Name of County Supervisor: ______________________ Name of Payam Assistant: _______________________ Signature: ________________________________ Signature: __________________________ A-3: Information to be kept in the Payam Assistant’s Logbook Logbook information for contacts with KIs during the month State: County: Payam: Date of Name of KI Location of Reason of contact* Follow-up action Signature contact contact of KI * Reason for contact can be: a) Routine visit by PA, b) Report of suspect case by KI, or c) Other Logbook information for meetings conducted/attended during the month State: County: Payam: Date of Meeting Purpose of Type of Number Main issues Follow-up actions meeting Location Meeting attendees attended discussed
Name of Payam Assistant: _______________________ Name of County Supervisor: ______________________ Signature: ________________________________ Signature: __________________________ A-3: Information to be kept in the Payam Assistant’s Logbook Logbook information for contacts with KIs during the month State: County: Payam: Date of contact Name of KI Location of contact Reason of contact* Follow-up action Signature of KI * Reason for contact can be: a) Routine visit by PA, b) Report of suspect case by KI, or c) Other Logbook information for meetings conducted/attended during the month State: County: Payam: Date of meeting Meeting Location Purpose of Meeting Type of attendees Number attended Main issues discussed Follow-up actions
Field-Guide-for-Community-Based-Surveillance.docx