Universal Salt Iodization Programme

A project of Ministry of Health and the Micronutrient Initiative

Form-C
Date: 18 – 12 – 2018
Monitoring at Household Level
For the Month of Dec 2018, District: THATTA
Do you know about Do you use
Iodization
S. Name & Address of Date of the sign of Hand iodized If not why
Test1 Remarks
No. Household visit and “Handi” Salt (write reasons)
(PPM2)
(Y/N) (Y/N)
1 Mr. Misri Memon , 18-12-2018 Yes Yes - 15
Memon Muhalla, Gharo

2 Mr. Khammoo 18-12-2018 No No - 10

3 Mr. Urs Memon 18-12-2018 Yes No Local 15

4 Mr. Rasool Bukhsh 18-12-2018 Yes No Costly 15

5 Mr. Muhammad Khatti 18-12-2018 Yes No Local Salt 10

6 Mr. Fazal Khan 18-12-2018 Yes Yes - 20

7 Mr. Ibrahim Memon 18-12-2018 Yes No Local 15

8 Mr. Usman Memon 18-12-2018 Yes No Local 20

9 Mr. Azeem Panhwer 18-12-2018 Yes No Local 10

10 Mr. Nasir Khan 18-12-2018 Yes No Local 30

11 Mr. Allah Bukhsh 18-12-2018 Yes No Costly 20

12 Mr. Iqbal Memon 18-12-2018 Yes Yes - 20

13 Mr. Shah Nawaz 18-12-2018 Yes No Local 15

14 Mr. Abdul Karim Mir 18-12-2018 Yes No Local 15

Bahr

15 Mr. Rizwan Panhwer 18-12-2018 Yes No Local 15

16 Mr. Juma Butt 18-12-2018 Yes Yes - 20

17 Mr. Soomar Shah 18-12-2018 Yes Yes - 15

18 Mr. Fazal Khan 18-12-2018 Yes No Local 10

19 Mr. Fida Shoro 18-12-2018 Yes No Local 30

20 Mr. Ahmed Memon 18-12-2018 Yes Yes - 30

Monitor’s Name: DR. M. Ibrahim Designation: DFP

1
State whether or not iodine is present in the salt using Rapid Test Kit
2
Match with the help of Rapid Test Kit for the nearest ppm of iodine in salt