compliances to the query raised during the … · q form (weekly reporting p format -idsp) name of...
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COMPLIANCES TO THE QUERY RAISED DURING THE PRESENTATION FOR EC ON 20TH MARCH, 2017
Query- 1 Documentary proof that West Bengal Mineral Development and Trading Corporation Ltd. will carry out mining and not grant sub-contract to other mining companies. The copy of the advertisement /tender document published by the proponent to invite sub-contract needs to be submitted to the EAC to ascertain the nature of sub-contract.
Compliances West Bengal Mineral Development & Trading Corporation Limited (WBMDTCL) is undertaking stone mining activity at Birbhum district since 1978. Till 2001, WBMDTCL did mining deploying own manpower and did marketing departmentally, stone being a very low value mineral and available in abundant in the market through Private mining and crushing, WBMDTCL could not improve productivity beyond 4,00,000 tons per annum during more than two decades till 2000.
Since 2001, when construction of Golden Quadrilateral came in India, demand of black stone increased manifold but users of blackstone in road project under National Highway Authority wanted to produce their own requirement with high precision of quality and quantity. Since this period, WBMDTCL entered into contractual agreements with end user companies who were interested to do mining by their own and purchase the processed stone for their end use as per their own specifications.
However, during last two decades, when production of blackstone reached as peak as 1 million tons per annum through contractual agreements, WBMDTCL continued to oversee their statutory compliances directly with investment by the end user companies under management control, supervision and direction of mine by WBMDTCL from drilling, blasting and mining operation to each and every work of mine. Requisite labour license has been obtained from the Ministry of Labour & Employment, Govt. of India, under rule 20 of the Contract Labour (Regulation & Abolition) Centre Rules, 1971.
Statutory compliances as required from different government authorities being looked after by WBMDTCL as a lessee during the pendency of the lease period.
It is therefore very much clear that statutory Compliances under Environmental Laws are obligatory to the lessee and WBMDTCL will comply the Acts, Rules and Regulations, bye Laws and Orders there under for Hatgacha-Jethia stone project. Moreover, raising of minerals through Mine Developer and Operator (Contractor) is practiced since long in India both in Coal and other mineral sectors.
However, as desired, the Tender Document for the selection of Contractor is furnished in Annexure-I for your perusal.
Query- 2 Detailed traffic analysis and transportation plan along with number of trucks and their capacity which will be used for transportation is to be submitted.
Compliances The transportation shall be done on the road to the proposed specific site by tippers of 28T capacity. Major traffic in the road near the mines are trucks & tippers of 28T capacity, which would be used in transporting the black stone to the consumer sites. The waste material shall be transported within the ML area whereas the mineral shall be transported through lease road & village road connecting to the NH.
Saleable Blackstone – 8,00,000 MT/annum or 3,810 MT /day (by taking into consideration of 210 work ing days in 8months of a year)
Overburden /Top soil, Waste from crusher & Blacks stone rejects – 8,84,798.4m3 during the 5years or 842.7 m3/day
To transport the mineral and waste, 18 nos. of tippers would be required daily within the lease area (as per the mining plan). In all, the heavy vehicles like 28 MT capacity truck /tippers plying on the road to supply the saleable black stone will be 95 (in case of 300 working days) or 136 (in case of 210 working days), if used ones daily. These are described in Chapter – 3 & 4 of EIA-EMP Report.
The transportation route map is attached as Annexure II. This route which connects the mines to NH -60 is selected in order to avoid habitation area as far as possible. As per the traffic study the 19140 no. of Light & Heavy vehicle per day is likely to reach 19288 after the proposed mining activity.
Query- 3 Copy of approved mine plan is to be submitted for the production capacity of 0.8 MTPA (ROM).
Compliances Copy of the Approved Mining Plan and Approved Progressive Mine Closure Plan is furnished in Annexure-III.
Query- 4 The details of dwelling units in the buffer zone of the mine lease area and the R & R plan if any, needs to be submitted.
Compliances There are no dwelling units within the leasehold area.
Query- 5 Health details of the inhabitants to be analyzed and data to be collected from the PHCs.
Compliances The nearest Public Health Centre is located at Bharkata Village. Data from this Health centre for 15 months (January, 2016 to March, 2017) has been collected and analysed. Major diseases are found to be acute respiratory infection (ARI) problems and diarroheas. ARI’s increased during the winter season. Data collected from Bharkata PHC is furnished in Annexure-IV.
Detailed discussion was done with the Medical Officer of the PHC, Barkata, who is of the view that respiratory problem is mainly due to smoking and inhalation of tobacco.
Query- 6 List of schedule – I wildlife species present in the mine lease area duly authenticated by the DFO needs to be submitted. If there are any schedule I species, then a detailed conservation plan is to be prepared along with budget allocation and submitted to the CWLW. The proof of submission to the CWLW should be submitted to the EAC.
Compliances Flora – Faunal list duly authenticated by DFO, Birbhum is being furnished in Annexure-V of this document. No Schedule- I wildlife found to be present in the mine lease area.
Query- 7 A certificate from the DFO that no forest land is involved in the mine lease area and there are no protected areas within 10km of the mine lease area needs to be submitted.
Compliances The mine lease is devoid of any forest land and the location map of the lease area certified by the DFO in this regard is being furnished in Annexure-V.
Query- 8
A certificate for land diversion for mining should be submitted duly approved from State Land Use Board or the concerned competent authority.
Compliances Government of West Bengal granted 71.20 ha of area to WBMDTCL vide their letter no. 1021/CI/O/MM/42/10/Mines dt. 16.12.2010.
The plot schedule under this grant order is attached along with the Grant Order Copy (enclosed as Annexure-VI). Mining activity will commence after the execution of lease deed between WBMDTCL and Government of West Bengal once Environmental Clearance and other requisite statutory permissions are obtained from different authorities.
Once lease is executed and Statutory clearances are obtained, land procurement will start with the progress of mine following schedule of the approved mining plan.
As per Rule 22 (h) of Mineral Concession Rule, 1960, land needs to be obtained before commencement of mining operation in that area and may be furnished after execution of the lease deed. However, at present in case of Hatgachha-Jethia blackstone project, lease deed is yet to be executed and is only possible when all pre-mining statutory clearances are obtained as per the conditions imposed in the lease grant order.
Since only Grant order is issued by the Government of West Bengal through land availability report of DL & LRO, Birbhum, no further clearances from Government of West Bengal is required at this stage.
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FORM P(Weekly Report ing Fornrat -IDSP)
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Acu te D ta r rhoea l D i scase ( i nc l ud
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ch icken Pox
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V i ra l Hepa t i t i s
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Feve r o f l Jnknov /n Or i g i n (pUO)
Lep tosp | l os i s
Acu tc F lacc rd Pa rJ l ys i s < 1S yea rs o f0og b i t e (An ima l B i t e
Snake b i t c
l e n l c o s i s
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FORN1 P( \Veek ly Repor l in E For rna t - lDSp)
s w r ̂ e p o f l t n q I n s l t t u t i o n I . D . N o .
