PLEASE FOLLOW THE INSTRUCTIONS:

1.) DO NOT INSERT OR DELETE ANY ROWS OR COLUMNS.

2.) FILL-OUT ONLY THE SHEET ASSIGNED PER MUNICIPALITY/CI
3.) CHOOSE THE STATUS OF YOUR PLAN FROM THE SCROLL DO
4.) IF YOUR PLAN IS ONGOING OR NOT DONE, KINDLY COMPLE
ON THE FOLLOWING COLUMNS INDICATING THE REASONS OF
UNACCOMPLISHED PLAN, ACTION PLAN, AND TARGET DEADLIN
COMPLIED.
5.) DEADLINE OF COMPLETION IS ON OR BEFORE OCTOBER 20
S.
LITY/CITY/AREA.
OLL DOWN CHOICES.
OMPLETE THE DETAILS
ONS OF
DEADLINE TO BE

BER 20, 2022.

 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA

O1
CAVITE PROVINCE

CH
TY
OR

AS
CI
L

O
TA

CO

IÑ
TE
PH
TO

AR

AR
VI
BA

CA

M
SM

S
DA

DA
Area Critical activities plan achieved plan achieved plan achieved plan achieved plan achieved
(Y/N) (Y/N) (Y/N) (Y/N) (Y/N)

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization 2 ONGOING ONGOING ONGOING ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
4 ONGOING ONGOING ONGOING ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
1 ONGOING ONGOING ONGOING ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
3 ONGOING ONGOING ONGOING ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
12 ONGOING YES ONGOING YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) 21 YES ONGOING NO YES

b. Vaccine, Cold Chain & Logistics Management Team 29 YES YES YES YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team 20 YES YES YES YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team 26 YES YES YES YES

7. Is there an adequate number of human resources identified/organized for the catch-up

15 ONGOING NO NO YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport,
9 ONGOING NO NO NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? 3 ONGOING ONGOING ONGOING ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to
9 ONGOING ONGOING NO YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally 6 ONGOING NO NO YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

7 ONGOING NO ONGOING NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
3 ONGOING NO ONGOING NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? 2 ONGOING YES ONGOING NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up 28 YES YES YES YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? 23 YES YES ONGOING YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? 26 ONGOING YES YES YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? 25 ONGOING YES YES YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), 23 ONGOING YES NO YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? 1 NO NO NO NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
26 YES YES YES ONGOING
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? 21 YES YES YES YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? 29 YES YES YES YES

24. Are there enough vaccine refrigerators at the City/Municipal level? 25 YES NO YES YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? 20 YES YES ONGOING YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

3 ONGOING ONGOING YES ONGOING

communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other 0 ONGOING ONGOING ONGOING ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, 0 ONGOING ONGOING ONGOING ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 422 11 14 11 17
Circle time of assessment: 59% 35% 45% 35% 55%
Is the regional level on track to conduct the ORI?
 O1

O3
O2

O4

S
AS

TY

RE
CH

CH

CH

CH

O2

O3

CI

A
I

TI

EO
HO
TR

ON
AS

AS
AS

AS

NS
AR
CH

CH

AD
TA
L

C
IÑ

IÑ

IÑ

IÑ

RM
RA

FO
M
US
US

US
AR

AR

AR

Y
AR

AM
GA

AL
NE

CA
IM

IM

IM

EC
SM

M
SM

SM

GE

TA
S

TR
DA

DA

DA
plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved
(Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N)

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO YES

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO YES YES

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING YES ONGOING ONGOING

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING YES

ONGOING YES YES YES YES YES YES YES YES ONGOING ONGOING ONGOING

YES YES YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES ONGOING ONGOING YES YES NO YES

YES YES YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES YES YES YES YES NO YES

NO NO NO ONGOING NO NO NO YES YES NO YES YES

ONGOING ONGOING YES ONGOING ONGOING ONGOING ONGOING ONGOING YES ONGOING ONGOING YES

ONGOING YES YES YES YES YES NO ONGOING YES ONGOING NO NO

ONGOING NO NO YES YES YES NO ONGOING YES NO NO ONGOING

NO NO NO NO NO NO NO YES YES NO NO YES

NO NO NO ONGOING NO NO ONGOING YES YES NO NO YES

NO NO NO ONGOING NO NO ONGOING ONGOING YES NO NO ONGOING

YES YES YES YES YES YES YES YES YES YES YES YES

NO YES YES NO YES YES NO YES ONGOING YES YES YES

YES YES YES YES YES YES YES YES YES YES YES YES

ONGOING YES YES NO YES YES YES YES ONGOING YES YES YES

ONGOING YES YES NO YES YES YES YES YES YES YES YES

NO NO NO NO NO NO NO NO NO NO NO YES

ONGOING ONGOING YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES YES YES YES YES NO NO

