tamil nadu panel survey urban questionnaire : part …€¦ · urban block questionnaire: part a...

1 URBAN BLOCK QUESTIONNAIRE: Part A

TAMIL NADU PANEL SURVEY URBAN QUESTIONNAIRE : Part A efuefuefuefu gpshf; gpshf; gpshf; gpshf; tpdhj;jhs; gFjp tpdhj;jhs; gFjp tpdhj;jhs; gFjp tpdhj;jhs; gFjp A

1.0 IDENTIFICATION (to be filled in office) ,dk; fh,dk; fh,dk; fh,dk; fhzzzzyyyy; (mYtyfj;jpy; epug;gg;gl ntz;oaJ); (mYtyfj;jpy; epug;gg;gl ntz;oaJ); (mYtyfj;jpy; epug;gg;gl ntz;oaJ); (mYtyfj;jpy; epug;gg;gl ntz;oaJ) 1.1 State

khepyk; Tamil Nadu jkpH;ehL 33

1.2 District name and CODE khtl;lk; bgah; kw;Wk; FwpaPL

_____________________________________________

1.3 CD Block name and CODE Rpo gpshf; bgah; kw;Wk; FwpaPL

_____________________________________________

1.4 Taluk/PS name and CODE jhYfh-gpv!; bgah; kw;Wk; FwpaPL

_____________________________________________

1.5 Town Name and Census Code efuk; - khefuj;jpd; bgau; fzf;bfLg;g[ (brd;r!;) FwpaPL

1.6 Ward Number thh;L vz;

1.7 Investigator Unit (IV) No.

I tp a{dpl; (IV) vz;

1.8 UFS Block within IV Unit I tp a{dpl; (IV) f;Fs; a{ v`g; v!; gpshf;

1.9 Sample UFS Block Number (Sl.no) rhk;gps; a{ v`g; v!; gpshf; vz; (thpir vz;)

1.10 Block 6- Digit Pin Code gpshf;fpd; 6 ,yf;f gpd; nfhL

1.11 Approximate area of the block ( to .00)

gpshf;fpd; njhuhakhd gug;gst[

1.12 Type of area surrounding the Block [CODE] gpshf;fpd; Rw;Wg;g[wj;jpy; cs;s gFjpapd; tif

Surrounding area code: residential =1, industrial = 2, commercial / Market Area = 3, Vacant Area = 4, others (specify) = 5 R[w;wpa[s;s gFjpapd; FwpaPL ? FoapUg;g[fs; = 1. bjhHpw;rhiyfs; = 2. th;j;jfR[w;wpa[s;s gFjpapd; FwpaPL ? FoapUg;g[fs; = 1. bjhHpw;rhiyfs; = 2. th;j;jfR[w;wpa[s;s gFjpapd; FwpaPL ? FoapUg;g[fs; = 1. bjhHpw;rhiyfs; = 2. th;j;jfR[w;wpa[s;s gFjpapd; FwpaPL ? FoapUg;g[fs; = 1. bjhHpw;rhiyfs; = 2. th;j;jfk; k; k; k; ---- khh;fl; gFjp = 3. fhypkhh;fl; gFjp = 3. fhypkhh;fl; gFjp = 3. fhypkhh;fl; gFjp = 3. fhypaaaaplk; = 4. plk; = 4. plk; = 4. plk; = 4. kw;wit (Fwpg;gplt[k;) = 5kw;wit (Fwpg;gplt[k;) = 5kw;wit (Fwpg;gplt[k;) = 5kw;wit (Fwpg;gplt[k;) = 5


2.0 LOCATION AND COMMUNICATION - mikmikmikmiktplk;tplk;tplk;tplk; kw;Wk; jfty; bjhlh;g[kw;Wk; jfty; bjhlh;g[kw;Wk; jfty; bjhlh;g[kw;Wk; jfty; bjhlh;g[

S. No

Location (name of the […]) miktplk; (,lj;jpd; bgau;)

Is there a […] Inside the block or outside the block?

[…] gpshf;fpw;Fs; ,Uf;fpd;wjh my;yJ gpshf;fpw;F btspapy; ,Uf;fpd;wjh>

If inside block How many (number) gpshf;fpw;Fs; vdpy; vj;jid (vz;zpf;iffs;)

GPS reading

$p gp v!; fzf;fPL [If more than 1, choose closest to center of block]

(1f;F nky; ,Ug;gpd; gpshf;fpd; ikag;gFjpf;F mUfpy; cs;sij njh;t[ bra;at[k;) ��Next Row mLj;j tupirmLj;j tupirmLj;j tupirmLj;j tupir

If not in block, Name of the nearest […]

gpshf;fpw;Fs; ,y;iy vdpy; . mUfpy; cs;s ,lj;jpd; bgah;

If not in block, distance in km to closest […] gpshf;fpw;Fs; ,y;iy vdpy; mUfhikapy; cs;s ,lj;jpd; J}uk; (Centralblock point)

gpshf;fpd; ikag;gFjpia mstPlhf bfhs;st[k;)

If not in block, usual form of transport used to reach this

[…] (CODE) gpshf;fpy; ,y;iy vdpy; ,e;j ,lj;ij miltjw;F tHf;fkhf gad;gLj;Jk; (nghf;Ftuj;J ) trjp (FwpaPL)(FwpaPL)(FwpaPL)(FwpaPL)

Travel time: 1 way gaz neuk; (tHf;fkhf gad;gLj;Jk; nghf;Ftuj;jpw;F) xU tHpf;F kl;Lk;

Inside block gpshf;fpw;Fs;

outside block gpshf;fpw;F btspapy; ��4

no information / not applicable jfty; ,y;iy - bghUj;j kw;wJ

��4

Hours kzpfs;

Minutes epkpl’;fs;

��Next mLj;j mLj;j mLj;j mLj;j tupirtupirtupirtupir

1. 2. 3. 4. 5. 6. 7. 8.

1. District Headquarters khtl;l jiyikaplk;

2. Tehsil/Taluk HQ jhrpy;-jhYf;fh jiyikaplk;

3. Block Headquarters gpshf; jiyikaplk;

4. National highway njrpa beL";rhiy 01 02 03

N

E

5. State Highway khepy beL”;rhiy 01 02 03

N

E

6. Bus Stop ngUe;J epWj;jk; 01 02 03

N

E

7. Metalled road

fy; nghlg;gl;l (bkl;ly;) rhiy 01 02

8. All weather road midj;J rPnjh&;z epiyfisa[k; jh’;ff;Toa rhiy

01 02

9. Railway Station uapy; epiyak; 01 02 03

N

E


S. No





GPS reading













��4

Hours kzpfs;



1. 2. 3. 4. 5. 6. 7. 8.

10.

Boat Jetty glF epWj;jk;

01 02 03

N

E

11.

Post Office jghy; mYtyfk;

01 02 03

N

E

12.

PCO bghJ bjhiy ngrp

01 02 03

N

E

13.