State Dis tr ict B l o c k
\ _ , , r I t ce r_ tn - \ . 11a ro e Name LlFdEar Y-Iit
61-.1 S i o n a t u r e :
,^;;;---:-:---r u ) r . H c p o n t n g W e e k ;
\?SssPHc''sr4 ol r r | :nJ D!r . f - - R.p". .^q D,*
c J I r ' ' | , - ^ I : r
tgl oE t.!.ikt1Rl .tl -oZlBrlT 2 ou_
N OOisea ses /Syn dron t es N o . o f
lZlJ
: : : : : l \ r : p l d ro ry | | ec r ] on (AX t ) r t n f t uen2a L i ke l l l ness ( c)
n
i
I' t 0
r s ! i i l ! ! r e r l / u o r
r L n r \ J n g L n y a-
L . i r O n ( n e I r J
l , l en ing i t i s
Acu le Encepha l i t i s Syu , t r o
Fever of L,nknolvn onoin a-
1 1
1 2
1 l
1 5
1 7
R a b i e s
) t \
. l.,N
I
v , ! e , , , e v . e e e J e r v P c ! r . r ,
A n r h r : Y
ha ' {assem ia
22
, ! v I w d p r u ' v u a r r u y e t J p e c t r y c l n t c J l d t a q n o s i s \-o lo t H" r , OPf i in "nO
"n\ c t r n n r r t a n i h h r i o l i l ' , h r ' . , , , 1 l ^ ^ . -. . . _ . . , . . _ _ . . _ - , - . . . , _ , - _ " - , , " - . s v , , , L d s c s / o ( } d r n s r o r a h y o t t h e a b o v e d i s e a s e s
Scanncd by CamScanner
ffiFORM P
(Weekly Reporting Format _JDSp)Name of R epor t in g l r rs t i tu t ion
Distr ict
Va/rata fjilC, lli bh urnI D S P R c p o r t i n g W e e k :
Diseases /Syndromcs
ute I icspirarorv lntcct jon rap r i l l i l l l- - , - - - , _ : - . . . J cnzJ L i ke l l i n sss ( l l l )
Acu te D io r r , t oea l O i se l sc l i nc tu l iB rc i l l r r y Oyscn
En te r i c Fevc r
V i ra l Hepa t i t i s
/ o H F / D S S
Per tuss i s
Ch i cken Pox
[ ' l en ing i t i s
Acu le Encepha l i t i s S
Feve r o f Unknown Or jg i n (PUO
Lcp losp j ros i s
Acu le F lacc id P < |5 Years o fDog b i t e (An i rna l I j t e
S nake b i l c
o lhe r S ta te Spec i f i c D i sease
F i l a r i a s i s
u 1y;y]1s y,, a,o _ o s N o ic ciioifEiGlE pi
P.i#lt i "n t r ton 'n b r lo I lun f f io f l ho abovo d leoosc !
Lm,**
Scanncd by Camscanr.rer
N a m e o r ne p oE n-dliJiijir r-6i
tosc ReporrfisTEikl
Diseases /Synd romcs
t!!rc_Ugu".ilrLl
5:l_prtg-;""," g1g"a!,3:lI99=;,,,Entcr ic Fevi
Vr : iHep r r i t l
/ oHF / os-
Lcarosptroid
ecu te Fhcc , r . i< 15 yea rs
o foos r;r" (a;;;id;
Sr rakc b r t e
*S"E *s_=-e.;il,d;as
Fi lar j r ; ;
33-""_Emffis*s##i#:,f.:.;;;.."-.r"";,
9r tro aoiiliEiiE
FORM P(WeektV Report ing Format _ tDSp)
(
fi
O ",nc,^u
-
*W*nu'
Scannecl by CarrScanner
t't ",r
e o r R n i, o.tI;l;;i ii;ii;;
I r r ) r . xcpor t ing Week:
Discases /Syndromes
Acute Res/ Inftuenza L it eliiiis s it r)-
Acurc pia.rtrooJlEiii
En te r i c Fave r
V i ra l Hepa t i t i s
Dengue / DHF /.S-S
Diph the r i a
Perl u s sis
Ch icken pox
M efl in q i t is
Acu le Enc ( ,pha l j l i s SF"uu' or unhn o*nii6lnlFd6
Acute F lacc id < 15 Years o fDog b i te (An imat B i te
Snake b i te
i"r:lh.l ' sr,r"
Arsen icos js
F i ia r ias is
Tha la s sc rn ia
i% clinicat Oiag;;E
O " ' , o n ' o t " n ,
9r tno abote oii iG
FORM P(Weekiy Reporl ing Format _lDSp)
II
-"\\',i''
Scanned by CarnScanner
I Olllvl I '
(Wcr: : l i ly i : i r1 ; , r ' l i t l i l I :cnr . t i t l l i ) : ' l
vARl (ATn l ' l l c
D.llp-**.----- '---
l^.! , {L> ", bDis t r ic t
OR PRAMII' GOSWAMI$I.O VARKATA PTIC
IDSP Report ing Wook:
D iscascs/SYndrolrl cs
c Respiratory Infec(ion (ARl)/ lnllucnza Llko l l lnrlse {lL0
Acutc Oiarfhocit Diseaso ( lncluding acutc gastrocntcri t is)
Bacil lary Dyscntory
DcnguL ' / DHF / DsS
Ch iku qunYa
Acute EncePhalit is SYndrome
Fwer o f LJnknown Or ig i n (PUO)
Leptospirosis
fcrte Fl"ccid Patrlysis < 15 Years of Agg
Dog b i tc (An imal B i te )
nnv o ther S ta te Spcc i f i c D iscrsc (Spec i fy )
G isFt syno-n t " t NoT capturcd Abovo {spcr i l y u l ln lca l d iagnos is )
ro tJ H. * opo o i l "ndanco (Not to bc f i cd up whcn da la co l loc tod fo r lndoor cases)
; ; i " " t "ka" in b r l " f i f unusua l Inc rccso no t lccd In < ,oscs /dcn ths lo r o t ry o l t l r c abovo d iscases
S igna tu rc o f M .O
S'N(r l.
Scanr.red by CamScanner
{d{:'t'
FORM P(Weekly Reporting Forrnat _lDSp)
t'r ".o oi REpffii?GiiililE
lose Report ing W;k-
D is eas es /Syn d ro rnes
P neu r l ] on ia
Acute D iar ,hoca l D ise i i acu te gas t roenter i t i sBac i l la ry
Enter ic Fevcr
V i ra l Hep3 t i t i s
D e n g u e / D H F / D S S
C h i k u n g u n y a
M e a s l e s
Diph the r i a
Penuss is
Cl r i cke i l Po ,<
1 , , 1Jh len i r l g i r i s
Ac u te Encepha l i t j s S
Feve r o f Unknown
Lepto sp i ro s is
Acr , rc F t rcc rd p , t13 lys is < 15 ye i io r
Doc i b i t e {A ,n in ra l B i t e
Any o thcr Srare Spec i t i c O jsease 6pec i fg
F i l a r i as i s
T h a l a s s e m i a
UnusL r r t Synd romes NOT Cap t ! r ed Above c l i n i ca l r J i cgnos i s
O", ,on , r * "n ,n Or ,o t , t unuru" ' t
.|
rl
" Aa\ i \ \
V",'p r1,ott,
- :-
Scanncd by Canscanner-
FES
WFORM P
(Weekly Report ing Format -IDSP)
l- t
I
lII
I
I-)
*#".'*ii
Narne o f Repor t inq Ins t i tu t io n U,,NZKnl-a t'' t4- L ! D . N o .
