Generated Narrative: Questionnaire MpoxSupervisorChecklist Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints Mpox Supervisor Checklist questionnaire for disease surveillance Questionnaire http://example.org/Questionnaire/MpoxSupervisorChecklist#0.1.0 #xD; 151479012557 Reporting Site 0..1 group #xD; 546255966914 Hospital/Facility Location 0..1 display #xD; user_role User Role 0..1 string #xD; user_facility User Facility 0..1 string #xD; user_ward User Ward 0..1 string #xD; user_sub_county User Sub County 0..1 string #xD; user_county User County 0..1 string #xD; facility_level null 0..1 group Enable When: user_role = VACCINATOR #xD; 294367770999 County 1..1 reference #xD; 819946803642 Sub County 1..1 reference #xD; 819943434 Ward 1..1 reference #xD; 819946803677 Health Facility 1..1 reference #xD; 438862163919 Type of health facility 1..1 choice Options: 3 options #xD; sub_county_level null 0..1 group Enable When: user_role = SUBCOUNTY_DISEASE_SURVEILLANCE_OFFICER #xD; 294367770999_sub_county County 1..1 reference #xD; 819946803642_sub_county Sub County 1..1 reference #xD; 819943434_sub_county Ward 1..1 reference #xD; 819946803677_sub_county Health Facility 1..1 reference #xD; 438862163919_sub_county Type of health facility 1..1 choice Options: 3 options #xD; county_level null 0..1 group Enable When: user_role = COUNTY_DISEASE_SURVEILLANCE_OFFICER #xD; 294367770999_county County 1..1 reference #xD; 819946803642_county Sub County 1..1 reference #xD; 819943434_county Ward 1..1 reference #xD; 819946803677_county Health Facility 1..1 reference #xD; 438862163919_county Type of health facility 1..1 choice Options: 3 options #xD; national_level null 0..1 group Enable When: user_role = ADMINISTRATOR #xD; 294367770999_national County 1..1 reference #xD; 819946803642_national Sub County 1..1 reference #xD; 819943434_national Ward 1..1 reference #xD; 819946803677_national Health Facility 1..1 reference #xD; 438862163919_national Type of health facility 1..1 choice Options: 3 options #xD; site_name Vaccination Site Name 1..1 string #xD; site_type Vaccination Site Type 1..1 choice Options: 3 options #xD; 728034137219 Date 1..1 date #xD; location_widget GPS Coordinate 0..1 group #xD; latitude Latitude 0..1 decimal #xD; longitude Longitude 0..1 decimal #xD; supervisor_name Supervisor Name 1..1 string #xD; supervisor_level Supervisor Level 1..1 choice Options: 4 options #xD; planning Planning 0..1 group #xD; team_movement_plan_available Team Movement Plan Available? 1..1 choice Options: 2 options #xD; rcce_strategy_in_place Risk communication & community engagement (RCCE) strategy in place? 1..1 choice Options: 2 options #xD; healthcare_worker_preparedness Healthcare Worker Preparedness 0..1 group #xD; trained_on_mpox_vaccine_admin Vaccinators trained on Mpox vaccine administration? 1..1 choice Options: 2 options #xD; trained_on_aefi_recognition_reporting Vaccinators trained on AEFI recognition & reporting? 1..1 choice Options: 2 options #xD; trained_on_infection_prevention Vaccinators trained on infection prevention (hard hygiene, waste disposal)? 1..1 choice Options: 2 options #xD; vaccine_supplies_and_cold_chain Vaccine supplies and Cold Chain Management 0..1 group #xD; vaccines_with_valid_vvm Vaccines carrier with foam pad? 1..1 choice Options: 2 options #xD; cold_chain_maintained_temp_logs Cold chain maintained (2–8°C) with temperature logs? 1..1 choice Options: 2 options #xD; sufficient_supplies_available Sufficient AD syringes, safety boxes? 1..1 choice Options: 2 options #xD; emergency_stock_reserved Emergency stock reserved for high-risk areas? 1..1 choice Options: 2 options #xD; backup_generator_or_solar_available Backup generator/solar system available? 1..1 choice Enable When: site_type = Static (static) Options: 2 options #xD; vaccination_site_setup Vaccination Site Setup 0..1 group #xD; site_meets_infection_standards Site meets infection prevention standards (handwashing, distancing)? 1..1 choice Options: 2 options #xD; separate_zones_present Separate zones: Registration, Screening, Vaccination, Observation? 1..1 choice Options: 2 options #xD; privacy_ensured Privacy ensured (e.g., curtains for undressing if intradermal)? 1..1 choice Options: 2 options #xD; emergency_kit_available Emergency kit with adrenaline, 2ml Syringe and needle available? 