PDS/Fair Price store /Ration shop

bghJ tpepnahf - epaha tpiy fil-nu&d; fil

01 02 03

N

E

14. Police Station / Police outpost fhty; epiyak; - g[wf;fhty; epiyak; 01 02 03

N

E

15.Community Centre rKjha ikak; 01 02 03

N

E

16.Anganwadi center m’;fd;tho ikak; 01 02 03

17.Primary School Muk;gg; gs;sp 01 02 03


S. No





GPS reading













��4

Hours kzpfs;



1. 2. 3. 4. 5. 6. 7. 8.

18.Primary with upper primary school eLepiy gs;spa[ld; ,ize;j bjhlf;f gs;sp

01 02 03

19.

Primary with upper primary and secondary/ higher secondary school eLepiy - cau;epiy - nky;epiy gs;sp ,ize;j bjhlf;fg;gs;sp

01 02 03

20.Upper primary school (middle school) eLepiy gs;sp 01 02 03

21.

Upper primary with secondary/ higher secondary school cau;epiy - nky; epiy gs;sp ,ize;j eLepiy gs;sp

01 02 03

22.Secondary/ Higher Secondary school cau;epiy - nky; epiy gs;sp 01 02 03

23.College fy;Y}hp 01 02 03

24.Industrial Training Institute bjhHpy; gapw;rp epWtdk; 01 02 03

25.Adult Literacy Class / centre Kjpnahh; fy;tp tFg;g[- ikak; 01 02 03

26.Other Educational facilities kw;w fy;tp trjpfs; 01 02 03

27.Old Age Home Kjpnahu; ,y;yk; 01 02 03


S. No





GPS reading













��4

Hours kzpfs;



1. 2. 3. 4. 5. 6. 7. 8.

28.Government / Municipal Hospital murh’;f - Kdprpgy; kUj;Jtkid 01 02 03

29.Government Dispensary murh’;f kUe;J tH’;Fk; ikak; 01 02 03

30.UHC / UHP / UFWC a[b\r;rp - a[b\r;gp - a[v`g;lgps;a[rp 01 02 03

31.

Community Health Centre (CHC / Rural Hospital / UHC/ PHC rK:f ey ikak; - Cuf kUj;Jtkid -efu eythH;t[ ikak; - Muk;g Rfhjhu ikak;)

01 02 03

32.Sub Centre

Jiz epiyak; 01 02 03

33.Other Public Sector health facility kw;w bghJj;Jiw kUj;Jt trjp 01 02 03

34.NGO or Trust Hospital / Clinic muR rhuh bjhz;L epWtdk; my;yJ mwf;fl;lis kUj;Jtid - f;spdpf;

01 02 03

35.Private Hospital / Nursing Home / Clinic jdpahu; kUj;Jtkid-eu;rp’; n\hk;;- f;spdpf;

01 02 03

36.Private Medical shop / Pharmacy jdpahh; kUe;J fil - kUe;J tH’;Fkplk; 01 02 03


CODE - Mode of Transportation nghf;Ftuj;J tHpKiw Options CODE Options CODE Train uapy; 01 Cycle irf;fps; 08 Bus [Govt. /Private] ngUe;J (muR - jdpahh;) 02 Horse cart Fjpiu tz;o 09 School/Company bus gs;sp - epWtd ngUe;J 03 Bullock cart khl;L tz;o 10 4-wheeler ehd;F rf;fu thfdk; 04 Boat / Waterways glF - ePu; tHp 11 Share auto/auto n&u; Ml;nlh - Ml;nlh 05 Foot eil 12 Two Wheeler ,U rf;fu thfdk; 06 Other Mode (Specify) kw;w tHpfs; (Fwpg;gplt[k;) 13 Cycle rickshaw irf;fps; upf;&h 07

Q.no Questions Options

9. What is the price of petrol per litre In the nearest place of purchase? mUfhikapy; th’;fg;gLk; ,lj;jpy; xU ypl;lu; bgl;nuhy; tpiy vd;d>

Rs/litre xU ypl;lUf;F - U :

10. What is the price of Diesel per liter in the nearest place of purchase? mUfhikapy; th’;fg;gLk; ,lj;jpy; xU ypl;lu; Ory;; tpiy vd;d>

Rs/litre xU ypl;lUf;F - U :

:

11. What is the market price of kerosene per liter n the nearest place of purchase? mUfhikapy; th’;fg;gLk; ,lj;jpy; xU ypl;lu; kz;bzz;;iz tpiy vd;d>

Rs/litre xU ypl;lUf;F - U:

12. Place where kerosene is mostly purchased by people living in this block ,e;j gpshf;fpy; trpf;Fk; kf;fs; bgUk;ghYk; kz;bzz;izia v’;F th’;Ffpwhu;fs;>

Ration Shop / PDS nu&d; fil - bghJ tpepnahf fil 01

Open Market jpwe;jbtsp fil (nu|d; fil my;yhj kw;w ,l’;fspy;) 02

ACCESS TO THE BLOCK gpshf;gpshf;gpshf;gpshf;;if mqFk; tHp;if mqFk; tHp;if mqFk; tHp;if mqFk; tHp Q.no Questions Options Code

13. What is the type of main approach road to the block? gpshf;fpw;F Kf;fpakhf mqFk; rhiyapd; epiyik vd;d>

Kutcha road Kiwaw;w rhiy 01

Gravel road – no tar ruisf;fy;; rhiy ? jhu; ,y;yhky; 02

Stone paved fw; rhiy 03

Concrete rpbkd;l; rhiy 04

Broken tar cile;j jhu; rhiy 05

Tar jhu; rhiy 06

No Road / Foot path rhiy ,y;iy - fhy; tHpj;jlk; 07


PUBLIC SERVICES & INFRASTRUCTURE bghJbghJbghJbghJr;r;r;r; nritfs;nritfs;nritfs;nritfs;.... fl;likg;g[ kw;Wk; nritfisg; bgWk; trjpfs;; ? fl;likg;g[ kw;Wk; nritfisg; bgWk; trjpfs;; ? fl;likg;g[ kw;Wk; nritfisg; bgWk; trjpfs;; ? fl;likg;g[ kw;Wk; nritfisg; bgWk; trjpfs;; ? gpshf;gpshf;gpshf;gpshf; mstpymstpymstpymstpy; Q.no Questions Options CODE

14.

What Months in this Block are Summer months? ,e;j gpshf;fpy; ve;jbje;j khj’;fs; nfhil fhy’;fs;>

January $dtup 01

February gpg;utup 02

March khu;r; 03

April Vg;uy; 04

May nk 05

June $^d; 06

July $^iy 07

August Mf!;l; 08

September brg;lk;gu; 09

October mf;nlhgu; 10

November etk;gu; 11

December ork;gu; 12

DRINKING AND COOKING WATER Fog;gjw;F kw;Wk; rikg;gjw;fhd jz;zPu;Fog;gjw;F kw;Wk; rikg;gjw;fhd jz;zPu;Fog;gjw;F kw;Wk; rikg;gjw;fhd jz;zPu;Fog;gjw;F kw;Wk; rikg;gjw;fhd jz;zPu;

Q.no

Questions nfs;tpfs;

Options gjpy;fs;

Code FwpaPL

RANK nu’;f;

Write Ranks below. COPY RELEVANT CODES

fPnH nu’;f; vz;fis vGjt[k;(bghUj;jkhd FwpaPLfis vLj;J

vGjt[k;) Not summer midj;J

khj’;fs; Mdhy; nfhilf; fhyk;

jtpu

Summer; Months

nfhil khj’;fs;

15.

