34                              MANUAL OF VACCINATION FOR THE

VACCINATION FORM No. 7.

                                        Statement showing inspections made by the Assistant Superintendent of
                                                                Vaccination of—district for the—week of—
                                                                190 .

Date of
inspection.

Name of village
with tahsíl and
name of mohalla
with town.

Result of Inspection.

Name of
vaccinator.

Conduct and work
of vaccinator.

State of lymph and
instruments.

State of register.

Successful.

Unsuccess-
ful

Absent.

Total.

Total ...

        This statement should be forwarded to the District Superintendent of Vaccination
immediately after the expiry of the week.                                                                               

Date—
                                                                                                                                                        Signature of Assistant Superintendent of

                                                                                                                                                                                                        Vaccination.