Daily Activity Register for HIV Tests

Date: _______________________________
day/month/year

Type of Test
Screening Confirmatory Tiebreaker

Beginning Balance
Final Test Results
Quantity Received
Indeter-
Client No. Purpose* Result Result Result Positive Negative
minate

Quantity Used Page Total

Daily Total TOTAL Final Test Results
Losses/Adjustments Page Total
Daily Total
Physical Count
Remarks:

* Purpose of the Test: VCT, PMTCT, Clinical Diagnosis (CD), Quality Control (QC), Other (explain)

Summary of HIV Tests Used by Purpose

Type of Test Product Clinical Quality
VCT PMTCT Other TOTAL
Diagnosis Control
Screening
Confirmatory
Tiebreaker
TOTAL

Republic of Zambia: Standard Operating Procedures Manual for Management of the National HIV Test
Logistics System. (, Nov 2007)