Sta te Dist r ic t B l o c k M k "t,.e4
Off icer - in -Charqe Name MBdic€l (,flleer Sionatu r& ,c ll"4 | tfarkata PHQ, Errbnull
IDSP Re por t ing Week:ool-tn-f-iYYt o0
Whol ,4les t .N o .
D i seas es /Synd romes No , o t
cascs1 Acule Respiratory lnfect ion (ARl) / lnf luenza Like l l tness (tLl) t:q
2 Pneumon ia t2-3 Acu te D in r r l l oeJ l D i scase ( i nc l ud ing acu te gas t roen te r i t i s )
4 Bac i l l a r y Dysen te ry 35 En le r i c Fevc r
6 V i ra l Hepa t i t i s
7 lv l a lar ia
8 D e n g u e / D H F / O S S
I Ch ikungunya
1 0 ll leasles
11 l 0 i ph lhe r i a
1 2 ] P e n u s s j s13 Ichi"h.. P.,
r J t ^ L U r c c n c c p ' t a r r r s r y r r u r o r n c
16 lFeve r o f UnLnown Or ig i h (PUO)
1Z ILep (osp r ros i s
16 rAcu tc F lacc id Pa ra l ys i s < 15 yea rs o f Ag9
. ^ lDog b j l e (An i rna l B i re )' f f i20 lSnake b i l e
lAny olher State Specif ic Disease (Specify)
an lh ra,(
. . ]A rsc r r i cos i sKa la -aza (
lrffi' l n a r a l s e m t a
lUnusua l Synd romes NeT Cap tu red Above.t z . r .r'r lr*-npn-ll[Illllllii-ll-i.-iiil
c l i n i c a l t s
A c t ; o n ! i t . n i n h . i n l i l ' , ^ , , . , , , r r ; ^
w e|| oara coltected for Indoor casesI cdses/oeatnS ?Or ol tho abovo dlseasos
Scanncd by Camscanncr
FORM P/ \ r ^ ^ ' t h( v v e e K l y K e p o n t n g F o r m a t _ l D S p )
I
Name oI Rep-'tinlTliiGilii
tOSe Rcport ing Weetr :
Oiseas es /Syn d romes
Inlccr;on {ARt) / Influcn:" Lik"l i l i i i l
n.uro pir,, r,oo"r pi.n"JTEilli;liGGiiiiiGiGBac l l r ry Dyse ru ryEn te r i c Fevc r
D c r g u c / D H F i D S S
lvl c:r s lc s
Per luss i s
Acu tc Encepha l i t i s Synd rome
Fever o f Uoknown Or ig in (PUO)
Lep tosp i ros i s
Acu te F lacc id Pa ra l ys i s < 15 Yea rs o t Ag !Dog b i r c (An ima l B j t e
R a b i e s
S nake b i t c
o lhe r S ta te Spec i f i c D i sease
T lp lusscn r i o
Unusua l Syndromes NOT Capturod Above
Totatl iey/ OPD attcndance {Not to be {i lted up wtren data c-tt-iGol6iinqoor casesAcr ion taken In b r lo f i f unusuo l inc reaso no t lced In case s /d e a1h s -o i i i y o f tho abovo d isoases
Scanncd by CarnScanner'
FORM P
(Weekly Reporl ing Format -IDSP)
Name of Report ing In s t i tu t ion ' ,ar l (a*a P. *, ( l . D . N o .
State Distr ict Block M . ;,t 15 a,, D ttA !r -r\'\:,-cl
of f icer- in-Chatae Name [r.dl^al f:\a[^-- Sionature\ \ 'ri![u'-,;1t !
M , O i \Arkah Ptici EJirbtun ,9HirP''IDSP Report ing Week: Strn Or le
c,D-ftlr f r.'Y
End Orto\tAl r Report i , rg Drto
OD
l , l 4 l t 0 l A | t6 z o l o l e o t 6 3 I L ] DIROIA
s l .D iseas eb /Syn drornes
No. o f
cases
'l Acutc Resp i r r to ry ln fec t io , ) (ARl ) / l I l t i ucnza L ike l l l ness ( lL l )
2 Pneumon ia
3 Acute D iar rhoea l D isease ( inc lud ing acu te gas t roenter i l i s )
4 Brc i l la ry Dysentery
5 En te r i c Feve r
6 Y i r a l H e P J t i t i s
7 t la la r ia
D c n g u e / O H F / D S S
9 Ch i kung unya
1 0 l v l eas les
11 Diph the r i a
1 2 Per lu ss is
1 3 Chicken Pox'14 l i ,4eningi l is
1'5 Acute Encep l ra l i t i s Syndrome
1 6 Fcver o f Unknown or ig in (PUo)
1 7 eptosprrosrs
\cute Flaccid Paraiysis < 15 Years ofAg!
Dog b l te (An imal B i te )
Rab ies
20 Snake b i l e
21
Any olher Stale Specific Disease (Specify)
An th rax
Kala-azar
22sis)
for indoor ci
r any o t tho a
rses) 7l C t J ()n rJXen In Df lc t I t unusua l inc rcaso no t iced In cases /dca f t rs fc
Scanncd by CamScanner
, ' . ' l ' l ' / r | '
( \Nec: | .1 , / l , . . ! l ) ' ) 1 t . tg i : ( , i ' t ) t r l ! . t , l ' 1
N.:!.Ic-o!Bqlo,l1i| ct_!!S_titr_4 io n _.VN RKATA ' ,HC
I
I
Dist r ic tM?d'rcatOflfu
\Arksta PHC, Blfbfun
takcn in brrcr ir unusurr rocrcasc noliccd rn ( o."rr,r..uiiirfii7rrr-llJi-lilil"J
Si0ni lurc ot r, t .O
[I.O VARKATA PII C
I D S P R c p o r t i n g W c c k :
eascs /Syndrorncs
Ac!1c Resp i ra to ry In fcc t ion (ARl ) / ln t lucnza L ike l l l n r )ss ( lL l )
Pncumon ia
n cL t c D i3 ( l r oca l D i scasc { l c l ud i U acu tc g3 r t r ocn l , : r l t i s )
Bac i l la ry Dyscntc ry
Er l c r i c Fcvc r
! l l cpa t i t i s
D c n r J U c / D H F i D S S
C I r ; k u n g u n y a
Per tuss is
Ch ickcn Pox
fi len ingit i5
Ac ! t e Encepha l i t i s Syndaomc
Fcvcr o f Unknown Or ig in (PUO)
Lcp losp i ros is
utc Flaccid Paralysis < 15 Years of 4-q!