1..1 choice Options: 2 options #xD; vaccination_process Vaccination Process 0..1 group #xD; correct_site Did the vaccinators administer Mpox vaccine in the correct site as per the guidelines (Observation)? 1..1 choice Options: 2 options #xD; correct_route_used Vaccine administered via correct route? 1..1 choice Options: 2 options #xD; aseptic_technique_followed Aseptic technique (Dry cotton swap, sterile syringe and needle)? 1..1 choice Options: 2 options #xD; reporting Reporting 0..1 group #xD; data_entered_in_nphiis Vaccination data entered in National Public Health Intelligence platform daily (NPHIIS)? 1..1 choice Options: 2 options #xD; any_aefis Was there an AEFI? 1..1 choice Options: 2 options #xD; aefi_reported_immediately AEFIs reported immediately to the team supervisor? 1..1 choice Enable When: any_aefis = Yes (yes) Options: 2 options #xD; data_collection_tools_available Data Collection tools available and adequate? 1..1 choice Options: 2 options #xD; which_tool Which Tool? 1..* choice Enable When: data_collection_tools_available = Yes (yes) Options: 2 options #xD; infection_prevention_and_waste Infection Prevention & Waste Disposal 0..1 group #xD; ppe_used PPE used by all vaccinators (gowns)? 1..1 choice Options: 2 options #xD; sharps_in_safety_boxes Sharps in WHO-approved safety boxes? 1..1 choice Options: 2 options #xD; biomedical_waste_disposed_correctly Is the generated healthcare waste properly segregated? 1..1 choice Options: 2 options #xD; community_engagement Community Engagement 0..1 group #xD; rumors_addressed Rumors addressed via hotline/community leaders? 1..1 choice Options: 2 options #xD; sensitization_materials_local_languages Sensitization materials in local languages (Swahili, vernacular)? 1..1 choice Options: 2 options #xD; post_vaccination Post-Vaccination 0..1 group #xD; observation_after_vaccination Recipients observed for 15+ minutes post-vaccination? 1..1 choice Options: 2 options #xD; aefi_forms_ready Have the AEFI forms been filled at the facility level and cascaded to the sub-county? 1..1 choice Enable When: any_aefis = Yes (yes) Options: 2 options #xD; rumour_tracking Rumor Tracking 0..1 group #xD; mpox_rumor_heard Have you heard any rumors / hesitancy on Mpox vaccine? 1..1 choice Options: 2 options #xD; mpox_rumor_options If yes, select all that apply 1..* choice Enable When: mpox_rumor_heard = yes (yes) Options: 6 options #xD; mpox_rumor_other_specify If other kindly specify 1..1 string Enable When: mpox_rumor_options = other (other) #xD; mpox_rumor_action State what you did with the rumor 1..1 string Enable When: mpox_rumor_heard = yes (yes) #xD; mpox_rumor_source_trusted Did you trust the source of the rumor? 1..1 choice Enable When: mpox_rumor_heard = yes (yes) Options: 2 options #xD; mpox_rumor_investigated Was the rumor investigated? 1..1 choice Enable When: mpox_rumor_heard = yes (yes) Options: 2 options #xD; mpox_rumor_steps_taken Which steps did you take to address the rumor? 1..1 text Enable When: mpox_rumor_heard = yes (yes) #xD; supervisors_final_assessment Supervisor's Final Assessment 0..1 group #xD; any_challenges Were there any challenges? 1..1 choice Options: 2 options #xD; key_challenges Key challenges: 1..1 string Enable When: any_challenges = yes (yes) #xD; corrective_actions_taken Corrective actions taken for gaps. 1..1 string Enable When: key_challenges exists true #xD; recommendations_for_next_phase Recommendations for next phase 1..1 string #xD; Documentation for this format Options Sets Answer options for 438862163919 null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 438862163919_sub_county null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 438862163919_county null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 438862163919_national null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for site_type null#static ("Static") null#temporary_fixed ("Temporary Fixed") null#mobile_sites ("Mobile sites") Answer options for supervisor_level null#National ("National") null#County ("County") null#Sub County ("Sub County") null#Partner ("Partner") Answer options for team_movement_plan_available null#yes ("Yes") null#no ("No") Answer options for rcce_strategy_in_place null#yes ("Yes") null#no ("No") Answer options for trained_on_mpox_vaccine_admin null#yes ("Yes") null#no ("No") Answer options for trained_on_aefi_recognition_reporting