TCV Catch-up Campaign, Pakistan 2022

List of Zero Dose Children for Routine Immunization - Sheet for Social Mobilizer
Each Social Mobilizer should ask caregivers of children under 2 years age who are recorded in Missed Children List for TCV,
whether child is already vaccinated for routine vaccines or not. If Not, record names of Zero dose* children. This list will be used
to vaccinate Zero Dose children for Routine vaccination after TCV catch-up campaign.
*Any child less than 2 years of age and not vaccinated for routine vaccinations.

Name of Social Mobilizer: ______________________________________Team No._______________

Union Council: ____________________________

Tehsil/Town/Taluka: _______________________________________
District: ___________________

Site/Location: __________________________________________ Date:____/_____/2022 Day No._________

Age
S. No. Zero Dose Child Name Father's Name Contact Number House Number/Village/Mahalla
(Months)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Name of the 1st Level Supervisor:__________________________________________Signature: ________________________

Intructions for 1st Level Supervisor:
1. Collect all Zero dose sheets from Social Mobilizers and Team Assistants, count total number of Zero Dose children, write on Daily Report with
pen and enter zero dose data in Mobile/Web app online (after AEFI entry)
2. Handover these all Zero dose sheets to Medical Officer/EPI Incharge of the nearest Health Facility/EPI Centers for covering these Zero dose
children in Routine vaccination