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.

ANNEXURE-I

ANNEXURE-III

ANNEXURE-III

ANNEXURE-III

ANNEXURE-III

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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

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L - ) i i l l l '

( 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 {

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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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(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

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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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FOI1M P

Rcporl ino Fornrat -IDSP)

l . D . N o .

-..'-...:--..1B l o c k M . /

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2

era.:i::...r/- t/'

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

!i*r" Iu

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

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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

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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

^

4W

. , . A h Yft\,,'."$r,,nl,u1ty ,( ,qN* \ \\

.'V' ..^Yt

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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 \*

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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

ANNEXURE-V

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ANNEXURE-V

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ANNEXURE-VI