Dog b i t e (An ima l B i t e )
Sn i ke b i l e
Any o ther S t ! tc Spec i f i c D iscase (Spec i ty )
Unus,.ral Syndromcs NOT Capturcd n bovc (Spccify , j lgt ,f i .t "".1,Total fJew OPD attondanco (Not to bc ti l tcd up whci.i irt"
""i l .",.,, f91-ll,1"._"*"1
frw
Scanncd by CaniScauncr.
i r r i i l l l '
( \ / r 'ce l i ly i i . . :1 . ; , r , j11q i :o i i i |n l - lD: ,1 ' )
Mfl
VARKATA PHC
Sta tc Dist r ic tl i /est Be/Url Sirbhum
Off ice r - in -Cha roc Nt tne S i cr n a t rr rc*:=+{&7=f{.xr I r'o'
IV,O VARI(ATA PHC oR+FtAt! t:GOSWAMt-. ' . .rrtPHc
g'- '"
IDSP Report ing Wcck: 4t l l f . . t Or lc EDd Oateo I r,ri"l oo o I Mr\
l o + ; l / l 1 6 i / 3 1, i f t t 1 _T-si .No.
D is eascs/Syn dronr es N o . o tcases
l2
,.. ,er! ,)url , drury r ' r . ,cuon (AKIJ / to uenza L (e l l ln.ess ( lLl)Po c unlon ia
^ * , , - : i ^ - - , ; : - - ; - - r , -
-1-1,
3 . 1 e e ! w v r q r I r r v v d r u r s u i r S e
8 : . i l h ^ , n r , . . ^ r ^ ^ ,
( r o c l uo l o g acute gastroenllrlt js)t44
5 Enlcric Fcvcr
V i ra l Hcpo t i t i s
lll i ln ria
D e n g u e / D l t F / D S S
lh i k r rnqunya
c6
7
I
9
1 0 r'l eas le s
) i ph lhc : i 1
)e rtuss is
;hickco Pox
1a" r, i l i
1 J
1 4 l ^
1 5 l Acute Encr'phalit is Syndrome
1 6 J Feve. of Unknown origin tpUO)17 l L ' ptospirosis
1j_.lncute Flrccid paratysis < 15 ycrfs ot Aqe
. ̂ lDog b i rc {An imat B i te l| J | ; - : - - _
1 X 3 0 t e s
20 Sn, rke b i tc
Arry ottrcr st3rc Spe"tfic OiseasuGplcdAn th r i x
h-h : - - - = = -ru
- _ - -+l,ul!y"j,o,!: Nor c"prr.,t nGGGpil" p I
22 l o l aJ Ncw OPD a*cndJn r " t f . f o f t o f r . f i f f oO ,o , f , " r f f i
Aclion takcn tn bricl if un,i i i i l l l l l-- **ffi 34q
Qs..fd
'W15p'ir6Signaturo ot tu1,O
Scanned by Carnscanner
l{r 01-a.:4lj,4 poIl![ql!-s|i-!r!1]?L-vt'RK/'TA PHC-- MdralOtraj
\hrkrbPHC, BltfirrmSta te Dist r ic tetft,itN.n
N a m e S'(l n alu[c;:p a l l.^l t1
I ,1,O VARKATA PHC Y-DE@3&ekX- 1
IDSP Report ing Weck: qt .|,rt Oato En.l Oaraa
' , I t l )
- - ? T t t lrt I a!t.(. ) u l 2 c 1 . L
nf l'
J oiscur"rrsln,l..omos
No. o f
1 lAcute Rcapirotory Inlect ion (ARJ),/ Int luenza Like l l lness ( lLl) I ttTP^rn."",,3 lAcu le O ia r rhoca t O i seasc ( i nc l ud ing acu te gasUoen tc r i t i s ) O A
4 lD rc ; l l a r y Dysen le ry
5 En l c r i c Fcve r
6 Yiral Hcpati l is
7 l i a l a t i a
3 D e n g ( l c / D H F / D S S
I Ch i kung u nya
1 0 l . l eas les
' 1 1 0 iph the r i a
?2r l ! ts i i
ch i c l . cn Pa ,
'14 ,leningit is
1 5 Acu tc Enccpha l i t i s Synd rome
Feyet of Unknovn Otigin (PUO)
1 7 Leptospirosis
Acute Flaccid Patalysis < 15YearsolAgg
1 9Dog b i t e (An ima l B i t e )
Rabies
Snake b i t e
Any otior Slale Specitic Disease (Specify)
An th rJ r
l r scn icor is
Ka la .azaa
tlantr- i-"
l na la99c f i iA
rnusu ; r 5yno ron le9 OT Cap tu rcd Above (Spec i f y c l i n i ca ld i t gnas i s )ud i r . e - l / upu a r r cndanc0 ( l l o t l o bc f j l l cd up whcn da ta co l l c c ted f o r I nJoor cases) a (^".,"" \dar:I l In oncr I unusual Incrcase notlccd In ( ases/dcalhs for any of tho abovc diseascs
i t 'r i \ l I I '
( \ . 1 1 . : . : r . i l ' , t , . , , . t , . t g F r i ( i l a i - i " i : ' i ' i
,i',J
kq,fi*Signaturo ot M.O
/
Scanned by Camscanner
\ l n lq q lBgp qr t i r lo Ins t i t t l t i on - - -
F')il{"4 P
(Week ly Repor i i r r i Fo rn ra l - IDSP)
VARKATA PIrc
D is tr ict
- t - . - * -* , - - - - -
Medbsl Officsr
S l ! n r l u r c o l M . O
Scanncci by CamScanncr.
rT.O VARI(ATA PHC
IDSP Rcpo r t ing Wcek:
No. o l
casesD iscases /SYr ld ro lncs
Acu to Resp i ra to r y l n f cc t i on (AR l )/ l n l l uenza L i ke l l i ness ( l L l )
Acu tc D ia r rhoea l O i seasc ( i oc l ud ing acu te gas t roen t ( ) r i t i s )
B acil iary Dyscntery
E f i t c r i c F e v e r
f!1a la flil
Dcnguo / D l lF / 0SS
Ch ickc r r Pox
N4 en ing i t is
Acu te Encepha l i l i s SYnd rome
Feve r o f U known Or ig i n (PUo)
Lcptosp i ros is
Acute Flaccid Paralysis < 15 Years of Aqg
Dog b i t e (An i rna l B i t e )
K 3 D t e S
Any o lhe r S ta t c Spec i f i c D i sease (Spec i f y )
A n t h r i x
A r s e n i c o s i s
Unusua l Synd ro r l cs NOT Cap iu red Abovc (Spec i f y r ! i n i ca l d i agnos i s )
To l r l Ncw OPD a t t end ince (No t t o bc l i l l ed up when da ta co l l ec l ed f o r i ndoo r cascs lAcllon takcn in brie I if unusr.I!1"rga" lgtial! in (,ases/deaths lor a|ly of the above diseascs
VARI(ATA PHC
D is tric t
I \4.O VARKATA PIJC
i6IP Reporting Weck:
oiscases/SYnd rom es
A"rl" R".Fil"ty l,,f*1i".(ARl) / l"f luenza Likc l l ln')ss (lLl)
ta i l t r l ' * r l D l * *c l i r rc lud ing 3cu te gJs t rocn tL ' r i t i t
Bacil lary DYs entery
Entc r ic Fever
D c n g u c / D H F / D S S
Ch iku qunYa
l\'1eas lc s
c l t i chen Pox
utc EncePha l i t i s SYndrome
Fever o f Unknown Ot ig in (PUO)
Lcptospirosis
Acute Flaccld Paralysis < 15 Years ofAgg
DoO b i te (An imal B i te )
Any othcr State Specific Discase (Spccify)
Arsen icos is
KJ la -a la r . . j
Fi la r ias ls
Tha lasser r ) ia
unusunl Syndromos NOT Capturec l Abovo(Spcci fy c t in lca l d lognosls)Tota lNew OPD a t tcndancc (Not to bc f i odup wh0n da ta co t lcc tcd lo f Indoor cascs , l
'u I r rJXcn rn b r ic r I unus uJ I Inc rc rso no l l c0d In ( rasos i dca ths fo r any o f rc abovc d iseascs
(Wce i i lY
i () ii ft'{
F i lP , . l ; i . t i l g-t i;:j lr )
B,4edtcat OttcerWrkaia pHC, Birbhum
