APPENDIX – A: Community Health Volunteer (CHV) Profile Form Community Health Services Assessment & Mapping of Community level Health Workers CHV Profile – County: _____________________ District: ____________________ Facility: _________________ Community: _____________ Vital Data Training Supplies Mass Journey Diarrhea-CCM Malaria-CCM FP Photo Qualification Year Drugs How Orientation CHEST ARI ARI-CCM Backpack Raincoat ORT CBD-FP HBLSS WASH Awareness Bicycle Ledger Fistula Status DOTS CLTS Boots ENA Vest Age No. Sex selected selected Timer number Distribution of Set Kit Hope
APPENDIX – A: Community Health Volunteer (CHV) Profile Form Community Health Services Assessment & Mapping of Community level Health Workers – CHV Profile County: _____________________ District: ____________________ Facility: _________________ Community: _____________ Vital Data Training Supplies No. Status Age Sex Qualification Year selected How selected Orientation Diarrhea-CCM ARI-CCM Malaria-CCM ENA CBD-FP DOTS WASH FP Awareness Journey of Hope CHEST Kit Mass Drugs Distribution CLTS HBLSS Fistula Bicycle Boots Raincoat Vest Ledger Backpack ORT Set ARI Timer Photo number