
345
26
16
1250
222
130
8403
25
38
54
49
30
26
222
14
24
30
31
15
16
130
736
1655
2195
1744
823
1250
8403

Block: Bhavani
PHC / UHP / Mpty : UPHC Bhavani
HSC / Urban Area: Kaverinagar
Kilakkupalli
AWC
0.3K 20.02.1
m
7
Jothivinayaga Kalthozhilala
r Street
r AWC
0.3K 20.02.1
m
7
Kuduthuraiko Kilakkupalli
vil
AWC
0.6K 21.02.1
m
7
175
93
69
113
450
Indelibl
(2 e
per
Marker
site)
Pens (1
pen per
250
benefci
MR
aries)
vaccina
tion
Addres
card
s&
(=F)
Contact
No. of
nearest
AEFI
Manage
ment
Kilakkupalli
Name of volunteers Contact Number

(ASHA, AWW,
of Volunteers
others)
(with mob no)
AEFI
Black
(1
bag
Plastic
per 50
Bags
syringe
s)
(5
ml)
Hub
(= K)
Cutter
(1
per
Red
vaccina
Plastic
tor)
Bags
Name of
Vaccinators
Team Details
Measle
sRubella
Vaccine
Vials*
(10
dose
Measle
vial)
s- X
[(F
Rubella
1.11)/1
Diluent
0]
Ampoul
es
AD (0.5
(=
K)
ml)
syringe
(0.5 x
[(F X
Reconst
1.11)
itution
syringe
No. of
vaccinators
=( F/150)
Date of
vaccination
Number of
Target children
(9 mo to <15
yrs)
Distance from
ILR point
Name of
Name of
S. No Village / Urban
session sites
Locality
Time of
vaccination
Type of Area
(R/HRA)
Name of Supervisor with contact no: Dr.D.Sathika & 9865273240
1.T.R..Renuga2.
Maheshwari
Saranya ANM
9698919095
19
19
194
19
175
1.R.M.Jeyamani
SHN
Vijayalakshmi
2.Puvanasasi
S/N
9659682950
10
10
103
10
93
9698919095
77
69
9578627408
9597282071
13
13
128
13
113
50
50
502
50
450
1.T.R..Renuga
2. Saranya
ANM
1.Maheswari 2.
Kanimozhi HW
UPHC BHAVANI
8 Am to 4 Pm
3
Vivekanada
Private
School
Vivekanada
Private
School
0.6
21.02.1
7
Total
1.R.M.Jeyamani
SHN
Kalarani
2.Puvanasasi
S/N
Anitha
* It is assumed that at least 50% of the benefciaries of the village or confned urban area (ward or sub ward) will be covered during school vaccination in the frst week of the campaign.
The vaccine and other logistics for outreach session should be calculated/distributed subject to school based coverage. For Eg. 1. If the coverage is > 50%, plan for 50% supply of vaccine
& logistics. (2) If school coverage is <50% , plan for 75% supply of Vaccine & logistics (3) If school coverage is not done then plan for 100% supply of vaccine & logistics
EACH VACCINATOR MUST HAVE ONE FUNCTIONAL HUB CUTTER AND INDELIBLE INK MARKER PEN EVERY DAY

FORM - 5 B -PHC/UPHC Vaccine, Logistics and Human Resource Planning Form- Abstract
District :_Erode_______
HUD :_______Erode______________________ Block/Mpty/Corporation:_____Bhavani____________

