india-odk.ona.io

Submission Time

start

end

today

1.1 Name of the Division:

1.2 Name of the district

1.3 Name of the block

Is this village flood affected

1.9 Organization of the monitor

1.10 Designation of the monitor:

1.11 Date of the monitoring:

1.14 Sex of the child:

1.15 Date of birth:

1.16 Place of delivery

1.17 Type of delivery

1.18 Weight taken at health facility-

1.19 Weight of the baby at birth

1.20 Name of the Zone

2.1 Type of HBNC visit / contact by ASHA

2.2 Did ASHA wash hand with soap for 40 seconds at your place?