Rank the three most common sources of water for drinking and cooking

Fog;gjw;Fk; kw;Wk; rikg;gjw;Fk;; jz;zPu;; fpilf;Fk; K:d;W Kf;fpakhd Mjhu’;fis tupirg;gLj;jp brhy;Y’;fs;/

Piped into dwelling FoapUg;g[f;F FHha; K:yk; tpepnahfk; 01

Rank 1 nu’;f;; 1

Piped to yard/plot Kw;wk;-kidf;F FHha; K:yk; tpepnahfk; 02

Rank 2 nu’;f ; 2

Public tap/stand pipe bghJf;FHha; - epiyahd FHha; 03

Rank 3 nu’;f;; 3

Tubewell or borehole FHha; fpzW my;yJ MH;Jis 04

Protected well ghJfhf;fg;gl;l fpzW 05

Unprotected well ghJfhf;fg;glhj fpzW 06

Protected spring ghJfhf;fg;gl;l Cw;W 07

Unprotected spring ghJfhf;fg;glhj Cw;W 08

Rain water kiH ePu; 09

Tanker truck nl’;fu; jz;zPh; yhhp 10

Cart with small tank khl;L tz;oapy; ,izf;fg;gl;l rpwpa

lh’;f; 11

Surface water [river/dam/lake/ ponds/stream/canal/

irrigation channel] epygug;gpy; cs;s ePu; (MW - miz - Vup

- Fsk; - Xil - fhy;tha;; - ePh; ghrd tha;f;fhy;)

12

Bottled water ghl;oypy; milf;fg;gl;l ePu; 13

Other [specify]

kw;wit (Fwpg;gpLf)____________________

14


WATER TESTING: 3. PRIMARY SOURCES OF DRINKING WATER IN THE BLOCK FoFoFoFoePu; gupnrhjiePu; gupnrhjiePu; gupnrhjiePu; gupnrhjid ? d ? d ? d ? 3333//// gpshf;fpgpshf;fpgpshf;fpgpshf;fpy; FoePUf;fhd y; FoePUf;fhd y; FoePUf;fhd y; FoePUf;fhd Kjd;ikKjd;ikKjd;ikKjd;ik Mjhu’;fs;Mjhu’;fs;Mjhu’;fs;Mjhu’;fs; Rank of

drinking water source from Community

Questionnaire rK:f nfs;tpj; jhspypUe;J FoePh; Mjhu’;fspd; nu’;f; tupiria vLf;ft[k;

Type of water source [CODE] FoePu; Mjhu tiffs; (FwpaPL)

GPS

$p gp v!; Collection Time, Date

00:00 dd/mm/yyyy

jz;zPu; vLf;Fk; neuk;.

ehs;; 00:00

ehs;/khjk;/tUlk;

Reading 1 – Time: 00:00 Date: dd/mm/yyyy

mstpLk; neuk; 1

00:00

ehs;/khjk;/tUlk;

01=Color black �next row 02=Black precipitate �next row 03=No color change

Kot[fs; 01= epwk; fUg;ghf khWtJ �mLj;j thpir 02= fUg;ghd tz;ly;fs; gojy; �mLj;j thpir 03 = epwj;jpy; khw;wkpy;iy

If no Color Change after 1st Reading Kjy; mstPl;ow;F gpwF epwj;jpy;; khw;wkpUe;jhy; Reading 2: Time, Date

00:00 dd/mm/yyyy

mstpLk; neuk; 2

00:00 ehs;/khjk;/tUlk;

01= Color change balck 02= Black precipitate 03=No color change

Kot[fs; 01 = epwk; fUg;ghf khWtJ 02= fUg;ghd tz;ly;fs; gojy; 03 = epwj;jpy; khw;wkpy;iy

16. 17. 18. 19. 20. 21. 22.

All months but not

summer

midj;J khj’;fs;

midj;J khj’;fs;

midj;J khj’;fs;

midj;J khj’;fs;

.Mdhy;

.Mdhy;

.Mdhy;

.Mdhy; nfhil

nfhil

nfhil

nfhilf;f; f;f; fhy

fhy

fhy

fhyk;k;k;k;

jtpu

jtpu

jtpu

jtpu

1 N: Time neuk; Time neuk; Time neuk;

E: Date ehs; Date ehs; Date ehs;



3

N: Time neuk; Time neuk; Time neuk;


Summer

nfhil fhyk;

nfhil fhyk;

nfhil fhyk;

nfhil fhyk;





3

N: Time neuk; Time neuk; Time neuk;



WASHING AND BATHING WATER Jitg;gjw;F kw;Wk; Fspg;gjw;F njitg;gLk; jz;zPu;Jitg;gjw;F kw;Wk; Fspg;gjw;F njitg;gLk; jz;zPu;Jitg;gjw;F kw;Wk; Fspg;gjw;F njitg;gLk; jz;zPu;Jitg;gjw;F kw;Wk; Fspg;gjw;F njitg;gLk; jz;zPu;

Q.no

Questions nfs;tpfs;

Options gjpy;fs;

Code FwpaPL

RANK nu’;f;

Write Ranks below. COPY CODES

fPnH nu’;f; vz;fis vGjt[k;

(bghUj;jkhd FwpaPLfis vLj;J

vGjt[k;) Not Summer midj;J khj’;fs; Mdhy; nfhilf; fhyk; jtpu

Summer; Months nfhil khj’;fs;

23.

Rank the (up to three) most common sources of water for washing and bathing for people who live in this block

Jitg;gjw;F kw;Wk; Fspg;gjw;F ,e;j gpshf;fpy; trpf;Fk; kf;fSf;F jz;zPu;; fpilf;Fk; K:d;W Kf;fpakhd Mjhu’;fis tupirg;gLj;jp brhy;Y’;fs;/

Piped into dwelling FoapUg;g[f;F FHha; K:yk; tpepnahfk; 01

Rank 1 nu’;f; 1

Piped to yard/plot Kw;wk;-kidf;F FHha; K:yk; tpepnahfk; 02

Rank 2 nu’;f; 2

Public tap/standpipe bghJf;FHha; - epiyf; FHha; 03

Rank 3 nu’;f; 3

Tubewell or borehole FHha; fpzW my;yJ MH;Jis 04

Protected well ghJfhf;fg;gl;l fpzW 05

Unprotected well ghJfhf;fg;glhj fpzW 06

Protected spring ghJfhf;fg;gl;l Cw;W 07

Unprotected spring ghJfhf;fg;glhj Cw;W 08

Rainwater kiH ePu; 09

Tanker truck nl’;fu; jz;zPh;; yhhp; 10

Cart with small tank khl;L tz;oapy; ,idf;fg;gl;l rpwpa lh’;f; 11

Surface water [river/dam/lake/ ponds/stream/canal/ irrigation channel]

nkw;gug;g[ ePu; (MW - miz - Vup - Fsk; - Xil - fhy;tha; - ePh; ghrd tha;f;fhy;;

12

Bottled water ghl;oypy; milf;fg;gl;l ePu; 13

Other [specify] ______________ kw;wit (Fwpg;gpLf) 14


SANITATION Rfhjhuk;Rfhjhuk;Rfhjhuk;Rfhjhuk; Q.no Questions Options Code RANK nu’;f;

24.