YES YES YES YES YES YES YES YES YES YES YES YES

YES NO YES YES YES YES YES YES YES NO YES YES

YES NO NO YES YES YES NO YES YES YES YES 0

YES ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING YES NO NO NO NO

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING
ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING ONGOING

12 14 17 15 18 18 13 19 21 15 14 21
39% 45% 55% 48% 58% 58% 42% 61% 68% 48% 45% 68%
 ON
S
NE
A

TA
ND

IO
Z
NG
ON

NG

A
IT

DE
LA

LE
A

IC

R
A

NZ
GO
W
GM

DA

SA
RM

GE

LA
AL

NA
EN

VE
KA

TA
A

RO
AG

SI
IN

NO
M
CA

AR
M

M
plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved plan achieved
(Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N) (Y/N)

ONGOING ONGOING NO ONGOING NO YES ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING

YES ONGOING NO ONGOING YES ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING

ONGOING YES NO ONGOING ONGOING ONGOING ONGOING ONGOING YES NO ONGOING ONGOING

ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING YES ONGOING NO ONGOING YES

YES YES ONGOING ONGOING YES ONGOING YES YES ONGOING ONGOING YES YES

YES YES YES YES YES YES YES YES YES YES YES YES

ONGOING YES ONGOING YES NO YES ONGOING YES YES ONGOING YES YES

ONGOING YES ONGOING YES YES YES YES YES YES YES YES YES

ONGOING ONGOING NO ONGOING NO YES YES ONGOING ONGOING YES ONGOING ONGOING

ONGOING YES NO YES YES YES ONGOING ONGOING YES NO ONGOING ONGOING

ONGOING ONGOING NO ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING

ONGOING ONGOING ONGOING ONGOING NO ONGOING YES YES ONGOING NO ONGOING ONGOING
ONGOING NO NO ONGOING NO ONGOING YES ONGOING ONGOING NO ONGOING ONGOING

ONGOING YES NO YES NO ONGOING ONGOING ONGOING YES NO YES NO

ONGOING ONGOING NO ONGOING NO ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING

ONGOING ONGOING NO ONGOING NO ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING

YES 0 YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES YES YES YES NO YES YES

YES YES YES YES YES YES YES YES NO NO YES YES

YES YES YES YES YES YES YES YES YES YES YES YES

YES 0 YES YES YES YES YES YES YES NO YES YES

NO NO NO NO NO NO NO NO NO NO NO NO

YES YES YES YES YES YES YES YES YES YES YES YES

YES ONGOING ONGOING YES NO ONGOING YES YES YES ONGOING YES YES

YES YES YES YES YES YES YES YES YES YES YES YES

YES YES YES YES YES YES NO YES YES YES YES YES

YES ONGOING YES YES YES ONGOING YES ONGOING YES NO YES YES

NO ONGOING NO ONGOING NO ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING

ONGOING ONGOING NO ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING
ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING ONGOING NO ONGOING ONGOING

13 13 10 15 14 14 15 15 15 8 15 15
42% 42% 32% 48% 45% 45% 48% 48% 48% 26% 48% 48%
 E
A

AT
NZ

RN
TA

TE

plan achieved
(Y/N)

NO

NO

ONGOING

NO

ONGOING

ONGOING

YES

ONGOING

ONGOING

NO

NO

ONGOING

ONGOING
 NO

NO

NO

NO

YES

YES

YES

YES

YES

NO

YES

ONGOING

YES

YES

YES

NO

NO
ONGOING

10
32%
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: __________CAVITE_____________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
ONGOING X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
week?
ONGOING X
6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
immunzation (specify # of vaccination teams)?
ONGOING X
8. Are there funds available to the city & municipal level for operational costs including transport,
etc.
ONGOING X

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING X
10. Does the city/municipality have catch-up immunization guidelines printed and distributed to
lower levels?
ONGOING X
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?
ONGOING X

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

monitoring, and RCA available (transportation)?

