Get University Of Washington Form Iv: Health Center Questionnaire

This guide provides clear, step-by-step instructions on completing the University of Washington Form IV: Health Center Questionnaire online. It is designed to assist users in providing accurate information for healthcare facilities involved in vaccine supply logistics.

Follow the steps to successfully complete the questionnaire.

1. Click ‘Get Form’ button to obtain the form and open it in the designated platform.
2. Fill in the interviewee's name, health center name, and their title as well as geographical information such as district and region. Collect necessary identifiers before proceeding.
3. In the health facility general information section, indicate the cold chain functions provided by the health facility. Mark the applicable methods of routine vaccine supply, ensuring only one box is marked for each question as specified.
4. Detail energy sources available to power cold chain equipment, selecting from grid electricity, bottled gas, kerosene, or solar energy. Choose the option that accurately reflects the situation at your facility.
5. Under population data, fill in the total population and demographic details such as the number of children under 12 months and the number of pregnant women. Ensure precise numbers are provided.
6. Input wastage rates for syringes and safety boxes, ensuring percent values are accurate as they will influence reporting.
7. For vaccine data, record the time period for reporting, and fill in vaccine names along with stocks and received doses for the specified months. Accurately calculate annual coverage rates.
8. Complete the human resources section by identifying each health worker involved in vaccine or injection supply logistics. For each worker, list their job title, responsibilities, and frequency of tasks, providing a detailed account of their activities.
9. Proceed to cold chain inventory management and provide detailed information regarding cold storage equipment, capacities, and utilization rates.
10. Complete the transportation section, detailing distances and costs associated with the collection of vaccines and dry goods, including mode of transport used.
11. Lastly, review the completed form for accuracy and completeness. Once finalized, you may choose to save changes, download, print, or share the form as necessary.

Encourage others to complete their forms online for efficiency and accuracy.