Where do the people who live in this block defecate? (CODE) LIST UP TO THREE PLACES ,e;j gpshf;fpy; trpf;Fk; kf;fs; fhiyf; fld;fis v’;nf Kof;fpwhu;fs;> (FwpaPL) ( K:d;W ,l’;fis Fwpg;gplt[k;)

Individual toilets/latrine jdpg;gl;l fHpg;giwfs;- byl;upd;fs;

01

Rank 1 nu’;f; 1

Rank 2 nu’;f;; 2

Rank 3 nu’;f; 3

Public toilets bghJf; fHpg;gpl’;fs; 02

Open defecation jpwe;j btspfs; (ikjhd’;fs;;;;;

,uapy;nt jz;lthsk.; Mw;w’;fiu nghd;wit)

03

25.

IF CODES 01 OR 02 RANKED ABOVE (IF INDIVIDUAL, COMMUNITY TOILETS) Rank the most common type of latrines used in the block [up to three]

nkny 01 my;yJ 02 nkny 01 my;yJ 02 nkny 01 my;yJ 02 nkny 01 my;yJ 02 Fwpg;gpl;oUFwpg;gpl;oUFwpg;gpl;oUFwpg;gpl;oUe;jhy; e;jhy; e;jhy; e;jhy; ((((jdpg;gl;l. rGf jdpg;gl;l. rGf jdpg;gl;l. rGf jdpg;gl;l. rGf fHpg;gpl’;fs;)fHpg;gpl’;fs;)fHpg;gpl’;fs;)fHpg;gpl’;fs;) gpshf;fpy; bghJthf cgnahfpf;fg;gLk; K:d;W tifahd fHpg;gpl’;fis Fwpf;ft[k;

Flush or pour flush toilet `g;s&; bra;a[k; my;yJ jz;zPh; Cw;wp `g;s&; bra;a[k; fHpg;giw

RANK BELOW – COPYCODES nu’;f; bra;ag;gl;l tw;Wf;fhd FwpaPLfis kl;Lk; fPnH

vLj;J vGjt[k; Flush to piped sewer system

FHha; K:yk; ,izf;fg;gl;Ls;s fHpt[ ePh; mikg;gpw;F `g;s&;

bra;ag;gLtJ

01

Rank 1 nu’;f; 1

Flush to septic tank fHpt[ ePh;j; bjhl;of;F `g;s&;

bra;ag;gLtJ 02

Rank 2 nu’;f; 2

Flush to pit latrine fHpg;giw FHpf;Fs; `g;s&; bra;ag;gLtJ; 03

Rank 3 nu’;f;; 3

Flush to somewhere else ntW v’;fhtJ tpl;LtpLjy; 04

Flush to don’t know where v’;F Cw;wg;gLfpwJ vd;gJ

bjupahJ 05

Pit latrine fHptiw FHp

Ventilated improved pit (VIP)/biogas fhw;nwhl;lk; nkk;gLj;jg;gl;l FHp (tpIgp) - rhz vuptha[ fHptiw

06

Pit latrine with slab K:lg;gl;l fHpt[ePh; FHp 07

Pit latrine without slab/ open pit K:lg;glhj fHpt[ePh; FHp ----jpwe;j FHp 08

Twin pit/ composting toilet ,ul;il FHp ---- cuf; FHp 09

Dry toilet cyh;e;j fHpg;giw 10

Other (specify)_____________ kw;wit (Fwpg;gpLf)

12

ONLY OPEN DEFECATION PRACTICED IN BLOCK

jpwe;j btspfs; (ikjhd’;fs;;;;; ,uapy;nt jz;lthsk;. Mw;w’;fiu nghd;wit) kl;Lnk gpshf;fpy; cgnahfpf;fg;gLfpwJ

13


Q.no Questions Options Codes Skips

26. Number of public toilets in this block ,e;j gpshf;fpy; cs;s bghJf; fHpg;giwfspd; vz;zpf;if

Number vz;zpf;if

IF 00 �� 31

For each public toilet, answer: [f more than 2, select closest to central point in block

xt;bthU bghJ fHptiwf;Fk; gjpyspf;ft[k; (,uz;Lf;F nky; ,Ug;gpd; gpshf;fpd; ikag;gFjpf;F mUfpy; cs;sij njh;t[ bra;at[k;)

Facility 1 trjp 1

Facility 2 trjp 2

27.

� select all that apply: bghUe;Jk; vy;yhtw;iwa[k; njh;e;bjLf;ft[k; /; INVESTIGATOR: ASK KNOWLEDGABLE PERSON/ USER, “DOES PUBLIC TOILET [….]”?

ngl;obaLg;gtu; ? bjupe;jtu;fsplk; - cgnahfpg;gtuplk; nfl;ft[k; “bghJ fHptiwapy; [….];;”trjp cs;sjh>

Have permanent water supply epue;ju jz;zPh; rg;is ,Uf;fpwJ

01 01

Have a bath facility Fspg;gjw;fhd trjp ,Uf;fpwJ

02 02

connected to septic tank or sewerage

fHpt[ ePh; fhy;tha[ld; ,izf;fg;gl;oUf;fpwJ

03 03

28. Is this public toilet maintained? ,e;j bghJ fHptiw guhkupf;fg;gLfpd;wjh>

Yes Mk; 01 01

Not maintained guhkhpf;fg;gLtjpy;iy 02 02

29. Is this public toilet used?

,e;j bghJ fHptiw cgnahfpf;fg;gLfpwjh? Yes Mk; 01 01

No ,y;iy 02 02 30. Who is permitted to use this toilet

[MULTICODING POSSIBLE] ahh; ,e;j fHptiwia cgnahfpf;fyhk;> (gy gjpy;fs; rhj;jpak;)

Men Mz; 01 01 Women bgz; 02 02

SC/ST Mjpjpuhtplu; - gH’;Foapdu; 03 03

SEWAGE AND DRAINAGE fHpt[ ePu; kw;Wk; fHpt[ ePu; kw;Wk; fHpt[ ePu; kw;Wk; fHpt[ ePu; kw;Wk; tofhy;tofhy;tofhy;tofhy; Q.no Questions Options Codes Skips

31. Does the block have an underground sewage system? gpshf;fpy;; xU ghjhs rhf;fil Kiw bray;gLfpwjh>

Yes Mk; 01

No ,y;iy 02

32.

