Atoll Name
Island Name
Ciiaic Name |
Clinic Location
Incerriewer Name
QUESTIONNAIRE FOR CLINIC <2Y HOLDER
What is the total number of nealth workers in the clinic serving
area including clinic personnel, tradicional nealers, nidwives,
veterinarians,
dentists, ete.
clinic personnel.
2.
Include clinic kay holder and orher
Who conducts deliveries in the clinic serving area?
(Check as many as
apply below and report the number of individuals of each tyne of health
worker wko conduct deliveries?)
Number of dealth Workers
Whe De Deliveries
{ J
Clinic Personnel
{ ]
_
{ ]
Traditional Midwives
Others (please specify)
For each health worker in the clinic serving area, record the following infornua-
tion.
Start with che clinic kev holder.
LYFORMATION ON CLINIC EY SOLDER
3.
4.
Primary occupation of clinic key holder.
Does this serson work in the clinic?
{ ]
[ ]
3.
Yes
No
Hours ver week spent in clinic work.