BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION

REGION: _____________________________________
PROVINCE: ___________________________________
CITY/MUNICIPALITY: ___________________________
BARANGAY: __________________________________
A. TOTAL NUMBER OF POPULATION (AS OF 2020):
B. TOTAL NUMBER OF UNVACCINATED INDIVIDUALS:
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS: Formula: B/A X 100
D. TOTAL NUMBER OF PARTIALLY VACCINATED INDIVIDUALS:
E. PERCENTAGE OF PARTIALLY VACCINATED INDIVIDUALS: Formula: D/A X 100
F. TOTAL NUMBER OF FULLY VACCINATED INDIVIDUALS:
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS: Formula: F/A X 100
H. TOTAL NUMBER OF INDIVIDUALS WITH BOOSTER SHOT:
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT: Formula: H/A X 100
AS OF (insert date): ____________________

Prepared by: Approved by:

__________________________________________ ____________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay

PRIMARY SERIES OF COVID-19 VACCINE Partially Fully BOOSTER DOSE

Date of vaccination Unvaccinated? (Put Vaccinated? Vaccinated? With Booster5
NO FULL NAME 1 if Yes and 0 if No) Date of
Brand (Put 1 if Yes (Put 1 if Yes shot? (Put 1 if Brand
1st Dose 2nd dose and 0 if No) and 0 if No) Yes and 0 if No)
vaccination
1                    
2                    
3                    
4                    
5                    
6                    
7                    
8                    
9                    
10                    
11                    
12                    
13                    
14                    
15                    
16                    
17                    
18                    
19                    
20