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Class- wise School MR Campaign Coverage Report

School Principal fills this up and shares with Planning unit / Block level MRC FORM - 9A

State: ____________ District: __________________ Block/urban area: ________________ Planning unit: ________________
School name: __________________________________________
Address (Village/Urban area): ______________________________________________ Encircle: Govt/ Private/ Aided

Principal name & Telephone number: ______________________ Board of school: ICSE/CBSE/State board/other (specify)
Total no days activity planned in school: 1/2/3/4/5/6
School nodal person for MR Campaign vaccination (Name & Tel number): _________________________
Sr Day of Total Target No of Children
Date of vaccination Class % achieved Activity Status
No vaccination Children in Class vaccinated
Day -1 Completed/Ongoing
Day -2 Completed/Ongoing
Day -3 Completed/Ongoing
Day -4 Completed/Ongoing
Day-5 Completed/Ongoing
Day-6 Completed/Ongoing
Total
* In case the activity is planned for >1 day in school then the data reporting officer should mention day/date wise report till activity compilation

Signature Principal

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