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Self Assesment Check List

The document is an Immunization Self-Assessment Tool designed for health centers and health posts to evaluate their immunization practices on a monthly basis. It includes a checklist of items to be monitored, such as immunization coverage, vaccine management, and temperature monitoring of refrigerators. The tool aims to identify problems, their root causes, and action points for improvement in immunization services.

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mershaadane83
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8 views3 pages

Self Assesment Check List

The document is an Immunization Self-Assessment Tool designed for health centers and health posts to evaluate their immunization practices on a monthly basis. It includes a checklist of items to be monitored, such as immunization coverage, vaccine management, and temperature monitoring of refrigerators. The tool aims to identify problems, their root causes, and action points for improvement in immunization services.

Uploaded by

mershaadane83
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Immunization Self-Assessment Tools For Health Centers And Health Posts

Woreda: __________ HC: _______________ HP__________ Assessment Month____________ Date_________


Months
S. No Item to be checked
July Aug Sep Oct Nov Dec Janu Feb Mar
1. Is immunization coverage and dropout monitored on monthly basis by kebele? yes
2. Is the health facility on the right track in immunization performance? (compare achieved coverage and dropout rate with plan) yes

3. Does the facility monitor EPI performance of the catchment HP/Gotes based on RED problem categorization and take actions according to their priority? noi

4. Is immunization monitoring chart available, correctly filled and updated for the completed month? noi
Were all immunization sessions executed without interruption in the completed month as per the plan?
5. noi
Number planned ______________ Number executed_____________
6. Has the health center conducted immunization review meetings as per the plan? (check for the availability of the minutes)

7. Has the health center conducted supportive supervisions for the health posts as per the plan? (Check for the standard checklist and feedback provided). (Enter NA for HP)

8. Does the facility have vaccine forecast for the fiscal year including minimum and maximum of the month?
9. Does the health facility use vaccine request format for requesting vaccine? (Check copy of VRF for the completed 3 months).
10. Is the vaccine balance updated everytime vaccine received or issued? (check for the last transaction)
11. Are all antigens in the fridge not expired and of VVM stage I and II? (Check physically)
12. Were all vaccines sufficient (no stock out) in this month? (Conduct physical count of vaccines in the refrigerator)
13. Is the wastage rate of each vaccine calculated for the last completed month? (Discuss on the calculated wastage)
14. Is the fridge temperature recorded twice a day including daily maximum and minimum? (check completed month record)
15. Are temperature records of fridges with vaccine free of alarm in the last one month? (Check from Fridge tag or records)
16. If no for Q#15, write # of High alarm____ # of low alarm____ (write yes <2 freeze alarm)
17. Were appropriate actions taken for temperature alarms that occurred this week / month?
18. Was temperature review conducted for the completed month?
19. Has the facility sent a copy of reviewed and completed fridge temperature monitoring recordto WoHo at the end of the month?

20. Have weconducted preventive maintenance for refrigerator during the week/month? (Check for the cleanliness of the refrigerators, frosting, cleanliness of the panel of SDD fridges etc.)

21. Are there wastes in my compound which are not completely burnt?
22. Does the facility have standard immunization registration book and properly use it?
23. Does the facility have standard tally sheet and is using for every session, both outreach and static sessions?
24. Are defaulters of this month tracked? # of defaulters identified_____ # of defaulters tracked_____________

25. Are all action points for previous month self-assessment executed as per the action plan?

Score

Summary Yes No Proportion of “Yes” responses (Y*100/(Y+N)


Summary of Major findings of Monthly Self-Assessment

Responsible Implementation
S.No Identified problems Root Cause of the problem Actions points Implementation status
body Timeline

Team members
1. Name _______________________________________________ Signature ___________________________ Date ___________________
2. Name _______________________________________________ Signature ___________________________ Date ___________________
3. Name _______________________________________________ Signature __________________________ Date ___________________
Yebichaye Tadesse
Apr May June

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