ONGOING X
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
preparedness planned and budgeted?
ONGOING X

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING X
15. Does the region have adequate supply of routine antigens and its diluents for catch-up
immunization?
YES X

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES X
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? ONGOING X

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? ONGOING X
19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields),
alcohols & cottons?
ONGOING X

20. Does the city/municipality have finger markers or indelible ink? NO X

21. Does the city/municipality continous conduct cold chain assessment completed and actions
taken?
YES X

22. Is there an immunization Waste management plan available at the city/municipal level? YES X

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES X

24. Are there enough vaccine refrigerators at the City/Municipal level? YES X

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES X
26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION

X
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING X
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING X
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 11 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
WILL REQUEST FOR FINGER
MARKERS/INDELIBLE INK OR
ALTERNATE METHOD OF
MARKING
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
NO
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? YES

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? NO

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 14 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: CAVITE CHO Respondent (Position): CJ POBLETE NURSE III Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) NO

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
NO
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to NO
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

ONGOING
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? ONGOING
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), NO
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? ONGOING

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

YES
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 11 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved If not accomplished Action required
(Y/N) describe deficiency
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
ONGOING
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 17 0 0 0 0 General Remarks:
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
Deadline Person Responsible Remarks
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally ONGOING
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? NO
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? ONGOING

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), ONGOING
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
ONGOING
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

YES
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 12 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: REGION IV-A/CALABARZON Province: CAVITE
City / Muncipality : DASMARIÑAS CITY Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
ONGOING
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? NO

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? NO

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 14 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 ]
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? YES

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? NO

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 17 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, ONGOING
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? NO
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? NO

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), NO
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 18 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 18 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: __________4A__________ Province: _______CAVITE________________________
City / Muncipality : ______IMUS CHO3__________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): ________ MIXED
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
ONGOING X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
week?
YES X
6. Is there a Local NIP Team/Committee established with clearly defined roles: X
a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES X
b. Vaccine, Cold Chain & Logistics Management Team YES X
c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING X
d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES X
7. Is there an adequate number of human resources identified/organized for the catch-up
immunzation (specify # of vaccination teams)?
YES X
8. Are there funds available to the city & municipal level for operational costs including transport,
etc.
NO X

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING X
10. Does the city/municipality have catch-up immunization guidelines printed and distributed to
lower levels?
NO X
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?
NO X

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

monitoring, and RCA available (transportation)?

NO X
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
preparedness planned and budgeted?
ONGOING X

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING X
15. Does the region have adequate supply of routine antigens and its diluents for catch-up
immunization?
YES X

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? NO X
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES X

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES X
19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields),
alcohols & cottons?
YES X

20. Does the city/municipality have finger markers or indelible ink? NO X

21. Does the city/municipality continous conduct cold chain assessment completed and actions
taken?
YES X

22. Is there an immunization Waste management plan available at the city/municipal level? YES X

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES X

24. Are there enough vaccine refrigerators at the City/Municipal level? YES X

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? NO X
26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION

X
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING X
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING X
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 13 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
ONGOING X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
week?
YES X
6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES X
b. Vaccine, Cold Chain & Logistics Management Team YES X
c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING X
d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES X
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING X
10. Does the city/municipality have catch-up immunization guidelines printed and distributed to
lower levels?
ONGOING X
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?
ONGOING X

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

monitoring, and RCA available (transportation)?

YES X
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
preparedness planned and budgeted?
YES X

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING X
15. Does the region have adequate supply of routine antigens and its diluents for catch-up
immunization?
YES X

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES X
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES X

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES X
19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields),
alcohols & cottons?
YES X

20. Does the city/municipality have finger markers or indelible ink? NO X

21. Does the city/municipality continous conduct cold chain assessment completed and actions
taken?
YES X

22. Is there an immunization Waste management plan available at the city/municipal level? YES X

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES X

24. Are there enough vaccine refrigerators at the City/Municipal level? YES X

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES X
26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION

X
SOCIAL MOBILIZATION

YES
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING X
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING X
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 19 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
ONGOING X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? YES

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

YES
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
YES
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? YES

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? ONGOING
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? ONGOING

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, NO
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 21 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up NO
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to YES
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? NO

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other NO
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization NO
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up YES
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team NO

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
NO
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to NO
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? NO

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING X
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 14 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
YES X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
YES X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
YES X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
week?
ONGOING X
6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES X
b. Vaccine, Cold Chain & Logistics Management Team YES X
c. Advocacy, Social Mobilization & Communication & Media Relations Team YES X
d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES X
7. Is there an adequate number of human resources identified/organized for the catch-up
immunzation (specify # of vaccination teams)?
YES X
8. Are there funds available to the city & municipal level for operational costs including transport,
etc.
YES X

9. Are there already available catch-up immunization microplans at all RHUs & health centers? YES X
10. Does the city/municipality have catch-up immunization guidelines printed and distributed to NO
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?
ONGOING X

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

monitoring, and RCA available (transportation)?