What type of disposal system for liquid waste does the block have? fHpt[ ePiu btspnaw;Wtjw;F gpshf;fpy;; ve;j Kiw filgpof;fg;gLfpwJ>

No Drain fHpt[ePu; tha;f;fhy; ,y;iy 01

Covered Drain K:oa fHpt[ePu; tha;f;fhy; 02

Mostly Covered drains bgUk;ghYk; K:oa fHpt[ePu;

tha;f;fhy; 03

Mostly Open Drain bgUk;ghYk; jpwe;j fHpt[ePu;

tha;f;fhy; 04

Open drains jpwe;j epiy fHpt[ePu; tha;f;fhy; 05

33.

Is the block waterlogged during the monsoon? [i.e., are there pools of standing/stagnant water in the streets] kiHf; fhy’;fspy; gpshf;fpy;; jz;zPu; nj’;Ffpwjh> (mjhtJ bjUf;fspy; M’;fh’;nf Fl;il khjpup jz;zPu; nj’;FtJ)

Yes Mk; 01

No ,y;iy 02

GARBAGE DISPOSAL Fg;igfis mfw;WtJFg;igfis mfw;WtJFg;igfis mfw;WtJFg;igfis mfw;WtJ Q. Questions Options Codes

34.

Where do residents dispose of their garbage? FoapUg;gth;fs; mtu;fs; tPLfspy; nrUk; Fg;igfis v’;nf nghLfpwhu;fs;>

Cans/barrels carried by sanitation worker Rfhjhu CHpau;fs; bfhz;LtUk; Fg;igj; bjhl;ofspy; ---- nguy;fspy;

01 Rank1 nu’;f; 1

Into the river MWfspy; 02

Rank2 nu’;f;; 2

Into the street bjUf;fspy; 03

Rank3 nu’;f;; 3

Into the yards/garden/ Kw;wj;jpy;;-njhl;l’;fspy; 04

Decompose kf;fr; bra;jy; 05 Into pits FHpfspy; 06

Others

kw;wit____________________________ 07


Q. Questions Options Codes

35.

If CODE 1 ranked in 34 above, Who manages the garbage collection?? nkny nfs;tp 34 y; 01?I FwpaPl;oUe;jhy;. ahh; Fg;igfis nrfupf;fpwhh;fs;> (bgUk;ghYk;) SINGLE CODING

xU gjpy; kl;Lk;

Town Panchayat / Municipality / corp efu g”;rhaj;J - efuhl;rp - khefuhl;rp 01

Resident(s) FoapUg;gth;fs; 02

Others [specify]

kw;wtu;fs; (Fwpg;gplt[k;)(Fwpg;gplt[k;)(Fwpg;gplt[k;)(Fwpg;gplt[k;) ________________

03

No arrangement ve;j Vw;ghLk; ,y;;iy 04

36.

If Town Panchayat / Municipality / corporation [CODE 1 above) frequency of collection

efu g”;rhaj;J - efuhl;rp - khefuhl;rp Vw;ghL bra;tjhdhy; (nkny 1 Fwpapl;oUe;jhy;) vj;jid ehisf;bfhU Kiw Fg;igfs; mfw;wg;gLfpwJ

No. of times per month___________

khjj;jpy; vj;jid Kiw

ELECTRICITY kpd;rhuk;kpd;rhuk;kpd;rhuk;kpd;rhuk;

37.

Is electricity/power available in this block, for any purpose?

,e;j gpshf;fpy; . VjhtJ gad;ghl;ow;F kpd;rhuk; - kpd;rf;jp fpilf;fpwjh >

Available fpilf;fpwJ 01

Not Available for any purpose ve;j gad;ghl;ow;Fk; fpilg;gjpy;iy 02 ��. 43

38.

If code 1 in Q37 above, what uses is electricity/power available for (CIRCLE ALL THAT APPLY)

nkny nfs;tp 37 y; 1 vd;why; . ve;j cgnahf’;fSf;F kpd;rhuk; - kpd;rf;jp fpilf;fpwJ> (bghUe;Jk; vy;yhtw;iwa[k; tl;lkplt[k;)

Electricity for domestic use tPl;L cgnahfj;jpw;F kpd;rhuk; 01

Electricity for Streetlights bjU tpsf;fpw;F kpd;rhuk; 02

Electricity for other purposes kw;w fhuz’;fSf;fhf kpd;rhuk; (specify)

(Fwpg;gplt[k;)__________________________

03

39.

Which is the month when you get the most hours per day of electricity? ve;j khjj;jpy; xU ehisf;F mjpfg;goahd neuk; kpd;rhuk; c’;fSf;F fpilf;fpwJ> SINGLE CODING (xU gjpy; kl;Lk;)

January $dtup 01


March khu;r; 03

April Vg;uy; 04

May nk 05

June $^d; 06

July $^iy 07

August Mf!;l; 08



November etk;gu; 11

December ork;gu; 12

40.

How many hours per day do households in the block get electricity for domestic purposes in the best month of the year (coded in Q39 above)

(nkny nfs;tp 39 39 39 39 y; Fwpg;gp;l;l) tUlj;jpd; rpwg;ghd khjj;jpy; tPl;L cgnahfj;jpw;fhd fhuz’;fSf;fhf gpshf;fpy; cs;s tPLfSf;F xU ehisf;F vj;jid kzp neuk; kpd;rhuk; fpilf;fpwJ>

Hrs per day xU ehisf;F vj;jid kzp neuk;

41.

Which is the month when you get the least hours of electricity per day ve;j khjj;jpy; xU ehisf;F Fiwthd neuj;jpw;F kpd;rhuk; fpilf;fpwJ> SINGLE CODING (xU gjpy; kl;Lk;)

January $dtup 01


March khu;r; 03

April Vg;uy; 04

May nk 05

June $^d; 06

July $^iy 07

August Mf!;l; 08



November etk;gu; 11

December ork;gu; 12


42.

How many hours per day do households in the block get electricity for domestic purposes in the worst month of the year (coded in Q41 above)

tUlj;jpd; nkhrkhd khjj;jpy; (nkny nfs;tp 41414141 y; Fwpg;gp;l;l) tPl;L cgnahfj;jpw;fhd fhuz’;fSf;fhf gpshf;fpy; cs;s tPLfSf;F xU ehisf;F vj;jid kzp neuk; kpd;rhuk; fpilf;fpwJ>

Hrs per day xU ehisf;F vj;jid kzp neuk;

LANGUAGE, RELIGION, CASTE, OCCUPATION IN THE BLOCK gpshf;fpygpshf;fpygpshf;fpygpshf;fpy; bkhHp. kjk;. $hjp. ntiy gfp; bkhHp. kjk;. $hjp. ntiy gfp; bkhHp. kjk;. $hjp. ntiy gfp; bkhHp. kjk;. $hjp. ntiy gfpu;t[fs; u;t[fs; u;t[fs; u;t[fs;

Q.no Questions Options Codes

% of Total Households bkhj;j rjtpfpj FoapUg;g[fs;

43.

LANGUAGE SPOKEN IN PRIVATE tPl;oy; ngrg;gLk; bkhHp

MULTICODING POSSIBLE gy gjpy;fs; tuyhk;

Tamil jkpH; 01 English M’;fpyk; 02 Hindi ,e;jp 03 Telugu bjY’;F 04 Kannada fd;dlk; 05 Malayalam kiyahsk; 06 Urdu cUJ 07 Others (specify)_______

kw;wit (Fwpg;gplt[k;) 08

44.

