Daily sheetto be filled by the UCMO

Year: 2018 Province: Balochistan District:____quetta____________ __

Tehsil: _chiltan town_____________ UC:
___aghberg_____________ Campaign Day: __1__

Vaccination Date: Name of UCMO: ____dr dawood____________________ No. of Teams Reported: (Mobile: 28 Fixed: 2 Transit Point: 1) SIA Name: __sNID_____

No of Zero Routine Injectable Dose Children

Vaccine Distribution Record

School/Madrassa Coverage
HH coverage Out of HH Coverage Missed Children Data (OPV Doses) House Hold

Children Found Already

No.of AFP Cases Reported

Signature of AIC

Vaccinated
New born

Houses With Multiple Families

Guests

HRMP
No. of Recorded Missed Children on the back No. of Children Covered by the team on same
of tally sheet day

Daily Target

Unusable Vaccine Vails

Serial No.

Total Houses Visited

Area Incharge 0-11 12-59 0-11 12-59
Codes Months Months Months Months

Returned
Given

Used
NA R NA R

Blue

Red
0-11 12-59 0-11 12-59
A1 A2 B1 B2 Months Months Months Months C1 C2 C1 C2 # # # # #

179 43 98 0 0 10 37 3 3 0 17 0 3 6 7 74 4 2 220 187 34 0 1 43 88 35

1 AIC 2218
139 20 80 0 0 6 18 5 14 5 14 1 10 20 12 2 1 0 220 191 29 0 0 6 65 56
2 AIC 2219
189 25 110 0 3 9 26 4 20 4 13 16 4 0 11 0 3 0 240 207 33 0 0 30 82 44
3 AIC 2220
263 29 188 0 0 3 38 2 3 0 11 2 3 16 10 63 0 0 360 270 90 0 0 23 59 41
4 AIC 2221
179 29 104 0 0 1 17 9 19 0 10 2 5 10 4 0 0 0 220 172 53 0 0 25 62 45
5 AIC 2222
150 33 90 0 6 3 23 3 2 0 10 2 0 1 0 6 4 0 220 160 60 0 0 36 62 33
6 AIC 2223
126 24 70 0 2 3 25 1 3 2 11 0 0 0 3 0 0 0 180 120 60 0 0 11 49 32
7 AIC 2224

8 AIC
9 AIC
10 AIC
11 AIC
12 AIC
13 AIC
14 AIC
15 AIC

Sub - Total 203 740 0 11 35 184 27 64 11 86 23 25

1225 53 47 145 12 2 1660 1307 359 0 1 174 467 286 0 0
Grand Total 943 11 219 91 97 48

Veccine Distribution Record

Fixed Site Coverage Transit Point Coverage (OPV Doses) Signature of AIC
Vaccine Vials
Unuseable

Afernoon

Name of Area Incharge 0-11 M 12-59 M 0-11 M 12-59 M

Morning
Retured
Given

Used

# # # #

0 15 40 17 23
1 AIC ubaid 2220
0 0 0
2 AIC zakria 2223
12 0 20 13 7
3 AIC bismillah 2224

4 AIC

5 AIC

6 AIC

Sub - Total 0 15 12 0
60 30 30 0 0 0
Grand Total 15 12

Signature of UCMO:______________________________

Total Vials: Given: 1720 Used: 1337 Return: 389 Unusable Vacine Vail: 0 Name of UCMO:_________________________________
Year: 2018 Province: Balochistan

Vaccination Date: Name of UCMO:

HH coverage

Daily Target
Serial No.

Area Incharge 0-11

Codes Months

A1

1 AIC 2218

2 AIC 2219

3 AIC 2220

4 AIC 2221

5 AIC 2222

6 AIC 2223
7 AIC 2224

8 AIC
9 AIC
10 AIC
11 AIC
12 AIC
13 AIC
14 AIC
15 AIC

Sub - Total 0
0
Grand Total 0

Fixed Site Coverage

Name of Area Incharge 0-11 M 12-59 M

# #

1 AIC ubaid 2220

2 AIC zakria 2223

3 AIC bismillah 2224

4 AIC

5 AIC

6 AIC

Sub - Total 0 0

Grand Total 0

Total Vials: Given: 0

 Daily s
Balochistan District:____quetta____________ __
Tehsil: _chiltan town_________

me of UCMO: ____dr dawood____________________ No. of Teams Reported:

