format asha monthly report

8/12/2019 Format ASHA Monthly Report

1/5

Target

Achievement

Target

Achievement

No.ofnew

ASHAwith

Drugkit

No.ofDrugkitReplished

TargetASHA

No.ofASHAPresentin

ASHADiwas

DistrictTrainerTeam

No.o

fASHA'sTrained

DistrictTrainerTeam

No.o

fASHA'sTrained

Target

Achievement

1

Best performance

award of Rs.1000/-

, Rs.500/- Rs.300/-

Rs.200/- Certificate

to ASHAs as BlockLevel

l No.

Status of Training Module

5,6 & 7

ASHABankA/C

Opened

StatusofIdentyCard

CapacityBuilding/Academicsupport

programmeNoofASHAenrolledinto10th

gradethroughopenSchool

ofIGNOU

ASHA Selection

ASHA

Facilitator

Selection

Drug kit Status ASHA Diwas

Monthly Physical Data Report of ASHA Programm for the Month of

ame of:- BCM/BHMName of :- Block

Phase-I Phase-II


2/5

NoofASHAEnrolle

d

Amounttobepaidfor

enrollment

Amountpaidforenrollm

ent

ASHAAwardedRs.10

00/-

ASHAAwardedRs.5

00/-

1

No.ofDrugKitReplishment

AmountforDurgkit

ReplishmentPaid

No.ofNew

DrugkitsProcured

Paidfornew

drugKit

No.ofSaree

Received

Monthly Financial Data/Report of ASHA Programm for the Month of ________________20

ame of:- BCM/BHM Name of :- Block

Sl

No.

Amount spent under the head of

Capacity Building/Academic

Support programme- no of ASHA

Enrolled into 10th gradehrough

open School or IGNOU

Best performance

ASHAs

Amounttobep

aidforsaree

No.ofASHADiwasOrganized

No.ofASHAPrese

ntinASHADiwas

AmountpaidtoASH

A'sinASHADiwas

AmounttobepaidtoA

SHAinModule5,

6,7

Train

ing


3/5

ASHAAwardedRs.3

00/-

ward to


4/5

Rural Area Urban Area

Janani Evam Bal Surakchha Yojana for Institutional

Dellivery and full Immunization of the new born400 200

* Registration 100 100

* BCG Immunization 300 100

5 to 10 Children 50

11 to 15 Children 100

16 to 20 Children 150

20 to above children 200

3 Providing DOTS under Tuberculosis Control Program250 per

patient

PB Case 300

MB Case 500

Training

D.A. Per Day 100

T.A. Per Day 100

6 ASHA Diwas 86

7 For Motivating for Sterilization 150

8 for Motivationg client for Vasectomy/NSV 200

9 Home visit under HBNC and IMNCI (After 6 visits) 250

10 National Blindness Control Programme 175

11 Kalazar 100

12 Social Marketing of Sanitary napkins 1 per pack

13 Facilitating monthly meeting with Adolescent at village 50

14

Reporting death of women (15 to 40 years) and

Children (0-1 years) by ASHA to the

Block,PHC,MO/ANM within 24 hours of occurrence of

death

50

No of newly married couple mobilized by asha to

have first child after two year of Marriage

500 per

couple

No of couple mobilized to have birth space of three

years between first and secound child

500 per

couple

No. of couples mobilized for vasectomy/tubectomy

after having two child

1000 per

couple

15

Sl

No.Program & Related Work

4

5

Mobilizing all the children of the village for Immunization (Under Muskan Ek Abhiyan) to be given to

For indentitying Patient of Leprosy and accompanying him/her to PHC

Incentive Details of ASHA Programe for the Month of ... 2Name of BCM/BHM:- BLOCK:- Date of Submissio

2

By CashBy

Whom

1

Incentives in Rs./- By

Cheque

Adarsh Dampati Yojana


5/5

Under RNTCP

Pruposed Under

HBNC( Part of

Child Health)Under NBCP

Under RNTCP

Undera ARSH

Programme

Under MDR

(Meternal Death

Review)

Under FP

Programme

SHA

Under National

Leprosy

Eradication

Programme

13:-

Under Universal

Immunization

Programme

Remarks

Under ASHA

Programme

Under Family

Planning &

Adarsh Dampati

Yojana

under JBSY

Programme

format asha monthly report

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