2019 Sbi Reporting Blank

2019 SCHOOL BASED IMMUNIZATION PROGRAM REPORT
as of __________________
No. of Total No. of

No. of No. of Doses
No. of Learners with Learners
Municipality/City Learners with Consent for
Schools 2 or more eligible for
Enrolled vaccination
MCV doses vaccination
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VACCINATION REPORT VACCINATION COVERAGE
% of % of % of
No. Learners
No. Deffered No. Refused learners learners learners
vaccinated with
MR MR vaccinated deffered refused VALIDATION
MR
with MR with MR MR
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
VALIDATION
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
as of __________________
No. of Total No. of

No. of No. of Doses
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VACCINATION REPORT VACCINA
% of
No. Learners No. Learners
No. Deffered No. Refused No. Deffered No. Refused learners
vaccinated with vaccinated with
MR MR TD TD vaccinated
MR TD
with MR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VACCINATION COVERAGE VALIDATION
% of % of % of % of % of
learners learners learners learners learners
deffered refused vaccinated deffered refused MR TD
with MR MR with TD with TD TD
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
as of __________________
No. of Total No. of

No. of No. of Doses
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
% of % of % of
No. Learners
vaccinated with
MR
with MR with MR MR
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
VALIDATION
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
as of __________________
No. of Total No. of

No. of No. of Doses
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
% of % of % of
No. Learners
vaccinated with
MR
with MR with MR MR
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
VALIDATION
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
as of __________________
No. of female No. of Total No. of

No. of
No. of learners Learners with Learners
Municipality/City Learners
Schools aged 9-14 2 or more eligible for
Enrolled
y.o. MCV doses vaccination
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VACCINATION REPORT
No.
No. of Doses No. Learners Learners No. Deferred No. Refused
No. Deferred No. Refused
with Consent for vaccinated with vaccinated HPV 1st HPV 1st
MR MR
vaccination MR with 1st dose dose
dose HPV
% of
% of % of
% of % of % of learners
learners learners
learners learners learners vaccinate
vaccinated deferred refused d with
deferred refused MR HPV
with HPV HPV 1st
with MR with MR MR HPV 1st
1st dose dose
dose
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
0 0 0 0 1 0
TION
HPV
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
as of __________________
No. of Total No. of

No. of No. of Doses
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
% of % of % of
No. Learners
vaccinated with
MR
with MR with MR MR
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
VALIDATION
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
as of __________________
No. of Total No. of

No. of No. of Doses
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
% of % of % of
No. Learners
vaccinated with
MR
with MR with MR MR
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
VALIDATION
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
as of __________________
No. of Total No. of

No. of No. of Doses
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VACCINATION REPORT VACCINA
% of
No. Learners No. Learners
No. Deffered No. Refused No. Deffered No. Refused learners
vaccinated with vaccinated with
MR MR TD TD vaccinated
MR TD
with MR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
% of % of % of % of % of
learners learners learners learners learners
deffered refused vaccinated deffered refused MR TD
with MR MR with TD with TD TD
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 1 0 1
as of __________________
TOTAL NO. OF ELIGIBLE CHILDREN MEASL

TOTAL NUMBER TOTAL NO. OF
OF LEARNERS LEARNERS WITH 2
MUNICIPALITY
ENROLLED OR MORE MCV MR TD HPV VACCINATED
KINDER-GRADE 7 DOSES
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
MEASLES RUBELLA TETANUS DIPHTHERIA
DEFERRE DEFERRE
% % REFUSED % VACCINATED % % REFUSED %
D D
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
HUMAN PAPILLOMAVIRUS
VACCINATED % DEFERRED % REFUSED %
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

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2019 SCHOOL BASED IMMUNIZATION PROGRAM REPORT

No. of Total No. of

No. of Total No. of

No. of Total No. of

No. of Total No. of

No. of female No. of Total No. of

No. of Total No. of

No. of Total No. of

No. of Total No. of

TOTAL NO. OF ELIGIBLE CHILDREN MEASL

VACCINATED % DEFERRED % REFUSED %

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