null#yes ("Yes") null#no ("No") Answer options for trained_on_infection_prevention null#yes ("Yes") null#no ("No") Answer options for vaccines_with_valid_vvm null#yes ("Yes") null#no ("No") Answer options for cold_chain_maintained_temp_logs null#yes ("Yes") null#no ("No") Answer options for sufficient_supplies_available null#yes ("Yes") null#no ("No") Answer options for emergency_stock_reserved null#yes ("Yes") null#no ("No") Answer options for backup_generator_or_solar_available null#yes ("Yes") null#no ("No") Answer options for site_meets_infection_standards null#yes ("Yes") null#no ("No") Answer options for separate_zones_present null#yes ("Yes") null#no ("No") Answer options for privacy_ensured null#yes ("Yes") null#no ("No") Answer options for emergency_kit_available null#yes ("Yes") null#no ("No") Answer options for correct_site null#yes ("Yes") null#no ("No") Answer options for correct_route_used null#yes ("Yes") null#no ("No") Answer options for aseptic_technique_followed null#yes ("Yes") null#no ("No") Answer options for data_entered_in_nphiis null#yes ("Yes") null#no ("No") Answer options for any_aefis null#yes ("Yes") null#no ("No") Answer options for aefi_reported_immediately null#yes ("Yes") null#no ("No") Answer options for data_collection_tools_available null#yes ("Yes") null#no ("No") Answer options for which_tool null#Tally_Sheet ("Tally Sheet") null#AEFI_form ("AEFI form") Answer options for ppe_used null#yes ("Yes") null#no ("No") Answer options for sharps_in_safety_boxes null#yes ("Yes") null#no ("No") Answer options for biomedical_waste_disposed_correctly null#yes ("Yes") null#no ("No") Answer options for rumors_addressed null#yes ("Yes") null#no ("No") Answer options for sensitization_materials_local_languages null#yes ("Yes") null#no ("No") Answer options for observation_after_vaccination null#yes ("Yes") null#no ("No") Answer options for aefi_forms_ready null#yes ("Yes") null#no ("No") Answer options for mpox_rumor_heard null#yes ("Yes") null#no ("No") Answer options for mpox_rumor_options null#death ("Mpox vaccine can cause death") null#infertility ("Mpox vaccine can cause infertility") null#depopulation ("Mpox vaccine is Bill and Melinda depopulation agenda") null#unsafe ("Mpox vaccine is not safe and can cause serious side effects") null#covid_finish ("Mpox vaccine is a way of finishing the COVID-19 vaccine") null#other ("Other") Answer options for mpox_rumor_source_trusted null#yes ("Yes") null#no ("No") Answer options for mpox_rumor_investigated null#yes ("Yes") null#no ("No") Answer options for any_challenges null#yes ("Yes") null#no ("No")
Mpox Supervisor Checklist questionnaire for disease surveillance
Record all supervisor related activities
Risk communication & community engagement (RCCE) strategy in place?
Vaccinators trained on Mpox vaccine administration?
Vaccinators trained on AEFI recognition & reporting?
Vaccinators trained on infection prevention (hard hygiene, waste disposal)?
Vaccine supplies and Cold Chain Management
Cold chain maintained (2–8°C) with temperature logs?
Emergency stock reserved for high-risk areas?
Backup generator/solar system available?
Site meets infection prevention standards (handwashing, distancing)?
Separate zones: Registration, Screening, Vaccination, Observation?
Privacy ensured (e.g., curtains for undressing if intradermal)?
Emergency kit with adrenaline, 2ml Syringe and needle available?
Did the vaccinators administer Mpox vaccine in the correct site as per the guidelines (Observation)?
Aseptic technique (Dry cotton swap, sterile syringe and needle)?
Vaccination data entered in National Public Health Intelligence platform daily (NPHIIS)?
AEFIs reported immediately to the team supervisor?
Data Collection tools available and adequate?
Is the generated healthcare waste properly segregated?
Rumors addressed via hotline/community leaders?
Sensitization materials in local languages (Swahili, vernacular)?
Recipients observed for 15+ minutes post-vaccination?
Have the AEFI forms been filled at the facility level and cascaded to the sub-county?
Have you heard any rumors / hesitancy on Mpox vaccine?
Mpox vaccine is Bill and Melinda depopulation agenda
Mpox vaccine is not safe and can cause serious side effects
Mpox vaccine is a way of finishing the COVID-19 vaccine
Which steps did you take to address the rumor?