LANGUAGE SPOKEN IN PUBLIC/ OFFICIALLY bghJtpy; - ntiy fhuz’;fSf;fhf ngrg;gLk; bkhHp


Tamil jkpH; 01 English M’;fpyk; 02 Hindi ,e;jp 03 Telugu bjY’;F 04 Kannada fd;dlk; 05 Malayalam kiyahsk; 06 Urdu cUJ 07 Others (specify)_______


45.

RELIGION kjk; (Fwpg;gplt[k;)


Hinduism ,e;J 01 Islam K!;yPk; 02 Christianity fpUj;Jtk; 03 Sikhism rPf;fpak; 04 Jainism b$apd; 05 Buddhism bgsj;jk; 06 Zoroastrianism (Parsi)

ghu;!p 07

Others (specify)_______



CASTE AND SUBCASTES- INFORMATION $hjpfs; kw;Wk; cl;gpupt[fs; gw;wpa jfty;fs; $hjpfs; kw;Wk; cl;gpupt[fs; gw;wpa jfty;fs; $hjpfs; kw;Wk; cl;gpupt[fs; gw;wpa jfty;fs; $hjpfs; kw;Wk; cl;gpupt[fs; gw;wpa jfty;fs;

S.no

LIST ALL JATIS/ CASTES CURRENTLY IN THE BLOCK

jw;rkak; gpshf;fpy; cs;s vy;yh $hjpfisa[[k; gl;oayplt[k;

JATI/ CASTE CODE $hjpapd; FwpaPL vz;

CASTE CATEGORY CODE $hjp gpupt[ FwpaPL

Subcaste (specify)

$hjp cl;gphpt[fs; (Fwpg;gplt[k;) Subcaste CODE $hjp cl;gphpt[ FwpaPL

% of total households

bkhj;j FLk;g’;fspy; vj;jid rjtpfpjk;

46. 47. 48. 49. 50. 51.

1.

2.

3.

4.

5.

6.


S.no

LIST ALL JATIS/ CASTES CURRENTLY IN THE BLOCK

jw;rkak; gpshf;fpy; cs;s vy;yh $hjpfisa[[k; gl;oayplt[k;

JATI/ CASTE CODE $hjpapd; FwpaPL vz;

CASTE CATEGORY CODE $hjp gpupt[ FwpaPL

Subcaste (specify)

$hjp cl;gphpt[fs; (Fwpg;gplt[k;) Subcaste CODE $hjp cl;gphpt[ FwpaPL

% of total households

bkhj;j FLk;g’;fspy; vj;jid rjtpfpjk;

7.

8.

9.

10.

11.

12.


STREET- ROSTER bjUbjUbjUbjUf;fspd;f;fspd;f;fspd;f;fspd; bgah; gl;oay; [bgah; gl;oay; [bgah; gl;oay; [bgah; gl;oay; [ STREET ID

bjU m

ilahs vz;

Street Name

bjU bgau;

No. of households FLk;g’;fspd; vz;zpf;if

Type Road/lane Construed/ path

mikf;fg;gl;l ghij - rhiyapd; tif 01. Kutcha �� 56 Kiwaw;w rhiy

02. Gravel-no tar ruisf;fy; rhiy? jhu; ,y;yhky;

03. Stonepaved fw;rhiy 04. Concrete rpbkd;l; rhiy 05. Broken tar cile;j jhu; 06. Tar jhu; rhiy 07. No road/ footpath rhiy trjp ,y;iy-fhy;

tHp ghij ��56

If CODE 02-06, when was it made?

02? 06 FwpaPL bra;ag;gl;lhy;; vg;bghGJ nghlg;gl;lJ

YYYY

Electrification kpd;rhu trjp Slum

Legal electrification rl;luPjpahd kpd;trjp

Year of electrific. kpd; trjp bra;ag;gl;l tUlk; [YYYY]

Electricityfo:r kpd;rhuk; gad;gLj;JtJ 1= HH use FLk;g gad;ghl;ow;F ��62 2= Streetlight bjU tpsf;F 3= Both ,uz;ow;Fk

if street lighting, Number streetlight points

bjU tpsf;fpw;F vd;why; bjU tpsf;Ffspd; vz;zpf;if

Number of functional streetlight points ,a’;Fk; bjUtpsf;Ffspd; vz;zpf;if

Is this street a slum?

1=yes 2=no ,e;j bjU xU Foirg; gFjpah > 1= Mk; 2=,y;iy �Next Row mLj;j tupir

1=notified slum 2= non-notified slum? Mk; vd;why; . mJ xU 1/mwptpf;fg;gl;l Foirg; gFjpah my;yJ 2/mwptpf;fg;lhj Foirg; gFjpah > �Next Row mLj;j tupir Yes

Mk;

No ,y;iy

��62 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63.

1 01 02

2 01 02

3 01 02

4 01 02

5 01 02

6 01 02

7 01 02

8 01 02

9 01 02

10 01 02


CONFLICTS AND SOCIAL RELATIONS :: :: rz;il rr;rut[fs;. rz;il rr;rut[fs;. rz;il rr;rut[fs;. rz;il rr;rut[fs;. fUj;J ntWghLfs; kw;Wk; rK:f cfUj;J ntWghLfs; kw;Wk; rK:f cfUj;J ntWghLfs; kw;Wk; rK:f cfUj;J ntWghLfs; kw;Wk; rK:f cwt[fs;wt[fs;wt[fs;wt[fs;

Conflict Type rz;il rr;rut[fs;. fUj;J ntWghLfspd; tif

2006 2007 2008

Mk;?01 ,y;iy?02

No. of Conflicts [ INCLUDE ONGOING] fUj;J ntWghL fspd; vz;zpf;if (,g;bghGJ cs;s fUj;J ntW ghLfisa[k; n\

Who resolved? CODE [MULTIPLE

POSS.]

ahu; jPu;j;J itj;jJ> FwpaPL (gy gjpy;fs;

tu tha;g;g[)

Mk;?01 ,y;iy?02

No. of Conflicts [ INCLUDE ONGOING] fUj;J ntWghL fspd; vz;zpf;if (,g;bghGJ cs;s fUj;J ntW ghLfisa[k; nru;j;J)


POSS.] ahu; jPu;j;J itj;jJ> FwpaPL (gy gjpy;fs;

tu tha;g;g[)

Mk;?01 ,y;iy?02

No. of Conflicts fUj;J ntWghL fspd; vz;zpf;if (,g;bghGJ cs;s fUj;J ntW

ghLfisa[k; nru;j;J)

Who resolved? ahu; jPu;j;J itj;jJ> FwpaPL (gy gjpy;fs; tu

tha;g;g[) �Next mLj;j tupir

Yes Mk;

No ,y;iy

��67

Yes Mk;

No ,y;iy

��70

Yes Mk;

No ,y;iy �� Next mLj;j tupir

Sl.no. 64. 65. 66. 67. 68. 69. 70. 71. 72.

