Inventory of Vaccinated Population
Inventory of Vaccinated Population
Inventory of Vaccinated Population
REGION:_________________
PROVINCE: ________________
CITY/MUNICIPALITY: __________________
BARANGAY: _________________________
Prepared by Approved by
Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong Barangay
Individuals 18 years
Fully Vaccinated 18 old and above with
Partially Fully Vaccinated years old and Booster Shot?
vaccinated? 12-17 years old? above? (Type 1 if (Type 1 if Yes;
Full Name of Partially or Fully Vaccinated Barangay Inhabitants (Type 1 if Yes ; (Type 1 if Yes ; Yes ; 0 if No; NA if 12-17 Date of Vaccination
No. Aged 12 Y/O and Above Birthday Age 1st Dose 2nd Dose Brand 0 if No) 0 if No) 0 if No) Y/O) (Booster Shot) Brand
1 EX: JUAN DELA CRUZ January 4, 1960 62 June 17, 2021 September 19, 2021 Pfizer 0 0 1 1 January 6, 2021 Pfizer
2 EX: JANE DOE November 11, 1978 43 October 20, 2021 NA Janssen 0 0 1 0 None
3 EX: MARIA SANTOS April 1, 1983 38 May 27, 2021 None Moderna 1 0 0 0 None
4 EX. JUANA DELA CRUZ October 13, 1999 22 April 19, 2021 June 21, 2021 Sinovac 0 0 1 0 None
5 EX. JOHN DOE December 5, 2004 17 October 10, 2021 January 17, 2022 Sputnik V 0 1 0 NA NA
6 EX. MARK SANTOS February 6, 2008 13 November 7, 2021 None Sinopharm 1 0 0 NA NA
7 EX. ISAY REYES August 20, 1955 66 September 25, 2021 NA Janssen 0 0 1 1 January 12, 2021 Janssen
8 EX. ANA REYES May 1, 1954 67 September 25, 2021 NA Janssen 0 0 1 1 January 12, 2021 Janssen
9 EX. ISKO SANTIAGO June 24, 2001 20 August 1, 2021 January 6, 2022 Moderna 0 0 1 0 None
10 EX. MARY SANTIAGO September 29, 1968 53 July 18, 2021 None Pfizer 1 0 0 0 None
TOTAL 3 1 6 3
PROVINCIAL MONTHLY INVENTORY OF VACCINATED POPULATION
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
Barangay
Inhabitants
Aged 12 - 17
No. Barangay Y/O
EX: BRGY A 1,160,000
TOTAL 1,160,000
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
1 Biliran -
2 Eastern Samar -
3 Leyte -
4 Northern Samar -
5 Samar -
6 Southern Leyte -
7 Tacloban City -
8 Ormoc City -
TOTAL -
PULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Almeria
2 Biliran
3 Cabucgayan
4 Caibiran
5 Culaba
6 Kawayan
7 Maripipi
8 Naval
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Arteche
2 Balangiga
3 Balangkayan
4 Borongan
5 Can-Avid
6 Dolores
7 Gen. Macarthur
8 Giporlos
9 Guiuan
10 Hernani
11 Jipapad
12 Lawa-an
13 Llorente
14 Maslog
15 Maydolong
16 Mercedes
17 Oras
18 Quinapondan
19 Salcedo
20 San Julian
21 San Policarpo
22 Sulat
23 Taft
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Abuyog
2 Alang-alang
3 Albuera
4 Babatngon
5 Barugo
6 Bato
7 Baybay
8 Burauen
9 Calubian
10 Capoocan
11 Carigara
12 Dagami
13 Dulag
14 Hilongos
15 Hindang
16 Inopacan
17 Isabel
18 Jaro
19 Javier
20 Julita
21 Kananga
22 La Paz
23 Leyte
24 Mac Arthur
25 Mahaplag
26 Matag-Ob
27 Matalom
28 Mayorga
29 Merida
31 Palo
32 Palompon
33 Pastrana
34 San Isidro
35 San Miguel
36 Sta. Fe
37 Tabango
38 Tabontabon
40 Tanauan
41 Tolosa
42 Tunga
43 Villaba
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Allen
2 Biri
3 Bobon
4 Capul
5 Catarman
6 Catubig
7 Gamay
8 Laoang
9 Lapinig
10 Las Navas
11 Lavezares
12 Lope De Vega
13 Mapanas
14 Mondragon
15 Palapag
16 Pambujan
17 Rosario
18 San Antonio
19 San Isidro
20 San Jose
21 San Roque
22 San Vicente
23 Silvino Lubos
24 Victoria
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Almagro
2 Basey
3 Calbayog
4 Calbiga
5 Catbalogan
6 Daram
7 Gandara
8 Hinabangan
9 Jiabong
10 Marabut
11 Matuguinao
12 Motiong
13 Pagsanghan
14 Paranas
15 Pinabacdao
16 San Jorge
17 San Jose De Buan
18 San Sebastian
19 Sta. Margarita
20 Sta. Rita
21 Sto. Nino
22 Tagapul-an
23 Talalora
24 Tarangnan
25 Villareal
26 Zumarraga
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Anahawan
2 Bontoc
3 Hinunangan
4 Hinundayan
5 Libagon
6 Liloan
7 Limasawa
8 Maasin
9 Macrohon
10 Malitbog
11 Padre Burgos
12 Pintuyan
13 San Francisco
14 San Juan
15 San Ricardo
16 Silago
17 Sogod
18 St. Bernard
19 Tomas Oppus
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Tacloban City
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director
Prepared by:
___________________________
Name and Signature of DILG Provincial Focal Person
Total No. of
City/Municipalit
y Inhabitants
Aged 12 - 17
No. Name of City/Municipality Y/O
EX: CITY A 1,160,000
1 Ormoc City
TOTAL -
OPULATION
Submitted by:
___________________________
Name and Signature of DILG Provincial Director