I
Ii
Slgnr tu rc o f M.O
Scanned t y Cu-S.u,rn.t
i 'oill '/t ll
(Weekly i '?epoi l i r rg Forrnal - !D:) i ' )
I
Signaturc ol l . , l .O
VARKATA PHC
IVI.O VARKATA PHC
IOSP Report ing Week:
Oiseases/Syndromes
Acutc Rcspiratory lnfection (ARl)/ Influcnza Like l l lni lss (lLl)
Acutc Diarrhoeal Discaso {including acute gastroentcrit is)
Bacil\ary D)sentery
V i . r lHcpat i t i s
Ma laria
Dcngue i DHF , DSS
Meastes
Diphtheria
Meningius
Acu(c E(cepha(i(is Sy(d(o((te
Fever of Unknown origin (PUo)
D flJcdd Paratysis < lSYears Dt I!9
Dog bite tAnimal Bite)
other statc Spccific Diseasc (Specify)
Unusual Syndromes NOT Captured Abovc (spocify 0lioical diagoosis)
ol.al Ncw OPD attendancc (Not to be l i l led up when data collected tor indoor cases)taken In bricf if unusual incrcasc noticod io cases/deaths lor any of the abovc dascascs
Scanned by CamScanner
$p -
i ( . , r i l l l l '(Wcel l iy t : l3 j r , i ' i i t tg Foin. t , j t . I i ) i . , i )
I
,
QPai*d'- \ q-,\'N
Sl0nrturo of tr4.O '1^' I
d
VARKATA PI-IC
State DistrictU/est Ben93l Birbhunr
O.IJiqqr-in-Charqe N a m c S i o n 3 l r r r G ! :NI"O VARKATA PHC 9BRAqB-GosvfAMl .2al/)
IDSP Report inq Week: f l lllart Dite l lo u r te I Repo. l inq Dr teDo l r , iM I ry f i | o r_ l l o
I l c l I l r l 1 ( ' i ? ( - l / 2 . 1 1 - VLIIEI- u.NO
1
2
3
DiseascslSyndromes
i""t"Ie"iIlgq r"glo,, 1nn[7Gii*-i.iIir,l rrli,ffi
No. o f
ca scs
t iAcutc Diarrhocal Disease
Bacil lary Dysentery
Enter ic Fever
V i ra l Hcpat i t l s
i\4a laria
D e n g u e / D H F / D S S
Chikungunya
{ including acute gastrocnl lr i t is 8,at5
7
B
9' i0 l\4 e aslcs
1 1 O i p h t h c f i i r
1 2 Pcrtussis
Ch i cken Pox1 3
tulen inq itis
Acute Encephali t is Svndromo
1 6 Fever o f Unknown Or io in {p tJOl
1 7 Lep losp i ros is
1B Acute Flaccid Paralvsis < 15 years of Aoe
1 9Doq b i t e (An ima l B i t e )
Rabies
20 Snakc h i t c
21
Any o lhe . S t r t c Spcc ; f i c D i seJse (Socc i f v l
Anth iax
Arse n icos is-̂ ! ta -azar-i 'r Ia rias is-lhJ lcsse ln ia-Jnusuat Syndromcs NOT Cap1ule.; n;;;;;; i ;,;;
22 I " r " t f r . r Op
Act;on tahcn In bricf rt urrusulli^Io,--i-il i*-Te u , , u s ( c o l O r I n d o o r c a S e S ) 4 t 6
. , eu r ' : d (ns l o r a t ) y o f l l l c above d : scascs
Scanned by Camscanncr
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( W t r : l i l y , l i : . 1 . r , r , r r i t r l l i , , r r r t r t l l l ) , i ' )
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Niure-_ _-___DR-PRAMI]_GOSWAMI
S lo r : i t l L l ro ;
IDSP Rcpo r t i ng Wook : l i l . r l l L l {
tLr{, *TwLl
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I f , . , o . f r ! | r t " y , " t , ' , 1 r t , r .' n ^ t t t i t 1 ' , " l ' ^ ^ l ' , , ,
QA I r-l t ( , c l l l ' f ) ( ) ! , ln l I t ' f
No,Dis c iscs /Synd.on lcs
l l t t , o t
I t \ cu lc Rc-sp i r r lo ry l t i r c l lon {ARl ) / l l l u0nr i L lko l l i r r r rss ( lL l ) Itt (l
P n cu oroo i i
3 Acut ! . D i inho€t l D lsc i tsc { lnc lud lng acu lc g rs t roc t } l ' t | l t l s ) ,4-z . tBr . i l h ry 0ysentc ry
5 E n t ! . dc Fcvc r
V i . l l i l L . p j r r i r i s
7 M f, lJ r ir
s Dc.n g uc. / D H F / OSS
s Chi lunguny; r
1 0 Lrle il s la s
1 1 Diph thc . i l
Pa r l uss l s
1 3 Cl r i c [ , cn I ) ox
Mening i t i s
1 5 Acu tc Enceph ! l i t l s Synd romc
1 6 F L ' v c r o l U n k n o w n O r i g i n ( P U O )
1 7 Lep losp i ros is
Acu lc F lJcc id P i rJ lys is < 15 Yeo|5 o f A ! !
1 9D09 b i tc (An imr l B i ro )
Rrb ics
Snrkc b i le
2 1
Any o ther S t3 tc Spcc i f i c D iseaso (Spcc l fy )
An l l l f ax
Arscn icos is
K r l f - f : l r
Fi l l r i r s i s
Th! l rssenr iJ
22
Unusuf , l Syndron)cs NOT Crp turcd Abov0 (Spcc l fy c l ln lc r l d l r0oos le )' t
o l 3 l N r 'w ( J l 'D a l t cnd rnc0 ( f . l o t t o b0 l r l l cd up w l l c i t d3 t t co l l c c tod l o r l i t doo . casq i ) ''>l /tAct ion t l kcn In b r ic I i f unusua l lnc rcaso t lo t l ccd In ( Jscsk lo ! ths fo r a r ry o l l l to a l )avq d l io0sos
4.;' i .) k. f 1
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t*0 i - ' l
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F O [ ? M P
(Wc'el<lY RcJ; ' i r t i r lg Fo rrn ai| l \ a F \
VARKATA PHC
Dis t r i c t
D*RP-A[llJ-6bswAMll,l.o vooxnta pnc
toEFT"Poti ing wunx:
Diseases lSYnd romes
::lu
Bac i l la ry DYsentery
Enter ic Fever
Viral HcPatit is
M a la r i a
D c n g u e / D l - l F / o S S
Ch ikungunYa
Chickeo Pox
IlJte EncePtralitis SY"dlome
iiflf un xnotn origio (PUo)
nrr t " n l " . io p-" rys is < 15 Ycars o l4g 'g
Dog b i te (An imal B i td
Snake b i te
n"v " t r * is t " to
sp"c i l ic Disease (Speci ly)
Fi la r ias is
f - r ' " , *n t SynOrotus NOT Captured Above {spec i fy t l in ica l d iagnos is )
o ta l New OPD a t tendance (Not to be f i l l ed up when da ta co l tec ted fo r indoor cases)
Act ion takco in b f ie t i l unusua l inc rease no t iced in ( :ascs /dca ths fo t a l ry o f the above d iSeascs
S lg ' r r t u r c o l [ l .O
Scanned by CarnScanner'
I ;FOi livl P
(Wue l . l y Repor t i ng Fo t r r r ; i - IDSP)
o f . D . N o .V A R K A T A P H C UJc.r omc-
\ar@ffi1\6i-OtrnrS t a c Dist r ic tWest Bengal Birbhum
Off icer - in -C haroe N a m e S io na r r r r o '
M,O VARKATA PHC DR PRAMI'I' GOSWAIV]I
IDSP Report in g Week:0 I 0 0
pslo_l:L!}_ ' , l s , l 0 l | ) - o / T I l 6 l o l | 2 t t 7 -
s i .No.
