BARANGAY MONTHLY INVENTORY OF VACCINATED POPULAT

REGION: _____________
PROVINCE: __________________
CITY/ MUNICIPALITY: ____________________
BARANGAY: ____________________________

A. TOTAL NO. OF POPULATION (AS OF 2020)*: *Note: This shall only cover individuals 13 years old and above.
B. TOTAL NO . OF UNVACCINATED INDIVIDUALS*:
C. PERCENTAGE OF UNVACCINATED INDIVIDUALS*: Formula: B/A x 100
D. TOTAL NO. OF PARCIALLY VACCINATED INDIVIDUALS*:
E. PERCENTAGE OF PARCIALLY VACCINATED INDIVIDUALS*: Formula: D/A x 100
F. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS*:
G. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS*: Formula: F/A x 100
H. TOTAL NO. OF INDIVIDUALS WITH BOOSTER SHOT*:
I. PERCENTAGE OF INDIVIDUALS WITH BOOSTER SHOT*: Formula: H/F 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 (Note: 1. If brand is

"Janssen, put NA in the column for "2nd Dose"; Put "None" if
unvaccinated) Unvaccinated?
No. Full Name (Put 1 if Yes or 0 if
Date of Vaccination No)
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
Y OF VACCINATED POPULATION

ividuals 13 years old and above.

Partially BOOSTER DOSE

vaccinated? Fully Vaccinated? (Put
(Put 1 if Yes or 0 if 1 if Yes or 0 if No)
No) With Booster Shot?
(Put 1if Yes or Date of Vaccination Brand
0 if No)