- Every Inspector or Vaccinator shall prepare after the end of each month a report on the general result of vaccination operations carried out during the preceding month and shall submit the same through the Superintendent to the Medical Officer of Health of the Local area concerned, together with a return showing :-(a)Number of males vaccinated during the month.(b)Number of females vaccinated during the month.(c)Results -(i)Number successful.(ii)Number unsuccessful.(iii)Number unsusceptible.(iv)Vaccination index of each village or ward in which vaccination was carried out during the month.Form I(Referred to in Rule 13)Health Department-----------------------------------(Name of district or town).Certificate of successful VaccinationI,-------------------, Inspector of Vaccination and Sanitation or Vaccinator do hereby certify that-------------------------, son/daughter of-------------------, resident of------------------was vaccinated on the-------------------(date) and that after due inspection, I am satisfied that the vaccination has been successful.(Sd.)...........Inspector of Vaccination and Sanitation ---------------- Vaccinator.Date------------------------Circle/Sub-Circle.Form II(Referred to in Rule 13)Health Department-------------------------------(Name of the District or town).Certificate of unfitness for vaccinationI,----------------------, Inspector of Vaccination and Sanitation or Vaccinator, do hereby certify that in my opinion---------------------------(Name of the child), son/daughter of------------------resident of--------------------------is in a state unfit for vaccination and that such unfitness shall continue during the whole/part of the current vaccination season.Date-------------(Signature)Inspector of Vaccination and Sanitation or Vaccinator, of-----------Circle/Sub-Circle,Form III(Referred to in Rule 13)Health Department------------------------------(Name of the District or town).Certificate of insusceptibility of successful vaccinationI,------------------do hereby certify that-------------------son/daughter of-----------------------, resident of-------------------------, has been unsuccessfully vaccinated three times and that in my opinion he/she is unsusceptible to vaccination.Date----------------(Signature)District Medical Officer of Health/ Municipal Medical Officer of Health,Medical Officer of Health, ---------------district/town.
