FEVER SURVEILLANCE REPORT (Body Temperature more than 98.6 F or 37 C)
Important Note :- All Nodal Officers ensure that the necessary entries are made in the prescribed format and submit the same latest by 5 PM daily without fail. Even if no cases are found, Nodal Officers are required to enter fields with NIL values in the given format. (Example Emp Name: Nil Mobile no:0)
Employee Details:
1. DATE *
MM
/
DD
/
YYYY
2 . Name of the Factory / Establishment with Address *
2 (A)NODAL OFFICER NAME (NIL NOT ALLOWED) *
2 (B) NODAL OFFICER MOBILE NO *
2 (C) SELECT INDUSTRY LOCATED TALUK NAME *
3. EMPLOYEE NAME (NAME IN CAPITAL & INITIAL AT THE END ) *
4. FATHER NAME (NAME IN CAPITAL & INITIAL AT THE END ) *
5. Age *
6. Gender *
7. Permanent Address (DOOR NO & STREET NAME) *
7 (A) VILLAGE NAME *
7(B) SELECT TALUK NAME (EMPLOYEE ADDRESS) *
7(C) PINCODE *
8. Mobile Number *
9. "Body Temperature (More than Normal Temperature of 98.6 F or 37 C)" *
10. Is there any Comorbidities (Diabetes, BP and other disease) ? *
11. Date of occurrence of symptoms
MM
/
DD
/
YYYY
12. Whether refered to Hospital or PHC *
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