1. Labour ntiyahs; 01 02 01 02 01 02

2. Sharing drinking water Fojz;zPiug; gfpu;e;J bfhs;tJ

01 02 01 02 01 02

3. Marriage other conflicts jpUkz’;fs; kw;w fUj;J ntWghLfs;

01 02 01 02 01 02

4. Caste (including intercaste marriage) $hjp (fyg;g[ $hjp jpUkz’;fs; cl;gl)

01 02 01 02 01 02

5. Religion (including interreligion marriage) kjk; (fyg;g[ kj jpUkz’;fs; cl;gl)

01 02 01 02 01 02

6.

Property issues and land disputes [land tenure, land title] brhj;J gpur;rpidfs; kw;Wk; epyj; jfuhWfs; (epy cupik fhy tuk;g[ . brhe;jk;-cupik gw;wpait)

01 02

01 02

01 02

7. Inheritance/ Division of Assets mLj;j jiyKiwf;F khw;WtJ- brhj;Jf;fisg; gpupg;gJ

01 02

01 02

01 02

8. Rent collection from tenants thliff;F Fo ,Ug;gth;fsplkpUe;J thlif tR{ypg;gJ

01 02

01 02

01 02

9.

Other property disputes (encroachment on public / private land for slums etc)—

SPECIFY kw;w brhj;J gpur;ridfs; (bghJ epyj;jpy; Foirg; gFjpfspy; Mf;fpukpg;g[ nghd;wit ) Fwpg;gplt[k;

01 02

01 02

01 02

10. Robbery jpUl;Lf;fs; 01 02 01 02 01 02

11.

Dowry violence, harassment, related problems tujl;riz td;Kiwfs; . tujl;rid bfhLik . kw;Wk; tujl;riz rhh;e;j gpur;rpidfs;

01 02

01 02

01 02

12. Other inter-family disputes FLk;gj;jpw;Fs; Vw;gLk; gpw gpur;rpidfs;

01 02 01 02 01 02


Conflict Type rz;il rr;rut[fs;. fUj;J ntWghLfspd; tif

2006 2007 2008

Mk;?01 ,y;iy?02

No. of Conflicts [ INCLUDE ONGOING] fUj;J ntWghL fspd; vz;zpf;if (,g;bghGJ cs;s fUj;J ntW ghLfisa[k; n\


POSS.]

ahu; jPu;j;J itj;jJ> FwpaPL (gy gjpy;fs;

tu tha;g;g[)

Mk;?01 ,y;iy?02

No. of Conflicts [ INCLUDE ONGOING] fUj;J ntWghL fspd; vz;zpf;if (,g;bghGJ cs;s fUj;J ntW ghLfisa[k; nru;j;J)


POSS.] ahu; jPu;j;J itj;jJ> FwpaPL (gy gjpy;fs;

tu tha;g;g[)

Mk;?01 ,y;iy?02

No. of Conflicts fUj;J ntWghL fspd; vz;zpf;if (,g;bghGJ cs;s fUj;J ntW

ghLfisa[k; nru;j;J)

Who resolved? ahu; jPu;j;J itj;jJ> FwpaPL (gy gjpy;fs; tu

tha;g;g[) �Next mLj;j tupir

Yes Mk;

No ,y;iy

��67

Yes Mk;

No ,y;iy

��70

Yes Mk;

No ,y;iy �� Next mLj;j tupir

Sl.no. 64. 65. 66. 67. 68. 69. 70. 71. 72.

13. Political party violence murpay; fl;rpfspd; td;Kiwfs;

01 02 01 02 01 02

14.

“Eve-teasing” bgz;;;fis bjhe;jput[ bra;jy; (rpwpa mstpyhd ghypay; td;Kiwfspy; ,Ue;J bgupa ghypay; bfhLikfs; tiu)

01 02

01 02

01 02

15. Other [Specify] = kw;wtu;fs; (Fwpg;gplt[k;) 01 02 01 02 01 02

16. Other [Specify] kw;wtu;fs; (Fwpg;gplt[k;) 01 02 01 02 01 02

17. Other [Specify] = kw;wtu;fs; (Fwpg;gplt[k;) 01 02 01 02 01 02

Resolution CODES jPu;tpw;fhd FwpaPLfsjPu;tpw;fhd FwpaPLfsjPu;tpw;fhd FwpaPLfsjPu;tpw;fhd FwpaPLfs;; ;; Options Codes

Local Headman / Leader cs;Sh; jiytu;- jiytu; 01 Ward Members thu;L cWg;gpdu;fs; 02 Government official muR mjpfhup 03 School Headmaster / Teacher gs;sp jiyik Mrpupau; - Mrpupau; 04 Narpani Mandrankal (Welfare Assoc.) ew;gzp kd;w’;fs; 05 Caste Association $hjp r’;f’;fs; 06 Relative cwtpdu;fs 07 Political party leader / member murpay; jiytu; - cWg;gpdu; 08 Religious Leader kj jiytu; 09 Police fhtyu; 10 Tehsildar jhrpy;jhu; 11 Collector khtl;l Ml;rpau; 12 Court ePjp kd;wk; 13 Other important neighborhood person kw;w Kf;fpa mz;iltPl;lhu; 14 Other (specify) kw;wtu;fs; (Fwpg;gplt[k;) 15


ADVERSE EVENTS IN LAST 3 YEARS fle;j 3 tUl’;fspy; epfH;e;Js;s nkhrkhd fle;j 3 tUl’;fspy; epfH;e;Js;s nkhrkhd fle;j 3 tUl’;fspy; epfH;e;Js;s nkhrkhd fle;j 3 tUl’;fspy; epfH;e;Js;s nkhrkhd rk;gt’;fs;rk;gt’;fs;rk;gt’;fs;rk;gt’;fs;;; ;;

S. No Adverse Event nkhrkhd rk;gt’;fs;

2006 2007 2008

Yes=01 No=02 Mk;?01 ,y;iy?02

No. of cases

rk;gt’;fspd; vz;zpf;if

Yes=01 No=02 Mk;?01 ,y;iy?02

No. of cases

epfH;r;r;p fspd; vz;zpf;if

Yes=01 No=02 Mk;?01 ,y;iy?02

No. of cases

epfH;r;r;pfspd; vz;zpf;if

�Next Row mLj;j tupir

Yes Mk;

No ,y;iy

�� 75

Yes Mk;

No ,y;iy

�� 77

Yes Mk;

No ,y;iy � Next

mLj;j tupir

SLno 73. 74. 75. 76. 77. 78.

1. Closure of a large firm affecting livelihoods in your block xU bgupa epWtdk; K:lg;gl;ljhy; c’;fs; gpshf;fpYs;s kf;fspd; thH;f;ifiag; ghjpj;Js;sJ

01 02

01 02

01 02

2. Suicides jw;;;;;;;bfhiyfs; 01 02 01 02 01 02

3. Groundwater sources (borewells/ tubewells/ other wells) used for drinking water dried up MH;Jis fpzWfs; twd;Lnghjy;

01 02

01 02

01 02

4. Public taps non-usable bghJf; FHha;fs; gad;gLj;j ,ayhky; nghtJ

01 02 01 02 01 02

5. Starvation gl;odpr;rht[fs; 01 02 01 02 01 02

6.