HH coverage Out of HH Coverage Missed Child

No. of Recorded Missed Children on the back

of tally sheet
12-59 0-11 12-59
Months Months Months
NA R

0-11 12-59 0-11

A2 B1 B2 Months Months Months
 0 0 0 0 0 0

0 0 0 0

Transit Point Coverage Veccine Distribution Record

(OPV Doses) Vaccine Vials
Unuseable

0-11 M 12-59 M
Retured
Given

Used

# #
 0 0
0 0 0 0
0

Used: 0 Return: 0 Unusable Vacine Vail:

 Daily sheetto be filled by the U
hiltan town_____________ UC:
___aghberg_____________

of Teams Reported: (Mobile: 28 Fixed:

School/Madrassa Coverage
Missed Children Data

hildren on the back No. of Children Covered by the team on same

eet day

R NA R

12-59
Months C1 C2 C1 C2 #
 0 0 0 0 0
0
0 0 0

Signature of AIC
Afernoon
Morning
 0 0

e Vacine Vail: 0
by the UCMO

2 Transit Point: 1)

Vaccine Distribution Record

(OPV Doses)
Children Found Already
Vaccinated
New born
Guests

HRMP

Given

Used
# # # #
0 0 0 0 0 0
 (OPV Doses)
Returned

ne Distribution Record
Unusable Vaccine Vails

No.of AFP Cases Reported

No of Zero Routine Injectable Dose Children

SIA Name:

Total Houses Visited

House Hold

Houses With Multiple Families

Campaign Day: __6___

__sNID_____
0 0 0 0 0 0
Signature of UCMO:______________________________

Name of UCMO:_________________________________
NID_____

Signature of AIC
Afernoon
Morning
0 0
______________

_______________
Year: 2018 Province: Balochistan

Vaccination Date: Name of UCMO:

HH coverage

Daily Target
Serial No.

Area Incharge 0-11

Codes Months

A1

1 AIC 2218

2 AIC 2219

3 AIC 2220

4 AIC 2221

5 AIC 2222

6 AIC 2223
7 AIC 2224

8 AIC
9 AIC
10 AIC
11 AIC
12 AIC
13 AIC
14 AIC
15 AIC

Sub - Total 0
0
Grand Total 0

Fixed Site Coverage

Name of Area Incharge 0-11 M 12-59 M

# #

1 AIC naveed

2 AIC zakria

3 AIC bismillah
4 AIC

5 AIC

6 AIC

Sub - Total 0 0

Grand Total 0

Total Vials: Given: 0

 Daily s
Balochistan District:_____quetta___________ Tehsil:___chiltan_____________

me of UCMO: _____dr dawood___________________ No. of Teams Reported:

HH coverage Out of HH Coverage Missed Child

No. of Recorded Missed Children on the back

of tally sheet
12-59 0-11 12-59
Months Months Months
NA R

0-11 12-59 0-11

A2 B1 B2 Months Months Months
 0 0 0 0 0 0

0 0 0 0

Transit Point Coverage Veccine Distribution Record

(OPV Doses) Vaccine Vials
Unuseable

0-11 M 12-59 M
Retured
Given

Used

# #
 0 0
0 0 0 0
0

Used: 0 Return: 0 Unusable Vacine Vail:

 Daily sheetto be filled by the U
hiltan_____________ UC:
___aghberg_____________

of Teams Reported: (Mobile: 28 fixed

School/Madrassa Coverage
Missed Children Data

hildren on the back No. of Children Covered by the team on same

eet day

R NA R

12-59
Months C1 C2 C1 C2 #
 0 0 0 0 0
0
0 0 0

Signature of AIC
Afernoon
Morning
 0 0

e Vacine Vail: 0
by the UCMO

2 Transit Point: 1)

Vaccine Distribution Record

(OPV Doses)
Children Found Already
Vaccinated
New born
Guests

HRMP

Given

Used
# # # #
0 0 0 0 0 0
 (OPV Doses)
Returned

ne Distribution Record
Unusable Vaccine Vails

No.of AFP Cases Reported

No of Zero Routine Injectable Dose Children

SIA Name:

Total Houses Visited

House Hold

Houses With Multiple Families

_sNID__
Campaign Day: ___2____
0 0 0 0 0 0
Signature of UCMO:______________________________

Name of UCMO:_________________________________
Signature of AIC
Afernoon
Morning
0 0
______________

_______________
Year: 2018 Province: Balochistan

Vaccination Date: Name of UCMO:

HH coverage

Daily Target
Serial No.