PHC /UPHC:_____________________________
Vaccination site
S. No
PHC/UPHC
Target
(9 months to
<15 yrs.
children)
No. Of
School
session
sites
No. Of
Regular
Outreach
session
sites
Human Resources
Red Plastic
bags
(1 per 50
syringes)
=(J+K)/50
Black
Plastic
Bags
(2 per
session)
=G*2
No. Of
MeaslesTotal No. Measles-Rubella
Reconstituti 1 Hub
Special /
Rubella AD (0.5 ml)
Of session
Vaccine vials
on syringe (5 Cutter
Mobile
Diluent
syringe
sites
(10 dose vial)
ml)
/
Teams for
Ampoules (B x 1.11)
(B x 1.11)/10
(= H)
VHN
HRA
(=H)
Indelible
Cotton
MR
Marker Pens
roll
vaccinati
(1 pen per
(100 gm
on card
250
pack)
(=B)
beneficiaries)
(= G)
= B / 250
Total
vaccinators
(Number)
Total
Total
ASHA/AWW
Supervisors
/volunteers
(Number)
(Number)
Jambai
1380
16
20
153
153
1532
153
20
34
40
20
1380
20
20
24
Mylambadi
9908
15
23
38
1100
1100
10997.88
1100
38
242
76
38
9908
38
64
55
Periyapuliyur
5385
21
24
45
598
598
5977
598
45
132
90
45
5385
45
26
25
Odathurai
7232
14
28
42
803
803
8028
803
42
177
84
42
7232
42
71
82
Appakudal
4450
12
15
27
494
494
4940
494
27
111
54
27
4450
27
39
32
UPHC Bhavani
5794
13
16
29
643
643
6431
643
24
71
58
29
5794
29
30
59
34149
79
122
201
3791
3791
37906
3791
196
767
402
201
34149
201
250
277
30
Total

MRC Block Jambai Final Report

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Tamil Nadu MR Campaign 2017

Tamil Nadu MR Campaign 2017

9 months to < 5 yrs

5 yrs to < 10 yrs

10 yrs to < 15 yrs

Number of Target children

Indelible Marker Pens

Black Plastic Bags

Red Plastic Bags

Distance from ILR point

Village / Urban Locality

School Planning Form -3

Tamil Nadu MR Campaign 2017

HUD :___Erode__________________________ Block:Bhavani

20.02.201 18.02.201 11.02.201

Distance from ILR

Type of Area (R/HRA)

Name of Supervisor with contact no:Dr.P.Vidhyalakshmi MBBS,MO,99444

Tamil Nadu MR Campaign 2017

HUD :___Erode__________________________ Block:Bhavani

tance from ILR

Name of Supervisor with contact no:Dr.P.Vidhyalakshmi MBBS,MO,99444

Distance from ILR

Type of Area (R/HRA)

Tamil Nadu MR Campaign 2017

HUD :___Erode__________________________ Block:Bhavani

Distance from ILR

Type of Area (R/HRA)

Name of Supervisor with contact no:Dr.P.Vidhyalakshmi MBBS,MO,99444

Tamil Nadu MR Campaign 2017

Outreach Planning Form

HUD / Corporation: Erode

(Includes Regular, High Risk Area / Population)

PHC / UHP / Mpty : Mylambadi

HSC / Urban Area: Kannadipalayam

Distance from ILR

Type of Area (R/HRA)

Name of Supervisor with contact no: Dr.K.Ramya 9842763233

Tamil Nadu MR Campaign 2017

Outreach Planning Form

(Includes Regular, High Risk Area / Population)

Distance from ILR

Type of Area (R/HRA)

Tamil Nadu MR Campaign 2017

Outreach Planning Form

(Includes Regular, High Risk Area / Population)

PHC / UHP / Mpty : Mylambadi

Name of Supervisor with contact no: Dr.K.Ramya 9842763233

Type of Area (R/HRA)

HSC / Urban Area: Thotti Palayam

Tamil Nadu MR Campaign 2017

Outreach Planning Form

(Includes Regular, High Risk Area / Population)

PHC / UHP / Mpty : Mylambadi

HSC / Urban Area: Mylambadi

Distance from ILR

Name of Supervisor with contact no: Dr.K.Ramya 9842763233

Tamil Nadu MR Campaign 2017

Outreach Planning Form

(Includes Regular, High Risk Area / Population)

PHC / UHP / Mpty : Mylambadi

HSC / Urban Area: Urachikkottai

HUD :_Erode________________________ Block:Bhavani

HUD :_Erode________________________ Block:Bhavani

HUD :_Erode________________________ Block:Bhavani