You are on page 1of 14

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION

REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 ARNOLD NEGULO 12/18/21 1/18/22 SINOVAC
2 AILYN D. NEGULO 12/1/21 12/22/21 PFIZER
3 ALLEN D. NEGULO
4 TRICIA MARIE D. NEGULO 10/11/21 11/3/21 PFIZER
5 ROMIE L. DOMINES N/A JANSSEN
6 AMY E. DOMINES 12/1/21 12/22/21 PFIZER
7 NICO E. DOMINES 10/18/21 11/7/21 PFIZER
8 PATRICK E. DOMINES 11/8/21 1/3/22 ASTRAZENECA
9 MIKA E. DOMINES 11/6/21 1/11/22 ASTRAZENECA
10 WESLEY E. DOMINES 8/3/21 9/26/21 ASTRAZENECA
11 RODALYN E. DOMINES
12 RONAMAE E. DOMINES 12/20/21 1/20/22 PFIZER
13 LIMUEL T. BALINSOY N/A JANSSEN
14 PERLA B. BALINSOY N/A JANSSEN
15 DOMINIC PAUL B. BALINSOY 8/19/21 9/16/21
16 DIANNE PEARL B. BALINSOY 10/11/21 11/3/21 PFIZER
17 JOELITO B. BUENAFE 5/21/21 6/24/21 SINOVAC
18 GINA B. BUENAFE 5/21/21 6/24/21 SINOVAC
19 MICHELLE B. BUENAFE 11/26/21 12/24/21 SINOVAC
20 JOHN ADRIAN B. BUENAFE
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 JADE BOLLENA 5/21/21 6/24/21 SINOVAC
2 EFREN CALDIMON
3 ENVAGELINE B. VALENCIA 1/4/22 CLINICAL TRIAL
4 BEVERLY KAYE P. MENDOZA 9/16/21 11/3/21 ASTRAZENECA
5 ROBERTO A. HALLADO
6 ELMA P. HALLADO
7 VIVES P. HALLADO 8/9/21 9/16/21 MODERNA
8 VINCE P. HALLADO 10/21/21 11/11/21 PFIZER
9 VIA NICOLE P. HALLADO 11/12/21 12/3/21 PFIZER
10 VARBEE H. ARDIENTE 8/23/21 9/20/21 SINOVAC
11 RAMEL B. ARDIENTE
12 YKREAH H. ARDIENTE 1/19/22 PFIZER
13
14 REY A. HALLADO 1/18/22 N/A JANSSEN
15 EMILY M. HALLADO 12/21/21 SINOVAC
16 ZIAN JEAN M. HALLADO
17 ARNOLD L. PADEGARO 10/15/21 11/15/21 PFIZER
18 MILA G. PADEGARO 1/18/22 N/A JANSSEN
19 MARK LISTER G. PADEGARO
20 MARTIN DALE G. PADEGARO 10/11/21 11/3/21 PFIZER
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 SOFRONIO P. MAGNO 12/6/21 MODERNA
2 LILIAN P. MAGNO
3 ARNEL P. MAGNO
4
5 MARK P. MAGNO
6 ERIL P. MAGNO
7 ESTRELITA I. PORRAS
8 ALIZA P. GUARISMAL
9 MILER N. PORRAS
10 LYKA P. DELA CRUZ 11/9/21 12/3/21 ASTRAZENECA
11 ANDREW P. DELA CRUZ
12
13 ALEXANDER P. DELA CRUZ
14 AURELIO P. DELA CRUZ
15 ROSALIE P. PORRAS
16 ARIEL P. PORRAS
17 GLEN P. PORRAS
18 CRISTY P. PORRAS
19 KRISHA P. PORRAS
20 HIEZEL P. PORRAS
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:


