Measles Vaccination Campaign & Vit A Supplementation 2010

U Dinajpur Vitamin A 1ml/ 2ml Measles Date___/August 2010

Tally Sheet: Measles Vaccination Campaign & Vit A Supplementation 2010

Subcentre / Village Vaccination-Session Site
Name of Village site: ______________________________Sub-center :____________________________________
Name of Vaccinator :__________________________
Other team members ( as appropriate):  ASHA  Link persons  AWW  Community Volunteers  Others
Date: __ __/__ __/__ __ __ __ Day: 1/2/3/4/5/6/7/8/9/10/11/12/13/14/15/16/17/18/19/20
Estimated no. of beneficiaries in the village :
Number of children vaccinated
Grand
Age group Male Total Female Total Total
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
1
11 12 13 14 5 16 17 18 19 20 11 12 13 14 15 16 17 18 19 20
2
21 22 23 24 5 26 27 28 29 30 21 22 23 24 25 26 27 28 29 30
3
1-5 years

31 32 33 34 5 36 37 38 39 40 31 32 33 34 35 36 37 38 39 40
4
41 42 43 44 5 46 47 48 49 50   41 42 43 44 45 46 47 48 49 50    
Total children vaccinated   Total children vaccinated    

B. Tally of vaccine and logistics: (to be calculated at the end of every day)
Received Used Balance
Vaccine vials (5 doses per vial)
AD syringes
Syringe for reconstitution (5 ml)
Vit A bottles
Date: __ __/ __ __/ __ __ __ __ Signature of Vaccinator________________