Discascs /SyndromesNo. o l
cases
1 n cu t c Rosp i r c to r y l n f cc t i on (AR l ) / I n f l L ren r r L i kc l l l n r l s s ( l L l ) 52 Pncu f lon ia
3 Acu te D ia r rhoca l D i sease ( i nc l ud ing acu t c gas t roen t r r r i t i s )
Bac i l la ry Dysentery 35
6 V i fn l Hepa t i t i s
7 N4a la raa
8 Dengun / DHF , l DSS
I Ch i kungunya
1 0 Meas les
D ;ph th e r i a
1 2 PertLr s s;s
1 3
1 4
Ch icken Pox
Mening l t i s
1 5 Acute Enccphali t is SYndromc
1 6 Fcve r o f Unknown O f i g i n (PUO)
1 7 Leptospirosis
1 8 Acute Flaccid Paralysis < 15 Years of Agg
n^^ h i lo lAn imal B i te )1 9
Rabaes
Snake b i t c
anv d rhe r s ta te Spec i f i c D i sease (Spec i f y )2 0
21
F i la r ia! is
Tha lassemia
r r ^ , , - . , - r e . / ^ , r . ^da . NoT C .nh r .e r l Above I i pec i f y c l i n l ca l d i aqnos is )
22 fu t " f n " r OpO i t t "ndancs (Not to be f i l l ed up when da ta co l l cc led fo r indoor c tses ]
Ac t i on t akon I n b . i c l l f unusua l l nc rease no t i ced i n ( ' ases /dea lhs l o r a l l y o l t ne aoovo o rs t " c i u>
,t | .:,
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ai't* txla S lgn i t u ra o l M .O
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FOI1M P
Rcporl ino Fornrat -IDSP)
l . D . N o .
-..'-...:--..1B l o c k M . /
S la le- t\A;a_-
51y11111urc: 'fiO'a--' vJ {
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2
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i l A c U l r '
l J l j r r r r ' o u j r l u l r o i s o l r l r c r u u r l ' 1 , d ! u r u I r ' ' " ' ' " " ' ' " ' I
L l i r c i l l r r y I ) y 6 c t , t c r y
5
6
Enlcr lc I ovcr
V l r i r l l l c D i r t l t i s
tul;rl:r rla
D c n ( l ! , c / D H F / O S S
7
8
! C l , , l t ' r 1 l u " y l
1 0
1 l O l t ) l r t l r c r l i l
1 ?
1 l C h i c k o n P o r
M 0n i | 9 l t l s
1 5 Acu te , E r t ccp l r l l l t l g Synd ro rno
t 9 (
1 6 Fcvc r o l UnknowD Or lg l n (PLJO)
1 7 Lcp losD l ros l s
1B A c u l c f l . ' c c l d P i r . l l y s l s < 1 5 Y o i t s o f ^ q g
1 9OoU l i i t o (A r r l , nn l B l t o )
I l i r b i c s
2 0 S n i k o b l t o
21
Any o l l r o r S l r t o Spoc l f l c O l scaeo (Spcc l t y )
A r s e n l c o s l 9
K n l ! . a a i r
F l l r r i a s l s
Tha los ' " c rn l t
22
U ! r i r r , r l Synd romo5 NOT C ip tu rod Abovo i spoc l t y c n l c r t d l aono ! l r )
I o r J r f l c v . u | , u o I | onoanco {No t t o bo f l l i 0d uD whon dn tn co l l oc l od t o r I ndoo f c i t sog )O" , ' u , , , "Uon 'n Or , " t I t u , i
*""'''fi),u,\tr'1
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FORM P
(Weekly RePort ing Format -IDSP)
Name of RePo r t ing Inst i tu t ion
I D S P R e p o d i n g W e e k :
D is e a s es / Synd tom e s
Acu te Resp i ra l n fec t i on {AR l ) / I n f l uenza L i ke l l l ness ( l L l )
P n e u m o n i a
f u te D iar rhoeat D isease ( inc lud ing ac ! tc gas t roenter i t i s )
Ba c i l l a r y Dyscn {e ry
E n t e f l c F c v c r
D e n g u e / D H F / D S S
f t r lCasles
D r p h t h e r r a
Per luss rs
Ch i cken Pox
Acu te Encepha l i t i s S
Fevc r o f U r ) known Or ig i n (PUO)
L e p t o 5 p r r o s l s
Acu te F lacc id Pa fa l ys i s < 15 Yea rs o f
b i t e (An i r i a l B i t e )
any o lhe r S ta te
A r se n i co s l s
Tha l r ssem ia
Unusual Syndromes NOT Captured Above {Spcclfy clinical diag!g!l!
To l3 l Nev / OPO a t t endanco (No i t o bs f i l l ed up whcn da ta co l l ec ted f o r I ndoo r casos )
Acl ion tokcn In b r ie t i t unusua l lnc rease no t iced ln cases /deaths lo r any o l tho above d lsoases
' ,"\ \, i
B"'proi'tn-
Scanncd by CarnScanner
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FORM P(Weekly Report jng Format -IDSP)
\., h"\4"{ I ' t t ' i t
\s )''
'q\o)\o- - \ L - L
.."$i":)r \ \ { -
Name of Re por t in q lnst i tu t ion A^ l n - 7\ l . D . N o .
