Chart3

EPI Monitoring Chart EPI MONITORING CHART POPULATION AGE GROUP RATIO YEARLY MONTHLY 0-6 WEEKS 6W-11M 12-23M PREGNANT TYPE JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM COV CUM BCG PENTA-1 MR-1 DROPOUT % P1 → MR BCG → MR
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TALLY SHEET FOR ROUTINE IMMUNIZATION SESSION (FOR ONE DAY)

EPI PAKISTAN – DAILY TALLY SHEET (EPI-04)

DAILY TALLY SHEET FOR ROUTINE IMMUNIZATION SESSION

NAME OF CENTRE UNION COUNCIL NAME OF TALUKA NAME OF DISTRICT
NAME OF VACCINATOR MONTH YEAR DATE
ANTIGEN LESS THAN 1 YEAR 12–23 MONTHS 2 YEARS & ABOVE GRAND TOTAL
MALEFEMALETOTAL MALEFEMALETOTAL MALEFEMALETOTAL MALEFEMALE
PREGNANT LADIES & CHILD BEARING AGE WOMEN (CBAs)
ANTIGEN PREGNANT WOMEN (PL) TOTAL NON-PREGNANT WOMEN (CBAs) TOTAL
GRAND TOTAL
VACCINE CONSUMPTION AND VACCINE WASTAGE
VACCINE CONSUMPTION BCGHEP-BbOPVROTAPENTA PCV13IPVTCVMRTD
RECEIVED (DOSES) (a)
ADMINISTERED (DOSES) (b)
CONSUMED (DOSES) (c)
WASTAGE (%) ((c − b) / c × 100)
ABOUT VACCINE BCGHEP-BbOPVROTAPENTA PCV13IPVTCVMRTD
NO: OF DOSES PER VIAL 2012011 4105520
NORMAL RANGE WASTAGE % 50%5%20%5%5% 10%10%10%20%20%
DESIGNED & CREATED BY: RAZA MUHAMMAD DANDAN, EX-DISTRICT SUPERINTENDENT OF VACCINATION (EPI) SUKKUR
NAME OF VACCINATOR:
SIGNATURE OF VACCINATOR:
Location: Pakistan

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