Area Incharge 0-11

Codes Months

A1

1 AIC 2218

2 AIC 2219

3 AIC 2220

4 AIC 2221

5 AIC 2222

6 AIC 2223
7 AIC 2224

8 AIC
9 AIC
10 AIC
11 AIC
12 AIC
13 AIC
14 AIC
15 AIC

Sub - Total 0
0
Grand Total 0

Fixed Site Coverage

Name of Area Incharge 0-11 M 12-59 M

# #

1 0
1 AIC ubaid
0 1
2 AIC zakria

3 AIC bismillah
4 AIC

5 AIC

6 AIC

Sub - Total 1 1

Grand Total 2

Total Vials: Given: 60

 Daily s
Balochistan District:___quetta_____________ Tehsil:
__ chiltan town___________

me of UCMO: _______dr dawood_________________ No. of Teams Reported:

HH coverage Out of HH Coverage Missed Child

No. of Recorded Missed Children on the back

of tally sheet
12-59 0-11 12-59
Months Months Months
NA R

0-11 12-59 0-11

A2 B1 B2 Months Months Months
 0 0 0 0 0 0

0 0 0 0

Transit Point Coverage Veccine Distribution Record

(OPV Doses) Vaccine Vials
Unuseable

0-11 M 12-59 M
Retured
Given

Used

# #

20 1 19 0

20 1 19 0

0 7 20 7 13 0
 0 7
60 9 51 0
7

Used: 9 Return: 51 Unusable Vacine Vail:

 Daily sheetto be filled by the U
tan town______________ UC:
___aghberg_____________

of Teams Reported: 31 (Mobile: 28 Fixed:

School/Madrassa Coverage
Missed Children Data

hildren on the back No. of Children Covered by the team on same

eet day

R NA R

12-59
Months C1 C2 C1 C2 #
 0 0 0 0 0
0
0 0 0

Signature of AIC
Afernoon
Morning
 0 0

e Vacine Vail: 0
by the UCMO

2 Transit Point: 1)

Vaccine Distribution Record

(OPV Doses)
Children Found Already
Vaccinated
New born
Guests

HRMP

Given

Used
# # # #
0 0 0 0 0 0
 (OPV Doses)
Returned

ne Distribution Record
Unusable Vaccine Vails

No.of AFP Cases Reported

No of Zero Routine Injectable Dose Children

SIA Name:

Total Houses Visited

House Hold
Campaign Day: _4___

Houses With Multiple Families

_sNID______
0 0 0 0 0 0
Signature of UCMO:______________________________

Name of UCMO:_________________________________
ID______

Signature of AIC
Afernoon
Morning
0 0
______________

_______________
Year: 2018 Province: Balochistan

Vaccination Date: Name of UCMO:

HH coverage

Daily Target
Serial No.

Area Incharge 0-11

Codes Months

A1

1 AIC 2218

2 AIC 2219

3 AIC 2220

4 AIC 2221

5 AIC 2222

6 AIC 2223
7 AIC 2224

8 AIC
9 AIC
10 AIC
11 AIC
12 AIC
13 AIC
14 AIC
15 AIC

Sub - Total 0
0
Grand Total 0

Fixed Site Coverage

Name of Area Incharge 0-11 M 12-59 M

# #

1 AIC ubaid

2 AIC zakria

3 AIC bismillah
4 AIC

5 AIC

6 AIC

Sub - Total 0 0

Grand Total 0

Total Vials: Given: 0

 Daily s
Balochistan District:____quetta____________ Tehsil:
____clitan town___________

me of UCMO: ____dr dawood____________________ No. of Teams Reported:

