NIP VACCINE INVENTORY

NAME OF FACILITY: DATE COVERAGE: DATE CONDUCTED:

Dose ExpiryDate VVM STORAGE NAME QUANTITY IN RECORDS ACTUAL COUNT QUANTITY QUANTITY DIFFERENCE
Row ITEM DESCRIPTION MANUFACTURER BATCH/LOT NUMBER Remarks/ Notes
per vial (dd/mm/yy) STAGE (Ref/Freezer)
Vial Dose Vial Dose Vial Dose

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

- - - -

PREPARED/CONDUCTED BY: NOTED BY

NAFISA S. BANTO, RM ADELA SAIDAR, RN

Name and Signature Name and Signature
 NIP ANCILLIARY

NAME OF FACILITY: DATE COVERAGE: DATE CONDUCTED:

Item Manufacturer/ receive from BatchNumber RECEIVED Actual Count Quantity/Remaining

ExpiryDate Balance
Row Remarks/ Notes
(dd/mm/yy)
pcs box pcs box

1 SYRINGE 0.5ML WITH

NEEDLE

2 SAFETY COLLECTOR BOX

3 DILUENT

SYRINGE 1 ML WITH
4
NEEDLE

5 COTTON

6 ALCOHOL

10

11

12

13

14

15

16

PREPARED/CONDUCTED BY:

Name and Signature Name and Signature

Remarks/ Notes
 COVID 19 DAILY SUMMARY REPORT

NAME OF FACILITY: RHU-DAS WEEK: DATE CONDUCTED: 04-May-23

WASTAGE CURRENT STOCK ENDING CURRENT STOCK ENDING

BEGINNING BALANCE QUANTITY RECEIVED TOTAL UTILIZED/JABS BALANCE (vials) BALANCE (dose)
EXPIRED OTHERS
No. COVID VACCINES LOT /BATCH NUMBER REMARKS
VIAL DOSE VIAL DOSE VIAL DOSE VIALS DOSE VIALS DOSE e= (a+b)-(c+d) e= (a+b)-(c+d)
A B A B C D E F G H E E

1 Pfizer Adult 36081bd 20 120 - - 3 5 - - - - 17 204

2 Pfizer Kids GA6722 4 4 - - - - - 4 4
3 Sinovac C202109203 116 116 - - - - - - - - 116 116
4 - - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
18 - -

PREPARED BY: NOTED BY:

Name and Signature Name and SignatureName and Signature

 VACCINE
INVENTORY

NAME OF FACILITY: DATE COVERAGE: DATE CONDUCTED:

Item Manufacturer/ receive from BatchNumber RECEIVED Actual Count Quantity/Remaining

ExpiryDate Balance Quantity
Row
(dd/mm/yy) Difference
pcs box pcs box

1 SYRINGE 0.5ML WITH

NEEDLE

2 SAFETY COLLECTOR BOX

3 DILUENT

SYRINGE 1 ML WITH
4
NEEDLE

5 COTTON

6 ALCOHOL

10

11

12

13

14

15

16

PREPARED/CONDUCTED BY:

Name and Signature Name and Signature

Remarks/ Notes