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  Activity Monitoring Report Form

1.      Report Details

Report date:

  

RD1

Quarter reporting on

From:                                                                         to:

RD2

Name of Project

  

Project Number

  

RD3

Name of the Organisation

   RD4

Name(s) of district (s) in which your project has been implemented

   RD5

Report Compiled by

   RD6

For more information / questions about the report, contact:

Name:

 RD7

Tel number:          

Fax:

Email:

2.      HIV/AIDS Activities

a) Information, Education and Communication (IEC)

RADIO

TV

 PRINTED
#

Hours aired

#

Hours aired

#

types

# printed

# distributed

IEC1

 # new radio / TV programmes              

IEC2

 # IEC materials printed and distributed              

IEC3

#  of peer educators trained

 

IEC4

 # of  people directly reached through peer education   
 
b) Condoms TOTAL

ABC1

# of condoms distributed free to end users

  

ABC2

#  of socially marketed condoms distributed

 
 

c) Youth

In-school Out-of-school TOTAL
Male Female Male Female
ABC3

# of in school and out of school youth reached through life skills education or anti-aids clubs

         
ABC4

# of staff/volunteers trained in life-skills education and managing anti-aids clubs

          
ABC5

# of peer educators trained

          
 
d) Private Sector HIV/AIDS Workplace Male Female TOTAL
PSAW 1 # of Peer educators trained      
PSAW 2 # of  people receiving education on HIV prevention in the workplace      
 
e) High Risk Groups Male Female TOTAL
HRG 1 # of Peer educators trained      
HRG 2 # of people in the high group receiving training in life saving negotiation skills      
     
 

 
     
 
 

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