HH coverage Out of HH Coverage Missed Child

No. of Recorded Missed Children on the back

of tally sheet
12-59 0-11 12-59
Months Months Months
NA R

0-11 12-59 0-11

A2 B1 B2 Months Months Months
 0 0 0 0 0 0

0 0 0 0

Transit Point Coverage Veccine Distribution Record

(OPV Doses) Vaccine Vials
Unuseable

0-11 M 12-59 M
Retured
Given

Used

# #
 0 0
0 0 0 0
0

Used: 0 Return: 0 Unusable Vacine Vail:

 Daily sheetto be filled by the U
tan town____________ UC:
_____aghberg___________

of Teams Reported: (Mobile: 28 Fixed:

School/Madrassa Coverage
Missed Children Data

hildren on the back No. of Children Covered by the team on same

eet day

R NA R

12-59
Months C1 C2 C1 C2 #
 0 0 0 0 0
0
0 0 0

Signature of AIC
Afernoon
Morning
 0 0

e Vacine Vail: 0
by the UCMO

2 Transit Point: 1)

Vaccine Distribution Record

(OPV Doses)
Children Found Already
Vaccinated
New born
Guests

HRMP

Given

Used
# # # #
0 0 0 0 0 0
 (OPV Doses)
Returned

ne Distribution Record
Unusable Vaccine Vails

No.of AFP Cases Reported

No of Zero Routine Injectable Dose Children

SIA Name:

Total Houses Visited

House Hold
Campaign Day: __5__

Houses With Multiple Families

_sNID______
0 0 0 0 0 0
Signature of UCMO:______________________________

Name of UCMO:_________________________________
ID______

Signature of AIC
Afernoon
Morning
0 0
______________

_______________
Year: 2017 Province: Balochistan

Vaccination Date: Name of UCMO:

HH coverage

Daily Target
Serial No.

Area Incharge 0-11

Codes Months

A1

1 AIC 2218 376 71

2 AIC 2219 249 48
3 AIC 2220 298 62
4 AIC 2221 490 69
5 AIC 2222 320 50
6 AIC 2223 281 61
7 AIC 2224 234 36
8 AIC 0 0
9 AIC 0 0
10 AIC 0 0
11 AIC 0 0
12 AIC 0 0
13 AIC 0 0
14 AIC 0 0
15 AIC 0 0

Sub - Total 397

2248
Grand Total 1873

Fixed Site Coverage

Name of Area Incharge 0-11 M 12-59 M

# #

1 AIC

2 AIC

3 AIC
4 AIC

5 AIC

6 AIC

Sub - Total 0 0

Grand Total 0

Total Vials: Given: 3140

 Daily s
Balochistan District: ________________ Tehsil: ________________

me of UCMO: ________________________ No. of Teams Reported:

HH coverage Out of HH Coverage Missed Child

No. of Recorded Missed Children on the back

of tally sheet
12-59 0-11 12-59
Months Months Months
NA R

0-11 12-59 0-11

A2 B1 B2 Months Months Months

240 0 1 15 58 4
146 0 0 10 36 6
227 0 3 12 38 11
349 0 0 9 56 3
176 0 0 2 35 17
181 0 6 3 33 5
 157 0 2 4 29 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

1476 0 12 55 285 48

1873 12 340 152

Transit Point Coverage Veccine Distribution Record

(OPV Doses) Vaccine Vials
Unuseable

0-11 M 12-59 M
Retured
Given

Used

# #
 0 0
0 0 0 0
0

Used: 2438 Return: 708 Unusable Vacine Vail:

 Daily sheetto be filled by the U
_______________ UC: ________________

of Teams Reported: (Mobile: Fixed:

School/Madrassa Coverage
Missed Children Data

hildren on the back No. of Children Covered by the team on same

eet day

R NA R

12-59
Months C1 C2 C1 C2 #

4 0 19 0 4 16
16 6 25 1 10 54
43 4 14 19 10 0
4 0 16 2 3 27
29 0 15 4 7 17
2 0 10 4 0 6
 6 2 11 0 0 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

104 12 110 30 34
124
152 122 64

Signature of AIC
Afernoon
Morning
 0 0

e Vacine Vail: 0
by the UCMO

Transit Point: )

Vaccine Distribution Record

(OPV Doses)
Children Found Already
Vaccinated
New born
Guests

HRMP

Given

Used
# # # #

14 119 5 3 480 396

18 12 2 0 400 354
16 0 5 0 460 385
10 112 2 0 640 497
6 0 3 0 400 281
0 12 8 0 400 289
 4 0 0 0 360 236
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

