Format Asha Monthly Report 544o31
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Sl No. Drug kit Status ASHA Diwas Phase-II
Name of :- Block Status of Training Module 5,6 & 7
Achievement
Target
Capacity Building/Academic programme No of ASHA enrolled into 10th grade through open School of IGNOU
Status of Identy Card
ASHA Bank A/C Opened
No.of ASHA's Trained
Phase-I
District Trainer Team
No.of ASHA's Trained
Name of:- BCM/BHM
District Trainer Team
No. of ASHA Present in ASHA Diwas
Target ASHA
No. of Drug kit Replished
ASHA Facilitator Selection
No. of new ASHA with Drug kit
Achievement
ASHA Selection
Target
Achievement
Target
Monthly Physical Data Report of ASHA Programm for the Month of
Best performance award of Rs.1000/, Rs.500/- Rs.300/Rs.200/- Certificate to ASHAs as Block Level
Sl No.
1 ASHA Awarded Rs.500/-
Amount spent under the head of Capacity Building/Academic programme- no of ASHA Enrolled into 10th gradehrough open School or IGNOU ASHA Awarded Rs.1000/-
Amount paid for enrollment
Amount to be paid for enrollment
No of ASHA Enrolled
Name of:- BCM/BHM
Amount to be paid to ASHA in Module 5, 6,7 Training
Amount paid to ASHA's in ASHA Diwas
No. of ASHA Present in ASHA Diwas
No. of ASHA Diwas Organized
Amount to be paid for saree
No. of Saree Received
Paid for new drug Kit
No. of New Drug kits Procured
Amount for Durg kit Replishment Paid
No. of Drug Kit Replishment
Monthly Financial Data/Report of ASHA Programm for the Month of ________________20 Name of :- Block
Best performance award to ASHAs
ASHA Awarded Rs.300/-
ance award to HAs
Incentive Details of ASHA Programe for the Month of …... 2013 Name of BCM/BHM:Sl Program & Related Work No.
1
BLOCK:Date of Submission:By By Incentives in Rs./By Cash Whom Rural Area Urban Area Cheque
Janani Evam Bal Surakchha Yojana for Institutional Dellivery and full Immunization of the new born
400
200
* Registration * BCG Immunization
100 300
100 100
Mobilizing all the children of the village for Immunization (Under Muskan Ek Abhiyan) to be given to ASHA 5 to 10 Children
2 11 to 15 Children 16 to 20 Children 20 to above children
3 Providing DOTS under Tuberculosis Control Program
50 100 150 200 250 per patient
For indentitying Patient of Leprosy and accompanying him/her to PHC
4 PB Case
300
MB Case
500
Training
5 D.A. Per Day
100
T.A. Per Day 6 ASHA Diwas 7 For Motivating for Sterilization
100 86 150
8 for Motivationg client for Vasectomy/NSV
200
9 Home visit under HBNC and IMNCI (After 6 visits)
250
10 National Blindness Control Programme 11 Kalazar 12 Social Marketing of Sanitary napkins
175 100 1 per pack
13 Facilitating monthly meeting with Adolescent at village
50
Reporting death of women (15 to 40 years) and Children (0-1 years) by ASHA to the 14 Block,PHC,MO/ANM within 24 hours of occurrence of death
50
Adarsh Dampati Yojana No of newly married couple mobilized by asha to have first child after two year of Marriage
500 per couple
15 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
.. 2013
mission:Remarks
under JBSY Programme
en to ASHA Under Universal Immunization Programme Under RNT Under National Leprosy Eradication Programme
Under ASHA Programme
Under FP Programme Pruposed Under HBNC( Part of Child Health) Under NB Under RNT Undera ARSH Programme Under MDR (Meternal Death Review)
Under Family Planning & Adarsh Dampati Yojana
Sl No. Drug kit Status ASHA Diwas Phase-II
Name of :- Block Status of Training Module 5,6 & 7
Achievement
Target
Capacity Building/Academic programme No of ASHA enrolled into 10th grade through open School of IGNOU
Status of Identy Card
ASHA Bank A/C Opened
No.of ASHA's Trained
Phase-I
District Trainer Team
No.of ASHA's Trained
Name of:- BCM/BHM
District Trainer Team
No. of ASHA Present in ASHA Diwas
Target ASHA
No. of Drug kit Replished
ASHA Facilitator Selection
No. of new ASHA with Drug kit
Achievement
ASHA Selection
Target
Achievement
Target
Monthly Physical Data Report of ASHA Programm for the Month of
Best performance award of Rs.1000/, Rs.500/- Rs.300/Rs.200/- Certificate to ASHAs as Block Level
Sl No.
1 ASHA Awarded Rs.500/-
Amount spent under the head of Capacity Building/Academic programme- no of ASHA Enrolled into 10th gradehrough open School or IGNOU ASHA Awarded Rs.1000/-
Amount paid for enrollment
Amount to be paid for enrollment
No of ASHA Enrolled
Name of:- BCM/BHM
Amount to be paid to ASHA in Module 5, 6,7 Training
Amount paid to ASHA's in ASHA Diwas
No. of ASHA Present in ASHA Diwas
No. of ASHA Diwas Organized
Amount to be paid for saree
No. of Saree Received
Paid for new drug Kit
No. of New Drug kits Procured
Amount for Durg kit Replishment Paid
No. of Drug Kit Replishment
Monthly Financial Data/Report of ASHA Programm for the Month of ________________20 Name of :- Block
Best performance award to ASHAs
ASHA Awarded Rs.300/-
ance award to HAs
Incentive Details of ASHA Programe for the Month of …... 2013 Name of BCM/BHM:Sl Program & Related Work No.
1
BLOCK:Date of Submission:By By Incentives in Rs./By Cash Whom Rural Area Urban Area Cheque
Janani Evam Bal Surakchha Yojana for Institutional Dellivery and full Immunization of the new born
400
200
* Registration * BCG Immunization
100 300
100 100
Mobilizing all the children of the village for Immunization (Under Muskan Ek Abhiyan) to be given to ASHA 5 to 10 Children
2 11 to 15 Children 16 to 20 Children 20 to above children
3 Providing DOTS under Tuberculosis Control Program
50 100 150 200 250 per patient
For indentitying Patient of Leprosy and accompanying him/her to PHC
4 PB Case
300
MB Case
500
Training
5 D.A. Per Day
100
T.A. Per Day 6 ASHA Diwas 7 For Motivating for Sterilization
100 86 150
8 for Motivationg client for Vasectomy/NSV
200
9 Home visit under HBNC and IMNCI (After 6 visits)
250
10 National Blindness Control Programme 11 Kalazar 12 Social Marketing of Sanitary napkins
175 100 1 per pack
13 Facilitating monthly meeting with Adolescent at village
50
Reporting death of women (15 to 40 years) and Children (0-1 years) by ASHA to the 14 Block,PHC,MO/ANM within 24 hours of occurrence of death
50
Adarsh Dampati Yojana No of newly married couple mobilized by asha to have first child after two year of Marriage
500 per couple
15 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
.. 2013
mission:Remarks
under JBSY Programme
en to ASHA Under Universal Immunization Programme Under RNT Under National Leprosy Eradication Programme
Under ASHA Programme
Under FP Programme Pruposed Under HBNC( Part of Child Health) Under NB Under RNT Undera ARSH Programme Under MDR (Meternal Death Review)
Under Family Planning & Adarsh Dampati Yojana
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