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9-1/0025 |
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REPUBLIC
OF NAMIBIA MINISTRY OF HEALTH AND SOCIAL SERVICES |
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Rev. 08/00 |
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Health Information System 2000 (HIS2K) |
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ENVIRONMENTAL HEALTH SERVICES
MONTHLY SUMMARY REPORT FORM |
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Report For Month Of
_____________ Year: _____ Health District:
____________________________ |
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4 = No Environmental Health Services Provided This Month |
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1.Registrations,
Licensing and Control: |
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1.1 Total number of New Licenses, New
Registrations, New Building Plans, |
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New Certificates of
Fitness
...
.... |
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1.1 |
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2. Complaints Received
and Visits (Routine and Case Response Inspections): |
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Number of |
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Number |
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Number |
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Complaints |
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of |
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Unsatis- |
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Received |
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Visits |
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factory |
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2.1
Food Safety/Quality
. |
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2.1 |
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2.2
Occupational Health and Safety
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2.2 |
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2.3
Waste Control and Management
.. |
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2.3 |
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2.4
Air Pollution (indoors and outdoors)
. |
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2.4 |
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2.5
Sanitation
.. |
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2.5 |
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Drinking Water Supply: |
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2.6
Piped
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.. |
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2.6 |
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2.7
Well/Borehole
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2.7 |
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2.8
Surface Water
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. |
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2.8 |
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2.9
Pest Control
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2.9 |
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2.10
Malaria Control
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2.10 |
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2.11
Housing/Dwelling Conditions
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.. |
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2.11 |
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2.12
Communicable Disease Control/Investigations
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2.12 |
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2.13
Other
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..
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2.13 |
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2.14
Health Education/Promotion Visits
...
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2.14 |
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3. Sanitation |
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Number of New Latrines
Constructed At: |
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MoHSS |
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Other |
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3.1 Dwellings
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.. |
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3.1 |
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3.2 Schools
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3.2 |
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3.3 Other
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3.3 |
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3.4 Number of visits to communities using
participatory methods (e.g. PHAST, PRA)
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3.4 |
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4. Food and Drinking
Water Sampling |
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Number |
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Number |
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Unsatis- |
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Food (including
bottled/canned drinks) Samples Taken and Results: |
Taken |
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factory |
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4.1 Bacteriological Analysis
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4.1 |
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4.2 Chemical Analysis
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4.2 |
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Source of Drinking Water
Samples Taken (for Bacteriological |
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analysis) and Results: |
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4.3 Piped Supply
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4.3 |
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4.4
Well/Borehole
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4.4 |
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4.5
Surface Water (river, dam, etc.)
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4.5 |
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4.6
Number of Food Condemnation Certificates Issued
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4.6 |
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5. Port Health |
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5.1
Number of Food Consignmnets Examined/Inspected
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..
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5.1 |
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5.2
Number of Condemnation Certificates Issued
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.. |
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5.2 |
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5.3
Number of Export Certificates Issued
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5.3 |
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