S t ae District I2,t uA-, tw^n^ Btock I,t, A p,62 0\2
ofti ce r - in -Ch aroe Name hiodica lOi i icer S io nat u re:u l . 0 v&ftata Pf iC, BtrbhLrn
ioSP Report ing Week: srrd 9r 'c I - cnd oirs J -."e.nG
o"r"lro I
r.,lM I iYIY I p0 | llll Y]w I Do |l[1 I r..r
I l? -o i l 0 2 | t q - l \ , I o d )FTTtfoZ
N o .D iseas es /Syndrom es l- N"-f
I cases12
ry4u rc u r i r r r noc . ] | u r se3sc ( i nc l ud jnq ncu te gas l roe r-6acL I t s r y Dyscn te ry
En te r i c f evn r
V i ra l Heoa t i r i s
i-
ness { lL,)
1I5
6
7
8 D e n o u a / f l H F / n s s
9-
1 0 Nl c:)s le s
1 ' J Diph t he r i a
1 2 Peduss i s' t 3
Ch icken Pox
[ ' l c . n i n o i t i s
1 5 A c u t e E n c e o h a l i l i s S v n r i r n m o
Fever of Unknown oaiffiLeptosDiros isAcLrte FIJccid Prmtvsis < ts v"... ^ia-
-.. -...........-......-. ----1 7
l 9Dog b i t e (A i r na l B i t e )
Rab 'es
Snake 'b i t e
Anv ( , t nF rS l . l F s ^^ " i r i . f f i
2A
21
Arrthrax---.-_
Arscn i cos i s
Ka l a .aza r
F l l a r i as r s
Tha la s sem ia
I l n U < r I r l q v ^ . 1 . ^ ^ , - .
ses
I
Sclnncd by CarnSr-:anrct'
II
FORM P
(Week ly Repor t jng Format - IDSP)
Name of Report inq In s t i tu t ion Kkat'V,.l", -Al-l-L I , D , N O .
S t a c D istr ict Block
off c c r - i n - C h a r a c N a m e Sio na tu re :
I D S P R e p o r t i n g W e e k : Sta. l DntooD-f',rn-f- Yv/Y
End O.to I Reponinq Oate
oo oo
f l L l o > l w r z ' t r 8 | o t - l t - o t ; r 1 L o l a z - l2ott-
s t .N O
Diseases /SyndromesNo. o f
cases
1 Acu tc Rcsp i ra to r y I n fec t i on (AR l ) / I n f i ucnza L i ke I l l ness ( l L l ) q2-2 Pncun ron ia
3 Acu l c D i r r r l r occ l D i scasc ( i nc l ud i r r g acL r te g r s t rocn t c r i l r s ) t44 Ercil lary Dysentery
5 En te r i c Fcve r
6 V i ra l Hcpa ( i t i s
7 lvl ala r ia
8 Dengu { . : i D l lF / OSS
I Ch ikungunya
1 0 Meas l cs
1 1 Diph the r i o
Pcrtu s s is
1 3 Ch ickcn Pox
l \ l cn ing i t i s
1 5 Acu te Enccp l l a l i t l s SYnd rome
Fcve r o l Unknown Or ig i n (PUO)
1 7 Lcptosp i .os is
1B Acutc Flnccid Paralysis < ' l5 Years ot Ajg
1 9Dog b j t e (An jma l B i t e )
R a b ies
20 Snakl- bit . l
21
Any orhcr S ta te Spec i f i c D iscase (Spec i fy )
Arse n i cos l s
K J l a . a ! a f
Fi la r ies is
T l ra l Jsscm la
Unu !ua l Synd romo5 NOT Cap tu red Abovo (Spoc i f y c l i n i ca l d l agnos l s )
Tota l New OPD ar tondanco {Not to be f i l l ed up when da ta co l lec ted to r indoor casos) -<+qAclion tikan ln brlot It unusual Incroas€ notlced ln casos/d€aths for any of tho abovo disoases
Scauned by CamScanner
FORM P(Weekly Report ing Format _lDSp)
N a m e o fl . D . N o .
Sta te District Ll,,',.2L Block t, r) {. ,.., 0,.t
orricer-in -c n aiEi-_- Nilme lr,\rll.r-rl O Ific{}r Slonature:-. 2.7tru7M O Varkata PllC, Birbl tut nIDSP Rcport ing Week: Sl i rn O.rra E n d O a l o
oo I i'[1 I )1YY ou oo
t_gL 01 | l-t :1 t ,1c2L 1], I;;-t|
" / . t I a2_l t ! -
s t .No.
Diseases /Syndronres N o . o f
cases
P n e L r n r o D j a
e ry l ' | c cuon (AK t ) / t n uc za L i ke l l h l ess ( l L l ) l to2
3::j:=_ylrl,l lo_1il :./ls c a s c ( | | I c I u d I n g a c u t e g a s t r o e n r e r j r i s )
Er to ; ; Fo ! ,Fr
q .
, 94
5
6 V i r a l H p n a t i t i <
7
I D e n o u e / D l l F l n s s
I C h i k u t t o u n v a
1 0 \'l eas le s
e
1 1 l i ph the r i a
)e r t uss i s1 2
Ch icken Pox
lt l"r | | ""
i t l t
Acu t c E r | cepha l i t i s SyDdrome
6 Fever o f Unknown Or ig in (PUO)
1 7
Acute F lacc id Para lvs is < 15 Years Ja i
1 9u u g u 4 c l 4 ' r ' r d r o r r c . l
Ra b ie s
Snake b i t e20
Any o thc r S t r t e Spec i t i c D i sease (Spec i f y )
An l h rax
Ka la -aza r
.- i i r . l"5l ai
I ha lassem ia
]nu:yrl Syn_cljgmes NOT Caprured Above (Specify ctinGai?i rgnosrs ), u ! , r ue t ' ! u r r u u ( ' j u l | eo up wnen da ta co l l ec ted f o r i ndoo r csses ) .r ' t
r u>ec r r u r { i dse nouceq In cases /dea lhs t o r any o f t ho above d i seaseS
. -\eC
$ut"rl-. , ul\(\Af'
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FORM P
(Wcek ly Rcpor t ing Format - IDSP)
Nir tnc of Rcpor t lnct lnst i tu t ion l , \ hA' t k- f , t n l- l . D - N o .
S t i c District /11t ti ftTl v t'1 Btock l-14 c^, lr,"? o f
offlcc r-in-C lr r roc Ni r r r l c s i o n ^ l r r r . ! t - \ / /
{r l r l \ ' '
I D S P R e p o r t i n g W c c k : Str r l D i to
Lnr*T-ifi-f lrtY
E|d orro I Ropdr l lno ontdYr^ Y I Ot.) I ,,n,,
f - i r s a T ̂ , { r l f ^ l - a l ^ a l ^ ' t l , / t n ' / - t l , a / l / 1 . )l . ' i 7 l ( i l l ) l / l - / ' l l ) l ( ' ) 1 . < l ' l - / l ( 1 ' l L a | 2ot,^-----"t-
s l .N o
D is c r s c s/Syn rl ronr e sNo. o f
cascs
Ac \ r l c Resp i r l t o r y l n f cc t l on (AR l ) I I n f l L r cnzn L i ko l l l n css ( l L l ) X.C?
l Acu t c Diarlrcttl Di s0it sc li rcl udi ng a cut0 gasl roentclti s) L
J D.?d JrY Dj,senlcn/
5 tnleic tevel
D ))irr) Dr.prl)l)s7 Mali(iJ
6 D e n g u c I D H F / D S s
9 C h i k u n g u n y J
1 0 M e i l s l e s
t1 D iph t l l c r i a
12 P f r t r i s s i s
1 3 Ch ic ke r r Pox
1 4 ^1e ' g i t i s
1 5 Acu te Encep l r i i i t l s SYnd ron re
16 Fever o f U^known Or ig in (PUO)
1 7 Lep losp i roS lS
1 8 Acu le F l i t cc id Para lys is < 15 Years o l Agq
1 9Dog b r l c (An jma l B i l e )
Rab ies
Snako b i t e
21
Any o the r S ta le Spec i f l c D i sooso (Spcc i l y )
A rs en i co5 i s
Ka l a " i ! J r
Fi la r ia s is
Th ts l osse rn ia
Unusua l Syndror rcs NoT Captured Abovo (Spec i fy c l i r l ca l d lagnos ls )
To t i t Ncw OPD a t t endancg {No t t o bo f i l l od up when da ta co l l oc ted t o r I ndoo r cases }
Act ion laken in b r ic f i l unusua l inc reaso no t lced In cases /dca ths fo r anv o t th€ abovg d isoases
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FORM P
(Wcckly l lcporting Foi'nlat -IDSP)
l . D . N o .
