Sample Health Worker Data Collection Form

This is a sample data collection form that is intended to be used to gather data on health employees. Two versions of the same form are included. The printable (Microsoft Word) version can be printed, photocopied and filled out by hand, either by a data collector or by the respondents themselves. The electronic (Microsoft Excel) version is not intended to be printed, but should be filled out on the computer by the data collector; all of the respondents' data are stored in the same spreadsheet for easier importing into other systems. Either version of the form may be modified before use.

The information collected in this form is intended to be shared with the central Ministry of Health, so there will be an accurate picture of all the health workers employed in the country. Please modify this form as needed and customize the questions and selection options (items with checkboxes) to meet your country's needs. Make sure that data collected are consistent across districts, facilities and cadres, and critically consider form design to eliminate confusion and errors. Review all questions to ensure that they match the database structures and complementary data collection formats (such as electronic forms) you will use. Each field should meet a specific goal, such as answering one of the SLG's policy and management questions. If any fields are irrelevant, delete them. This will result in simpler forms that are easier for respondents to complete, which may help ensure compliance.

Sample Health Worker Data Collection Form - Printable Format

Suitable for printing and completing by hand. Microsoft Word

Sample Health Worker Data Collection Form - Electronic Format

Suitable for completing on the computer. Microsoft Excel