Department of Health

Regional Office IV-A

ORI ACTION PLAN

DIRECTIONS: Please complete this form completely prior to Outbreak Response Immunization activity for Vaccine Preventable Diseases in specific area. Prepare Spot Map
available in the health facility, Masterlist of target children, Identify immunization coverage of specific area with VPD case, available vaccine needed for immunization of target age
group, (0-59 months), man power, syringes and safety boxes, identify timeframe and to submit ORI report in NIP Program Manager and Assistant Program Coordinator.
Name :____Benerissa Quebral____________________________________________________________________________________________________
Office :_______PHTO Cavite_________________________________________________________________________________________________
ACCOMPLISHMENT (to be submitted to DOH RO IV-A Program
TARGET (to be accomplished by the LGU Nurse/Midwife)
Monitoring Team/Officer)

Area with
Person Target Activity
Strategies/Activities Expected Outputs Timeframe Measles Case/ Reason/Justification/Means of Verification
Responsible Achieved? (Yes/No)
# of cases
   Vaccinate children under 2
Outbreak Response years old with MMR
Immunization vaccine prioritized under 5
years of age, defaulters September Maria Teresa
(unvaccinated children) 12 2022 Ice land Tabujara, RN    
Immunization coverage at Maria Teresa
PasCam 2 Proper Jan to Tabujara, RN
June 11% Plan Spot map for Felisisima
identified target children September Tapawan BHW
aged 5 below 01, 2022  Ice land    
 Ice land
Green Land
  Netherland
Population 7362 Ireland
0-12:139 eligible children
Spain
0-23: EP
Update Masterlist for Finland Felisisima
children aged less than 5 France Tapawan - BHW
years old for defaulters September Switzerland Bell, Belinda,
tracking 21, 2022 Norway Wilma-BHW    
Contact No./s :_________09152123076_______________________________________________________________________________________________
Email :_______rissadohro4a@gmail.com_________________________________________________________________________________________________
Title of Activity :______ORI Planning__________________________________________________________________________________________________
 ACCOMPLISHMENT (to be submitted to DOH RO IV-A Program Monitoring
TARGET (to be accomplished by the LGU Nurse/ Midwife)
Team/Officer)

Area with Target Activity

Person
Strategies/Activities Expected Outputs Timeframe measles Achieved? Reason/Justification/Means of Verification
case/# cases
Responsible (Yes/No)

 
  Internal Rapid
Coverage Assessment   September  Country Maria Teresa
once done with the ORI 26,2020 Meadows Tabujara, RN    
 
External RCA once
declared that the area is  Country PDOHO/ NIP
ready for assessment   TBA Meadows Supervisor    

Mop up activity for MMR

containing vaccine
Country
TBA TBA Meadows Nurses/Midwives
Remarks:

_________________________________ ______________________ ________________________________________________________________

Nurse/ Midwife's Signature Date
________________________________________________________________

_________________________________ ______________________ ___________________________ ________________

Witness (Name & Signature) Date NIP Assistant Program Coordinator Date

DOH-ROIVA-MHRDS-SOP-02-CH-Form3 Rev0