Annex B:Vaccination Tally Sheets Cholera Vaccination Tally Sheet Sheet N°:……………… Team:…………………………………. District:………………………………….. Date:…………………………………… Health Zone:………………………………………….. Health Area:………………………………… Neighborhood:……………………………………… Number of vaccine vials used: Utilization rate= Number of people vaccinated x100 Utilization rate Number of doses used 1yr - 4 yr ≥ Total 1 - 4 yr 5 - 14 yr ≥ Total 5 - 14 yr 15 yr ≥ Total ry ≥15 Grand total Check a circle for a given dose (1 person vaccinated) 1 square = 100 doses administered Number of Extra number Total Number of Number of doses of doses remaining received received received doses doses used Utilization Vaccine doses Visial vial monitor Reading Interpretation Can be used Can not be used Number of VVMs with changed color
Annex B:Vaccination Tally Sheets Cholera Vaccination Tally Sheet Sheet N°:……………… Team:…………………………………. District:………………………………….. Date:…………………………………… Health Zone:………………………………………….. Health Area:………………………………… Neighborhood:……………………………………… Number of vaccine vials used: Utilization rate= Number of people vaccinated x100 Utilization rate Number of doses used ≥ 1yr - 4 yr Total 1 - 4 yr ≥ 5 - 14 yr Total 5 - 14 yr ≥ 15 yr Total ≥15 ry Grand total Check a circle for a given dose (1 person vaccinated) 1 square = 100 doses administered Utilization Number of doses received Extra number of doses received Total received Number of remaining doses Number of doses used Vaccine doses Visial vial monitor Reading Interpretation Can be used Can not be used Number of VVMs with changed color
vaccination_tally_sheets_0.docx