PROFORMA ON COVID VACCINATION DATED:- 19-04-2021

Total Staff Number Number Balance to Number Number Balance to EOPR&RD

Name of the Name of the Village Total Total Balance to be Reasons for Total Number VACCINATED
Sl.No. Mandal Sl.No. Secretariat Working( PS, VSFs Vaccinated 1st Vaccinated 2nd Vaccinated be Reasons for not Vaccinated GP Staff Vaccinated 1st Vaccinated 2nd Vaccinated Vaccinated not Vaccinated MPDO Staff Vaccinated be (YES/NO) IF NO ,
& Volunteers) Dose Today Dose Today Vaccinated Dose Today Dose Today Vaccinated
specify reason

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
T.P.Gudur Chinna Cherukur 18 8 8 0Yes
Chinthopu 22
T.P.gudur 30
Peduru 26
Narukuru 28
Iskapalem 32 3 0 25 7Pregnant women( count:1)
Lactating Women(count:6)
Koduru-i 21
Koduru-ii 45
South Amuluru
Macherlavaripalem
Eduru
potlapudi 31 0 0 17 14 Pregnant women( count:1)
Lactating Women(count:2)
Varigonda-ii
Venkannapalem 33
Varakavipudi

SIGNATURE OF MEDICAL OFFICER SIGNATURE OF EOPR&RD SIGNATURE OF THE MPDO

 MPDO VACCINATED
(YES/NO) IF NO ,
specify reason

21
Yes

GNATURE OF THE MPDO