Preparedness checklist at Sector/ CCP level, Special Immunization Drive, Assam

District:______Block: ______CCP/Sector: ______Name of the Monitor: ______Organization:Govt/UNICEF/WHO/OthersDate: ______Round:1/2/3/4

Sector/CCPLevel Preparedness and Planning
Have you receivedOperational Guidelines of Special Immunization Drive? / ☐Yes ☐No ☐Not aware
Has Sector/CCPreceived any communication regarding SID from the district/block? / ☐Yes ☐No ☐Not aware
Has sector/CCP issued or made any communication regarding SID to the SCs/FLWs? / ☐Yes ☐No ☐Not aware
Has sector/CCP received sufficient funds for SID from district/block/NHM? / ☐Yes ☐No ☐Not applicable ☐Not aware
Whether sector/CCP has given any incentives to SCs/ANMs/ASHAs for linelisting? / ☐Yes ☐No ☐Not aware
Whether sector/CCP has involved Elected representatives and other dept for SID? / ☐Yes ☐No ☐Not aware
Whether all Sub centers have at least One ANM? / ☐Yes ☐No ☐Not aware
Is sector/ block level orientation of ANMs held? / ☐Yes ☐No ☐Not aware If Yes in how many /
Is sector/ block level orientation of ASHAs held? / ☐Yes ☐No ☐Not aware If Yes in how many /
Has the sector/CCPreceived adequate number of all planning and reporting formats? / ☐Yes ☐No ☐Not applicable ☐Not aware
Has the sector/CCP distributed all planning and reporting formats to all SCs/ASHAs? / ☐Yes ☐No ☐Not applicable ☐Not aware
Is linelisting work completed in all the SCs of the sector? / ☐Yes ☐No ☐Not aware If Yes in how many /
Is the sector conducting field validation of linelist submitted? / ☐Yes ☐No ☐Not aware
Are the linelist being displayed in villages, SCs, PHCs and other govt. institutions? / ☐Yes ☐No ☐Not aware
No. of SCs completed SID micro planning and submitted to sector/ block / ☐Yes ☐No ☐Not aware If Yes in how many /
Whether all missed areas are covered in SID Microplan? / ☐Yes ☐No ☐Not aware
Whether Data Entry at block level has been initiated? / ☐Yes ☐No ☐Not aware
Whether adequate Vaccine and logistics available for SID? / ☐Yes Adequate ☐Yes, inadequate ☐No ☐Not applicable ☐Not aware
Whether Vaccine and logistics distribution plan in place to all planned sessions? / ☐Yes ☐No ☐Not aware
Whether all IEC materials are received in adequate quantity? / ☐Yes Adequate ☐Yes, but inadequate ☐No ☐Not aware
Whether all IEC materials are distributed? / ☐Distributed ☐Planned☐Not yet planned ☐Not aware
Is there any mechanism to review Notification of missed areas? / ☐Yes ☐No ☐Not aware
Implementation Monitoring and Review mechanism
From Sector/CCP level, how will implementation of SID be reviewed? / ☐Daily evening meeting ☐Daily data review☐Other specify):______
Has Sector/CCPidentified health functionariesto be deputed as supervisors for SID? / ☐Yes ☐No ☐Not aware
24a / If yes, numbers of sessions for which supervisors assigned out of total sessions? / /
DO you have a sector level monitoring checklist / ☐Yes ☐No ☐Not aware
25a / Does the sectormonitoring plan include the following details? / ☐SC level finalization and submission of SID Plans
☐ANM/ASHA orientation
☐Availability of all planning formats at all levels
☐Village level Linelisting
☐All missed areas are covered in SID Microplan
☐Payment of Incentives to ASHA
☐Vaccine and logistics availability and distribution plan
☐Cold chain assessment (Adequacy and Quality)
☐Display of linelist in SC/GPs
☐Preparation of updated Microplan and duelist
☐My Village My Home
☐Household display of stickers
☐Attending evening meetings
☐Notification of missed areas
☐IEC material distribution/ display / activities
☐AVD Plan
☐Supportive Supervision of sessions
☐Others, Specify______
IEC planning
What are the modes of IEC planned by your sectorfor SID? / ☐Launch activities
☐Miking
☐Drum beating
☐HH Stickers
☐My Village My Home
☐TV
☐Radio/ Community Radio
☐Public Announcement/ Announcement in religious places
☐Community meetings/ Mothers’ meetings
☐Rallies
☐Newspaper
☐Pamphlets/ Leaflets
☐Street Banner/ Hoarding
☐Session Banner
☐Media orientation
☐Meeting with Key influencers/ community leaders
☐Others, Specify______
Have you received any funds for IEC for SID? / ☐State funds ☐Not aware ☐other (specify)______
Vaccine Logistics planning
Are the given logistics available in sufficient quantities for the SID?Please check the box if available in adequate quantities. / ☐BCG vaccine
☐Pentavalent vaccine
☐Polio vaccine
☐IPV vaccine
☐JE vaccine
☐Measles vaccine
☐DPT vaccine
☐Vitamin A solution
☐0.1 ml AD syringes
☐0.5 ml AD syringes
☐5 ml reconstitution syringes
☐Red bags
☐Black bags
☐Hub cutters
☐Marker pens
☐Zipper bags
☐Planning formatsincluding linelisting and Due list formats
☐Reporting formats including Tally sheets and post drive linelists
☐HH Stickers
☐My Village My Home
☐Pamphlets/ Leaflets
☐Street Banner/ Hoarding
☐Session Banner
☐Posters
☐AEFI kits
☐Others, Specify______
Remarks/Comments(if any):