of initial report to CBS system B-7: CBS Checklist for County Supervisor (CS) Date of the visit: Name of the Supervisor: REMARKS County: State: Name of the county supervisor: 1) Does the county supervisor (CS) have a work plan for the Yes No current month (including a supervision plan)? 2) Does the CS have a list of the key informants (KI) by payam Yes No indicating the location and type KI? 3) Does the CS have a social map of the county map showing in Yes No which boma the payam assistant (PA) lives? 4) Does the CS have a copy of the PAs payam map showing KIs? Yes No 5) Does the CS have a diary/log book which shows all activities Yes No conducted during the last month? 6) Does the CS have the monthly reports by all PAs for last month? Yes No 7) Did the CS carry out planned visits to Payams during the Yes No previous month? 8) Does the CS have a copy of the filled-out checklists from Yes No previous visits to payams? 9) Does the CS have a copy of his monthly report of the previous Yes No month? 10) Does the CS keep a line-list of the suspect AFP cases reported? Yes No 11) Is the above line-list properly filled? Yes No 12) Did the CS conduct the planned coordination meetings during Yes No the previous month? 13) Does the CS know the name and have contact with the WHO Yes No disease surveillance staffs (all) in the county ? 14) Does the CS have both Budget Trackers (Funds Received and Yes No Funds Spent) format for the current quarter? 15) Is the Funds Received format for the current quarter filled-out Yes No correctly and up-to-date? 16) Is the Funds Spent format for the current quarter filled-out Yes No correctly and up-to-date?
of initial report to CBS system B-7: CBS Checklist for County Supervisor (CS) Date of the visit: Name of the Supervisor: REMARKS County: State: Name of the county supervisor: 1) Does the county supervisor (CS) have a work plan for the current month (including a supervision plan)? Yes No 2) Does the CS have a list of the key informants (KI) by payam indicating the location and type KI? Yes No 3) Does the CS have a social map of the county map showing in which boma the payam assistant (PA) lives? Yes No 4) Does the CS have a copy of the PAs payam map showing KIs? Yes No 5) Does the CS have a diary/log book which shows all activities conducted during the last month? Yes No 6) Does the CS have the monthly reports by all PAs for last month? Yes No 7) Did the CS carry out planned visits to Payams during the previous month? Yes No 8) Does the CS have a copy of the filled-out checklists from previous visits to payams? Yes No 9) Does the CS have a copy of his monthly report of the previous month? Yes No 10) Does the CS keep a line-list of the suspect AFP cases reported? Yes No 11) Is the above line-list properly filled? Yes No 12) Did the CS conduct the planned coordination meetings during the previous month? Yes No 13) Does the CS know the name and have contact with the WHO disease surveillance staffs (all) in the county ? Yes No 14) Does the CS have both Budget Trackers (Funds Received and Funds Spent) format for the current quarter? Yes No 15) Is the Funds Received format for the current quarter filled-out correctly and up-to-date? Yes No 16) Is the Funds Spent format for the current quarter filled-out correctly and up-to-date? Yes No