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Name of Agency/Office:_____________________________
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Date Accomplished: ________________________________
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A. Vaccination Status and Coverage
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Population GroupTotal Number of Eligible Population
(A)		Total Number of Individuals who Received First Dose of COVID19 Vaccine
(B)		Total Number of Individuals who Received Second Dose of COVID19
Vaccine
(C)		Total Number of Individuals who Received Single Dose of COVID19
Vaccine
(D)		Total Number of Fully Vaccinated Individuals
(E = C+D)		Coverage of Fully Vaccinated Individuals
(F = E/A)		Total Number of Individuals who Received 1st Booster Dose
(G)		Coverage of Individuals who Received 1st Booster Dose
(H = G/A)		Total Number of Individuals who Received 2nd Booster Dose
(I)		Coverage of Individuals who Received 2nd Booster Dose
(J = I/A)		Total Number of Remaining Unvaccinated Individuals
(K = A - E)
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Teaching staff
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Non-teaching staff
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Parents of Learners
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5-11 year old Learners
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12 and above year old Learners
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TOTAL
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Prepared by: ________________________
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Date: ______________________________
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Legend:
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A- Total number of individuals eligible for COVID-19 vaccination, aged 5 years old and above
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B - Total number of individuals who received one dose of a two-dose primary series (first dose) of COVID-19 vaccine
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C - Total number of individuals who received two doses of a two-dose primary series (second dose) of COVID-19 vaccine
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D - Total number of individuals who received a single dose COVID-19 vaccine (Janssen, Gamaleya Sputnik Light)
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E - Total number of individuals who received two doses of a two-dose primary series (second dose) and those who received a single dose COVID-19 vaccine
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F - Percentage of individuals who are eligible for COVID-19 vaccination that are fully vaccinated
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G - Total number of individuals who received an additional one dose of COVID - 19 vaccine after completing the two doses of a two-dose primary series (second dose) or receiving a single dose of COVID-19 vaccine
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H - Percentage of individuals who are eligible for COVID-19 vaccination that received an additional dose/booster of COVID-19 vaccine
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I - Total number of individuals who received an additional booster dose of COVID - 19 vaccine after completing their primary dose and an additional dose of COVID-19 vaccine
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J - Coverage of Individuals who Received 2nd Booster Dose
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K- Total number of individuals eligible for COVID-19 vaccination, aged 5 years old and above, that are not yet vaccinated
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