68 255 25 3 3140 2438

 Campaign Day: _______

SIA Name: _______

No of Zero Routine Injectable Dose Children

ne Distribution Record House Hold
(OPV Doses)
No.of AFP Cases Reported

Houses With Multiple Families

Unusable Vaccine Vails

Total Houses Visited

Returned

85 0 1 55 171 55
46 0 0 18 128 107
75 0 0 58 159 83
143 0 0 56 118 79
124 0 0 31 112 81
111 0 0 71 111 61
 124 0 0 15 86 59
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

708 0 1 304 885 525

Signature of UCMO:______________________________

Name of UCMO:_________________________________
Signature of AIC
Afernoon
Morning
0 0
______________

_______________
 Daily sheetto be filled by the UCMO
Year: 2017 Province: Balochistan District:__quetta______________ Tehsil:
__chiltan town______________ UC:___aghberg___________ Campaign Day: _______

Vaccination Date: Name of UCMO: ________________________ No. of Teams Reported: 29 (Mobile: 29 Fixed: 29 Transit Point: ) SIA Name: _______

No of Zero Routine Injectable Dose Children

Vaccine Distribution Record

School/Madrassa Coverage
HH coverage Out of HH Coverage Missed Children Data House Hold

Children Found Already

(OPV Doses)
Signature of AIC

No.of AFP Cases Reported

Vaccinated
New born

Houses With Multiple Families

Guests

HRMP
No. of Recorded Missed Children on the back No. of Children Covered by the team on same
of tally sheet day
Daily Target

Unusable Vaccine Vails

Serial No.

Total Houses Visited

Area Incharge 0-11 12-59 0-11 12-59
Codes Months Months Months Months

Returned
Given

Used
NA R NA R

Afernoon
Morning
0-11 12-59 0-11 12-59
A1 A2 B1 B2 Months Months Months Months C1 C2 C1 C2 # # # # #

1 AIC 2218 197 28 142 0 1 5 21 1 1 0 2 0 1 10 7 45 1 1 260 209 51 0 0 12 83 20

2 AIC 2219 110 28 66 0 0 4 18 1 2 1 11 0 0 34 6 10 1 0 180 163 17 0 0 12 63 51
3 AIC 2220 109 37 117 0 0 3 12 7 23 0 1 3 6 0 5 0 2 0 220 178 42 0 0 28 77 39
4 AIC 2221 227 40 161 0 0 6 18 1 1 0 5 0 0 11 0 49 2 0 280 227 53 0 0 33 59 38
5 AIC 2222 141 21 72 0 0 1 18 8 10 0 5 2 2 7 2 0 3 0 180 109 71 0 0 6 50 36
6 AIC 2223 131 28 91 0 0 0 10 2 0 0 0 2 0 5 0 6 4 0 180 129 51 0 0 35 49 28
7 AIC 2224 108 12 87 0 0 1 4 1 3 0 0 0 0 4 1 0 0 0 180 116 64 0 0 4 37 27
8 AIC
9 AIC
10 AIC
11 AIC
12 AIC
13 AIC
14 AIC
15 AIC

Sub - Total 194 736 0 1 20 101 21 40 1 24 7 9

1023 71 21 110 13 1 1480 1131 349 0 0 130 418 239 0 0
Grand Total 930 1 121 61 25 16

Veccine Distribution Record

Fixed Site Coverage Transit Point Coverage (OPV Doses) Signature of AIC
Vaccine Vials
Unuseable

Name of Area Incharge 0-11 M 12-59 M 0-11 M 12-59 M

Afernoon
Morning
Retured
Given

Used

# # # #

1 AIC zakria 0 0 0 0 20 0 20 0

2 AIC naveed 5 3 0 0 20 8 12 0

3 AIC bismillah 0 3 0 0 20 3 17 0

4 AIC

5 AIC

6 AIC

Sub - Total 5 6 0 0
60 11 49 0 0 0
Grand Total 11 0

Signature of UCMO:______________________________

Total Vials: Given: 1540 Used: 1142 Return: 398 Unusable Vacine Vail: 0 Name of UCMO:_________________________________