_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 MILA LUNA P. PORRAS 1/18/21 SINOVAC
2 BEA P. PORRAS 12/22/21 N/A JANSSEN
3 LEO P. PORRAS JR
4 ROGER ARAGONES JR SINOVAC
5 VINLEE P. ARAGONES 12/18/21 1/18/22 SINOVAC
6 DYLAN LUXEMBOURG ARAGONES
7 ZANDALE ARAGONES
8 ERNIE PAREJA
9 LINA PAREJA 1/18/21 N/A JANSSEN
10 ROSE ANN PAREJA 12/21/21
11 ANGELO P. PAREJA
12 JEREMY P. PAREJA 1/19/22 PFOZER
13 QUEENIE P. PAREJA
14 KAREN P. PAREJA
15
16 JM DACALDACAL
17 KRISTIAN PAREJA 12/21/21 1/18/22 SINOVAC
18 APRILYN BALAYO PFIZER
19 JOHN KEAN PAREJA
20 KRISALYN PAREJA
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 PACIANA B. PADEGARO
2 MARVIN G. PADEGARO 11/26/21 12/17/21 PFIZER
3 SHEILA PALAPARAN
4 GALVIN BRYCE PADEGARO
5 REY CONSTANTINOPLA
6 AIZA CONSTANTINOPLA
7 REIGN CONSTANTINOPLA
8 RAIN SEAN CONSTANTINOPLA
9 LILIA B. BUENAFE
10 KIAN AXEL PAQUINGAN
11 KIERSON B. PAQUINGAN
12 MARIEL N. PAQUINGAN
13 KIEYNA MHIEL PAQUINGAN
14 KIERBY LIAM PAQUINGAN
15 ELBERT PAQUINGAN
16 MELBA B. PAQUINGAN
17 KIER B. PAQUINGAN
18 VICEMAR P. HALLADO
19 GERLIE C. HALLADO
20 VICMAR VAYNE HALLADO
TOTAL
BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION
REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 VRIELLA VENIZZE HALLADO
2 VESMAL VYHIELLE HALLADO
3 DANILO J. ITUCAS
4 MARILOU T. ITUCAS
5 GEMMA T. ITUCAS 12/6/21 MODERNA
6 MADONNA T. ITUCAS 12/6/21 MODERNA
7 DANILO T. ITUCAS
8 ANGELICA T. ITUCAS 12/6/21 MODERNA
9 AIANNA BRIELLE ITUCAS
10 JEANNIE ORBITA
11 JOHNEL ORBITA
12 JENEVA ORBITA
13 JADE MARIE ORBITA
14 KISHA
15 MERCEDITA DELAMORES
16 ARGIE LEGASPI
17 JESRIL ORBITA
18 AERON FRITZ LEGASPI
19 CYREL PADEGARO
20 VERGENIA PADEGARO
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1 JASON PADEGARO
2 JAYPEE PADEGARO
3 JESSICA PADEGARO
4 KIANNA BLAIRE AGUIRE
5 ANGELODINE MAGNO
6 ARLENE MAGNO
7 ALDRIN MAGNO
8 ADRIAN MAGNO
9 JAKE ANGELO MAGNO
10 ALEX MAGNO 11/26/21 12/17/21 PFIZER
11 ANNIE MAGNO 10/11/21 11/3/21 PFIZER
12 ARVIN MAGNO 11/29/21 12/20/21 PFIZER
13 JASON VAFLOR 11/30/21 1/25/22 ASTRAZENECA
14
15
16
17
18
19
20
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:


_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL

BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION


REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL
BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION
REGION: VI
PROVINCE: ILOILO
CITY/MUNICIPALITY: POTOTAN
BARANGAY: GUIBUANGAN *Note: This shall only cover individuals 13 years old and above
A. TOTAL NO. OF POPULATION (AS OF 2020)*:
B. TOTAL NO. OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*:
D. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
E. PERCENTAGE OFF PARTIALLY VACCINATED INDIVIDUALS*:
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*:
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F x 100
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*:
AS OF (insert date): ___________

Prepared By: Approved by:

_______________________________________________________________ _____________________________________________________
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
No. Full Name PRIMARY SERIES OF COVID-19 VACCINE
(Note: 1. If brand is “Janssen”, put NA in the column for
Unvaccinated? Partially Vaccinated? Fully Vaccinated? BOOSTER DOSE
“2nd dose”. Put none if unvaccinated).
(Put 1 if Yes or 0 (Put 1 if Yes or 0 if No) (Put 1 if Yes or 0 if No)
With Booster Shot?
if No)
(Put 1 if Yes or 0 if No)
Date of Vaccination Brand Date of Vaccination Brand
1st dose 2nd dose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL

You might also like