YES X
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
preparedness planned and budgeted?
YES X

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING X
15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? YES

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? NO

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs?

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING X
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING X
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 21 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : _____GEN. E. AGUINALDO______________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and YES
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
ONGOING
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

YES
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields),
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? ONGOING

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? ONGOING

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 13 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
YES X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
week?
ONGOING X
6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES X
b. Vaccine, Cold Chain & Logistics Management Team YES X
c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING X
d. Risk Management, AEFI & COVID-19 Surveillance & Management Team ONGOING X
7. Is there an adequate number of human resources identified/organized for the catch-up
immunzation (specify # of vaccination teams)?
ONGOING X
8. Are there funds available to the city & municipal level for operational costs including transport, ONGOING
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING X
10. Does the city/municipality have catch-up immunization guidelines printed and distributed to
lower levels?
ONGOING X
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?
ONGOING X

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

monitoring, and RCA available (transportation)?

ONGOING X
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
preparedness planned and budgeted?
ONGOING X

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION

X
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING X
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING X
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 13 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization NO
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up NO
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and NO
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team ONGOING
7. Is there an adequate number of human resources identified/organized for the catch-up
NO
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? NO

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? ONGOING

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other NO
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 10 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: IV -A
City / Muncipality : ____Kawit____________________ Target Population (9-59 months): ______9187_(2022)_____
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
ONGOING
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally ONGOING
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

YES
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: __IV-A- CALABARZON__________________ Province: __CAVITE________________
City / Muncipality : ____MAGALLANES____________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization NO
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up YES
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team NO

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
NO
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to NO
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? NO

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 14 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization YES
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally ONGOING
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

ONGOING
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? ONGOING

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? ONGOING

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 14 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
ONGOING X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
week?
ONGOING X
6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, ONGOING
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally YES
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

ONGOING
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? NO

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency

6
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes?
ONGOING X
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up
immunization operations?
ONGOING X
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization?
ONGOING X
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
mobilize resources?
ONGOING X
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
ONGOING
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, ONGOING
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to YES
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally ONGOING
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

ONGOING
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? ONGOING

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and YES
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
ONGOING
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, YES
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally ONGOING
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

YES
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? NO

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: IV A____________________ Province: CAVITE _____________________________
City / Muncipality : ROSARIO ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and NO
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a NO
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles: NO

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
YES
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? NO

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to NO
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? NO
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? NO

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), NO
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? ONGOING

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? NO

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other NO
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, NO
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 8 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization ONGOING
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES
7. Is there an adequate number of human resources identified/organized for the catch-up
ONGOING
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, ONGOING
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally ONGOING
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

YES
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

ONGOING
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks:
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : ________________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

plan achieved If not accomplished
Area Critical activities Action required Deadline Person Responsible
(Y/N) describe deficiency
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization
purposes? ONGOING

2. Does the city/municipality have budget allocated at the city or municipal level for catch-up ONGOING
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to
Brgy. Officials) political commitment for catch-up immunization? ONGOING

4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and
ONGOING
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a
YES
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) YES

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team YES

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team YES

7. Is there an adequate number of human resources identified/organized for the catch-up

immunzation (specify # of vaccination teams)? ONGOING

8. Are there funds available to the city & municipal level for operational costs including transport,
ONGOING
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to
lower levels? ONGOING

11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ? ONGOING

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

monitoring, and RCA available (transportation)? NO

G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
ONGOING
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? ONGOING

15. Does the region have adequate supply of routine antigens and its diluents for catch-up
immunization? YES

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
IN AND LOGISTICS
 VACCINES, COLD CHAIN AND LOGISTICS
17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? YES

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

communication developed? ONGOING

27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other ONGOING
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 15 0 0 0 0 General Remarks:
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
Remarks
 FORM 2: CITY/MUNICIPALITY LEVEL READINESS MONITORING AND ASSESSMENT TOOL FOR MR SIA
Region: ____________________ Province: _______________________________
City / Muncipality : __TERNATE______________________ Target Population (9-59 months): ____________
LGU COVID-19 Zoning Status: _________________ Effective Dates of COVID-19 Zoning: ________________ Strategy (H2H/Fixed Posts/Mixed): _________________
Name of Monitor: _____________________ Agency: ___________ Respondent (Position): ____________________ Date of Visit/Assessment: ___________

6 wks 4 wks 2 wks 1 wk

Area Critical activities plan achieved
(Y/N)
Mark "X" planned activity deadline.

