% YES _________ Disease Surveillance Staff Profile for ____________ County (at time of visit) On Current CS Assigned Working? Paid up Total # of Date of Staff Location # or Full Name which (Yes/No) to what Key last AFP met? Remark of PA payam: Informants Case (Yes/No) residence 1 2 3 4 5 6 7 8 9 10 CS= County Supervisor; PA= Payam Assistant
% YES _________ Disease Surveillance Staff Profile for ____________ County (at time of visit) # CS or PA Full Name Assigned which payam: Current Location of residence On Working? (Yes/No) Paid up to what Total # of Key Informants Date of last AFP Case Staff met? (Yes/No) Remark 1 2 3 4 5 6 7 8 9 10 CS= County Supervisor; PA= Payam Assistant
Partners-and-CGPP-State-Coordinator-Field-Supervision-Trip-Report.docx