Promotor-Supervisor report.xlsx

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P
1	Field Officer Monthly Report
2	Note: This template is modeled after a program with 9 Cascade Groups per Field Officer and 14 CG Volunteers per Cascade Group. The template can be easily adapted to fit your program specifications.
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4	Field Officer Name:				Reporting Period:
5	Field Officer #:				Province/District:										Page 1 of 4
6															Page 1 of 4
7	Summary of Cascade Group Registers (CGVs)
8	Cascade Group Number				1	2	3	4	5	6	7	8	9	TOTAL
9	CGVs Contacted (visited, seen in group)													A	Average Attendance (A/B)=
10	CGVs Registered													B	Average Attendance (A/B)=
11	CG Infant Deaths
12	CG New Pregnancies
13	CG Births
14	Newest Module and Lesson # taught													Newest
15	# CGVs observed with QIVC*
16	Average QIVC Score
17	*Note: each Promoter should conduct a supervision visit for one CGV in each CG every two weeks. If a Field Officer has 8 CGs then this would be 16 CGVs visited each month.
18	Comments: Challenges encountered: Solutions proposed: What support is needed from your supervisor:
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23	Field Officer Name:
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25	Summary of Neighbor Circle Registers (Neighbor Circle Members)														Page 2 of 4
26	Cascade Group #:
27	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
28	NCM Contacted
29	NCM Registered
30	NCM Infant Deaths
31	NCM New Pregnancies
32	NCM Births
33	Newest Mod/Lesson taught															Newest
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35	Cascade Group #:
36	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
37	NCM Contacted
38	NCM Registered
39	NCM Infant Deaths
40	NCM New Pregnancies
41	NCM Births
42	Newest Mod/Lssn taught															Newest
43
44	Cascade Group #:
45	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
46	NCM Contacted
47	NCM Registered
48	NCM Infant Deaths
49	NCM New Pregnancies
50	NCM Births
51	Newest Mod/Lssn taught															Newest
52	Field Officer Name:
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54	Summary of Neighbor Circle Registers (Neighbor Circle Members)														Page 3 of 4
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56	Cascade Group #:
57	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
58	NCM Contacted
59	NCM Registered
60	NCM Infant Deaths
61	NCM New Pregnancies
62	NCM Births
63	Newest Mod/Lssn taught															Newest
64
65	Cascade Group #:
66	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
67	NCM Contacted
68	NCM Registered
69	NCM Infant Deaths
70	NCM New Pregnancies
71	NCM Births
72	Newest Mod/Lssn taught															Newest
73
74	Cascade Group #:
75	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
76	NCM Contacted
77	NCM Registered
78	NCM Infant Deaths
79	NCM New Pregnancies
80	NCM Births
81	Newest Mod/Lssn taught															Newest
82	Field Officer Name:
83
84	Summary of Neighbor Circle Registers (Neighbor Circle Members)														Page 4 of 4
85	Cascade Group #:
86	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
87	NCM Contacted
88	NCM Registered
89	NCM Infant Deaths
90	NCM New Pregnancies
91	NCM Births
92	Newest Mod/Lssn taught															Newest
93
94	Cascade Group #:
95	CGV Letter	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total
96	NCM Contacted
97	NCM Registered
98	NCM Infant Deaths
99	NCM New Pregnancies
100	NCM Births