1. Does the city/municipality have budgeted workplans plans developed for resource mobilization NO
purposes?
2. Does the city/municipality have budget allocated at the city or municipal level for catch-up NO
immunization operations?
3. Do the Local Chief Executives (LCEs) verbally expressed or through issuances (i.e. EOs, Leeters to ONGOING
Brgy. Officials) political commitment for catch-up immunization?
4. Are discussions done with LGU COVID-19 Task Force to support catch-up immunization and NO
mobilize resources?
PLANNING, COORDINATION & FINANCING

5. Is there a Local NIP Team/Committee established and do they have a meeting at least once a ONGOING
week?

6. Is there a Local NIP Team/Committee established with clearly defined roles:

a. Technical Committtee including Monitoring & RCA Teams (Management & Monitoring) ONGOING

b. Vaccine, Cold Chain & Logistics Management Team YES

c. Advocacy, Social Mobilization & Communication & Media Relations Team ONGOING

d. Risk Management, AEFI & COVID-19 Surveillance & Management Team ONGOING
7. Is there an adequate number of human resources identified/organized for the catch-up
NO
immunzation (specify # of vaccination teams)?
8. Are there funds available to the city & municipal level for operational costs including transport, NO
etc.

9. Are there already available catch-up immunization microplans at all RHUs & health centers? ONGOING

10. Does the city/municipality have catch-up immunization guidelines printed and distributed to ONGOING
lower levels?
 11. Does the city/municipality have campaign forms & Checklists (i.e. supervisory checklists, tally NO
sheets, summary report forms, AEFI forms, etc.) printed and distributed to lower levels ?

12. Does the city/municipality have a plan and budget for catch-up immunization supervision,
MONITORIN

SUPERVISIO

NO
monitoring, and RCA available (transportation)?
G/

13. Does the city/municiplaity conduct monitoring visits to RHUs & Health Centers to assess
NO
preparedness planned and budgeted?

14. Does the city/municipality have a budgeted logistics plan developed? NO

15. Does the region have adequate supply of routine antigens and its diluents for catch-up YES
immunization?

16. Does the city/municipality have adequate supply of AD syringes and mixing syringes? YES
VACCINES, COLD CHAIN AND LOGISTICS

17. Does the city/municipality have adequate supply of AEFI or epinephrine kits? YES

18. Does the city/municipality have adequate supply of safety collector boxes (SCBS)? YES

19. Does the city/municipality have adequate supply of COVID-19 PPEs (face mask, face shields), YES
alcohols & cottons?

20. Does the city/municipality have finger markers or indelible ink? NO

21. Does the city/municipality continous conduct cold chain assessment completed and actions
YES
taken?

22. Is there an immunization Waste management plan available at the city/municipal level? ONGOING

23. Are there enough vaccine carriers and ice packs at the City/Municipal level? YES

24. Are there enough vaccine refrigerators at the City/Municipal level? YES

25. Are there bundled vaccine and other ancillary supplies distributed to RHUS/HCs? YES

26. Does the city/municipality have a budgeted regional plan for advocacy, social mobilization and
AND COMMUNICATION
SOCIAL MOBILIZATION

NO
communication developed?
27. Did the city/municipality held advocacy meetings with partners and stakeholders - e.g., other
Departments (DSWD, DILG), NGOs, professional, medical societies, faith-based organizations, other NO
civil society groups (e.g., Red Cross, Rotary, Lions) and others?
AND COMMUNICATIO
SOCIAL MOBILIZATIO

28. Does the region have advocacy, social mobilization and communication materials developed,
distributed or disemminated (e.g., pamphlets, leaflets, T-shirts, caps, banners, posters, jingles, ONGOING
radio/TV announcements, etc.)?
Total score: No. items with "Yes" 10 0 0 0 0
Circle time of assessment: 0% 6w 4w 2w 1w
Is the regional level on track to conduct the ORI?
If not accomplished Action required Deadline Person Responsible Remarks
describe deficiency
General Remarks: