Polio Eradication Toolkit

Monthly Special Vaccination Post Report Form

Length: 1 page (A4)
Year: 2014
Organization: CGPP South Sudan with WHO South Sudan
Country: South Sudan
Language: English

Developed jointly by WHO South Sudan and the CGPP Secretariat, this form is used by vaccination teams to record one dose of oral polio vaccine administered to children under 15 years who are crossing state or international borders. The tool is divided into two sections: children who have received polio vaccines before and children who have never received oral polio vaccine, or zero dose children. The tool is further sub-divided by gender and age groups: 0 to 11 months, 12 to 59 months, and 60-179 months. The form lists county, payam, state, name of vaccination site, and type of the special vaccination site (international or interstate). This monthly special vaccination post report form is generally the summary of the information contained in the special vaccination posts tally sheets.

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