--^-\_/I-_
Oistrlct In>-, J lrl A^'ry,n B l o c k \ r . O r ^ n
n I l i - ^ . - l , r " a : l r ; r r . t oSlona tu rc ;
" -M,. t ) ,7*1l D S P R o l ) o r t i r t g W c c k : . ' ' ' " ' , " ' " , 1 , , , ,
-at-T-ii-T-wvi
-il-ff,iM-f \YrLl I'r' I M l , , I r Y r r
l - -i':-I-----:
t 4 t 0 { wr--!:t_
s t .N O .
-[E]]dfi:c-]-l-Llot l I - l - |
Dis { ! x r i c s /Syn d ro r Dos
N o . o f
t 0 2 -
1T*--7f-
)<
1
2
3
4
Acu tc ' Ros l ) i r i t l o r y I t l l o c l l oo (A l< l l / l r l r l ucnz r L rKu r r r U i r ! L r /
Pnoun ron l J
, r c u t n o i n i ' l ' o u , t D l s c n c o ( l l r c | u d l n 0 J c u t o 0 n s l r o c t ] | c r | t i s )
B rc i l l , r t v Ov r : r i r r l ( r r y
E r i t u r l c f cvo r
[1.1]:1rl :r
D c n o L r c / D l l F / D S S-. ,:,,
i t l o i s l ( ' 5
Dl t r l ' r l , " t "
C l l i c l { r l l ' o x
f , l r n i r r g i ( i s
\
!
;
I
)
---t!
t
I
Y.
X
I\
)
)^
_1.-i_
9
_19_t l
l 2
1 3
l 5 6 l l r l l r l s S v n d r o r n c
F , ! \ , c r o l Unk r l ow l r O t l g i n (PUO). . - 'I . ' I l u S l r l r O S l S
; ; , , , . , r r " . r , , l p j 1 r ; r l v s l s < 15 Yc i r r s o f nqq
1 6
1 7
1 B
l l oa u :1 r (A I r i n r r l B i t o )t ?
20 S n i j h c b i t o
? 1
^ . i i l c f l l so i t so {5ooc l rV ,
An l l t r t I
A f sc ' | l i cos lS
{ r l i -nri : r--,1"
rdt I t
f , r i l J n 5 s c r n l a
L"r;; sv"ar"."t ltol C"plrrpo eu""" (Sp'
.t"i-r,r "*
ocoiG"a"^"" 1N"t to bo fl1,0d up who data co Actod for lndoor cases)
ffiso nollcod ln cascsldcaths tof any of tho above dlsca-sos
!yl
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4W
. , . A h Yft\,,'."$r,,nl,u1ty ,( ,qN* \ \\
.'V' ..^Yt
Scanned by CarnScanner
FOP,IA P(rltl r: r:1,1,1 Rr: p o rli rJl) F o r rnat -lO SP )
Nif rro_ol R-oportll) g !t!!4i9!___V, ^Jtr,._lt*l)!_ t . o . l l o .
o Dlstr ict Elock 1 , , . ' , r : ; 1 , -
QIII ocr:iuQlrarq o l.-^--L, N a m o SLqnalure-
IDSP Rcpor t l n0 Wcck : 1un O a\ t Ena C?, a.r,...z6]i-t , ' ) l t / t ) l / / / / l - . t a ) a/a) | tt, I 4 -
I r , , l r2 , l r - r - i ' ) , : , ) 1 i : !
s t .N o .
D lscascs /Syndromcs t l o , o f
Acutc t l csp i r r lo ry ln fcc t ion {ARl ) i In t lucnzaL iks l t in !es i iL l ) t a h
2 Pncumon i : r
3 Acu l c D ln r rhoca l D i seasa ( l nc l ud lng acu to gag t roen t€ r i t i g ) 2 ? .4 Bac i l la ry Dyscn le ry
5 Entc r ic Fcvcr
6 VI r r l Hc pa t { l l s
7 I "4 i l a r i a
B O c n q u c i D H F / D S S
9 Chikungunya'10 L,l c as les
11 0 i p h l h c r i i
12 Per tuss is' t3 C h i c k e n P o x 2_--
l , 4en ing i t i s
Acute Encepha l l t l s Syn drome
Fcver o l Unknown Or lg ln (PUO)
1 7 Leptosp i ros is
J 8 Acute Ftaccid Paralysis < 15 Years ot l\gg
1 9Dog b i t e {An
jma l B i t e )
Rabies
2 0 Snakc b i t e
1 1
Any o ther S ta te Spec i t i c O isease (Spec i fy )
An th rax
Arsen icos is
Ka la -azaa
F i l a r i as i s
T h a l a s s e m i a
Unu:ur l Syndromes NOT Captured Above (Spec i ty c l in ica l d iagnos is )
T"1"n"* OPD ilondancc lYot lo ba ft edupwhen data collected for in door c-ases)
fi;n t 'rk"" l |.t bAt It unusual Increaso noticed in cases/deaths lor any of tha abovo diseases
- ?t'V't'- ' ,
,
r vrl
t"t:. )
.9 \*
Scrnned by CamScanner'
FORM P(Weekly Report ing Format - lDSp)
Name of Report ing Ini t i t l t r=i i ,
Distr ict Block
IDSP Rc,por t lng Wcek i
No, o f
cascsr.ur" R",pii'rtory rnr"clion iARt) / t]-iliilrriliilllirjjPncu rnon i i r
AcUtc Or . r r r l roco l Drsease ( inc luoGg acute gas t roent ; iG lB cc i l l J ry Dy s cn tery
Entc r ic Fevcr
V i rn l Hcpn t i t i s
D c n q u c / D H F / O S S
C h i k u f g u
C h l c k e n P o x
M e n i n a i t i s
ncu le Encepha l i t i s Syndrome
F e v c r o i U n l n o w n O r i g i n ( p U O )
Lep losp i ros is
Acute F lacc id Para lys is < .15 Years o f
Dog b i le (An imal B i te )
Snake b i t e
Any o ther S ta te Spec i f i c O isease (
The la : se rn ia
U n u s u a l S NOT Captured A-bove lSpe c l ln ica l d iagnos is
,qcrion tak"n,n uricr ir unusuat incieFelr=o-illlZliiIEji Gs tor- o l tho above d iseases
l rcas les
D i f h l h e / r a
P e d u s s i s
Scrrnncd by CanrScanncr