sample formYesNoW23Other ReasonsActual Pickup and Results ReportCheebaFacility CancelledNo Dedicated riderMotorbike bike breakdownNo fuel for sample pickABCDCancelled Pickup ReportGHEFW27W26ChikonkomeneChikombolaChikaniW22W25W24static_instance-province-0astatic_instance-province-1bstatic_instance-province-2cstatic_instance-province-3dstatic_instance-district-0aestatic_instance-district-1bfstatic_instance-district-2cgstatic_instance-district-3dhstatic_instance-facility-0echeebastatic_instance-facility-1fchikanistatic_instance-facility-2gchikombolastatic_instance-facility-3hchikonkomenestatic_instance-cancelled_reason-0fcstatic_instance-cancelled_reason-1ndstatic_instance-cancelled_reason-2mbstatic_instance-cancelled_reason-3nfstatic_instance-cancelled_reason-4orstatic_instance-report_type-0cpstatic_instance-report_type-1apstatic_instance-cancelled_pickup-0yesstatic_instance-cancelled_pickup-1nostatic_instance-rider-0aW22static_instance-rider-1bW23static_instance-rider-2cW24static_instance-rider-3dW25static_instance-rider-4dW26static_instance-rider-5dW27abcdEnter the name of the facility you are collecting samplesEnter Reporting DateCheck OK to confirm this is your ID.Enter your Mobile Money account starting from 09.. or 07..Ensure 'Location' is 'ON' on your device!cpapPlease enter the number of pickup schedules for the week!yesnoTake a picture of the Sample Collection LogTake a picture of the Result Return log