Monthly Progress Report

Office of the CMOH (DH & FW Samiti), Cooch Behar

(Programme Management Unit)

Name of the Block / Unit: Month: Year

1. Janani Suraksha Yojna (JSY) (Source.…………………)

Total No. of No. of women received

Total No. of Mother Registered Beneficiaries (Rs) 500/- under JSY for
Under JSY received institutional Delivery
(Rs) 500/-
BPL SC ST Total under JSY BPL SC ST Total
During the
Month
Up to the Month
from April

2. Referral Transport (Source.…………………)

No. of Beneficiaries received Fund utilized

(Rs.)
Rs. 150/- Rs.250/- Rs.350/- Rs.450/- Total
During the Month
Up to the Month
from April

3. Sterilization: (Source.
………………)
[Before submission, Figure should tally with the DEO Report]

No. of Sterilization Fund expenditure Other Total Fund

done utilized of IUD expenditure utilized (Rs.)
Vasectomy Tubectomy (Rs.) (if any) (If any for Sterilization
During the Month
Up to the Month
from April

4. Status of G.P. based Mobile Camps: (Source.………………)

[Before submission, figure should tally with the DEO Report]

Total expenditure
No. of patients
No. of Camp held incurred for mobility
treated
and contingency (Rs)
During the Month
Up to the Month
from April

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 5. Status of GPHQ Sub Centre (Source.…………………)

Received Construction Construction Civil work Remarks for

Name of the Construction Construction Construction
Fund completed completed completed completed
selected Sub not yet completed completed & Expenditure
Financial between between but not but not
Centre started upto 30% functioning
Year 31% - 70% 71% - 99% functional functional

Total

6. Status of Non GPHQ Sub Centre (Source.…………………)

Received Construction Construction Civil work Remarks for

Construction Construction Construction
Name of the Fund completed completed completed completed
not yet completed completed & Expenditure
selected Sub Centre Financial between between but not but not
started upto 30% functioning
Year 31% - 70% 71% - 99% functional functional

Total

This is to certify that information given above is checked properly & tally with FMR.

Signature of Signature of Signature of

BAM BPHN BMOH

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