Water-borne disease(s) [such as cholera] jz;zPupdhy; gut[k; neha;fs; (fhyuh nghd;wit

01 02 01 02 01 02

(specify if known:) bjupe;jhy; Fwpg;gplt[k;)

7.

Other disease epidemic- (ex:Chikungunya ) rpf;fd; Fd;ah my;yJ fhyuh nghd;w kdpjiuj; jhf;Fk; kw;w bjhw;W neha;fs;

01 02

01 02

01 02

(specify if known:) bjupe;jhy; Fwpg;gplt[k;)

8.

Other loss of property (________________specify): gpw brhj;Jf;fs; ,Hg;g[ (Fwpg;gplt[k;)

01 02

01 02

01 02


EMPLOYMENT, BUSINESS STRUCTURE IN THE BLOCK c’;fs; c’;fs; c’;fs; c’;fs; gpshf;fpgpshf;fpgpshf;fpgpshf;fpy; cs;s ntiytha;g;g[ ky; cs;s ntiytha;g;g[ ky; cs;s ntiytha;g;g[ ky; cs;s ntiytha;g;g[ kw;Wk; tu;j;jf mikgw;Wk; tu;j;jf mikgw;Wk; tu;j;jf mikgw;Wk; tu;j;jf mikgg[g[g[g[;fs; ;fs; ;fs; ;fs; Q. No Questions Options Code Skip 79. Are there any factories or companies in the block or in the vicinity of this block in which local

people are employed?

gpshf; kf;fs; ntiy bra;fpw VnjDk; bjhHpw;r;rhiyfs; c’;fs; gpshf;fpy; my;yJ mUfpy; cs;sdth>

Yes Mk; 01

No ,y;iy 02 �� 83 FACTORIES / COMPANIES INSIDE THE BLOCK OR IN VICINITY OF BLOCK WHERE LOCAL PEOPLE ARE EMPLOYED gpshf;fpgpshf;fpgpshf;fpgpshf;fpy; my;yJ mUfpy;y; my;yJ mUfpy;y; my;yJ mUfpy;y; my;yJ mUfpy; cs;s bjhHpw;rhics;s bjhHpw;rhics;s bjhHpw;rhics;s bjhHpw;rhiyyyy ---- epWtd’;fs;epWtd’;fs;epWtd’;fs;epWtd’;fs;

Factory / Company Name bjhHpw;rhiy - epWtdj;jpd; bgau; /

Type of Industry – Describe bjhHpw;rhiy tif

CODE NIC 5 DIDGIT CODE 5 ,yf;f vd; I rp FwpaPL

Q.no 80. 81. 82. 1

2

3

4

5

6


OTHER GOVERNMENT, NGO, OR PRIVATELY- SPONSORED DEVELOPMENT PROGRAMS IN THIS BLOCK IN THE LAST 12 MONTHS fle;j 12 khjj;jpy; fle;j 12 khjj;jpy; fle;j 12 khjj;jpy; fle;j 12 khjj;jpy; ,e;j ,e;j ,e;j ,e;j gpshf;fpy;gpshf;fpy;gpshf;fpy;gpshf;fpy; murh’;f. vd;$pX my;yJ jdpahu; Vw;ghL bra;Js;s nkk;ghl;Lj; jpl;l’;fs; murh’;f. vd;$pX my;yJ jdpahu; Vw;ghL bra;Js;s nkk;ghl;Lj; jpl;l’;fs; murh’;f. vd;$pX my;yJ jdpahu; Vw;ghL bra;Js;s nkk;ghl;Lj; jpl;l’;fs; murh’;f. vd;$pX my;yJ jdpahu; Vw;ghL bra;Js;s nkk;ghl;Lj; jpl;l’;fs; ntW ntW ntW ntW VjhtJ VjhtJ VjhtJ VjhtJ eilbgeilbgeilbgeilbgw;w;w;w;Ws;sWs;sWs;sWs;sjh>jh>jh>jh>

List all the programs/projects

vy;yh jpl;l’;fs;- g[uh$f;Lfisa[k; gl;oayplt[k;

Type of program? [USE CODES]

jpl;lj;jpd; tif (FwpaPl;il gad;gLj;Jf)

Sponsored by: Vw;ghL bra;jJ?Vw;ghL bra;jJ?Vw;ghL bra;jJ?Vw;ghL bra;jJ? Central / state Government kj;jpa-khepy murh’;fk;… 01

Govt.Foreign btspehl;L murh’;fk; ................ 02

NGO bjhz;L epWtdk; ...................... 03

Privately jdpahu; ......................................... 04

Pol. Party murpay; fl;rp .............................. 05

Other kw;wit ....................................... 06

Who is it for? ,J ,J ,J ,J ahUfahUfahUfahUf;fhf;fhf;fhf;fhf>>>> CODES

BPL… tWikf; nfhl;Lf;F fPnH cs;s ViHfs; 01 Landless.. epyk; ,y;yhjtu; 02 Women… bgz;fs; 03 SC/ST… v!;rp-v!;o04 Everyone.. vy;nyhUk; 05 Other… kw;wtu; 06 MULTICODING POSIBLE gy gjpy;fs; rhj;jpak;

Name of Organization epWtdj;jpd; bgau;

Code FwpaPL

Sl.no 83. 84. 85. 86. 87.

1

2

3

4

5

6

7

8

CODES FwpaPLfs;FwpaPLfs;FwpaPLfs;FwpaPLfs; Type of Program jpl;lj;jpd; tifjpl;lj;jpd; tifjpl;lj;jpd; tifjpl;lj;jpd; tif Codes

Education fy;tp 01

health/Nutrition/family planning Mnuhf;fpak;-rj;Jzt[-FLk;g fl;Lg;ghL 02

Drinking water FoePu; 03

Agriculture tptrhak; 04

Irrigation ghrdk; 05

Forestry fhLtsu;g;g[ 06

Transport/communication nghf;Ftuj;J-jfty;;;;;;;;;;;;;;; bjhlu;g[ 07

Electricity kpd;rhuk; 08

Other kw;wit 09


OBSERVATION OF ENUMERATION AREA me;j gFjpiag;gw;wp neuoahf fz;Lzu;jy; fzf;bfLgme;j gFjpiag;gw;wp neuoahf fz;Lzu;jy; fzf;bfLgme;j gFjpiag;gw;wp neuoahf fz;Lzu;jy; fzf;bfLgme;j gFjpiag;gw;wp neuoahf fz;Lzu;jy; fzf;bfLg;g[ gFjp;g[ gFjp;g[ gFjp;g[ gFjp

NEIGHBORHOOD WELFARE gpshf; gpshf; gpshf; gpshf; eyd;eyd;eyd;eyd; Q. Question Options Codes

97. Is there common association for security? (note: this is when residents cooperate for local security)

,e;j gpshf;fpd; Rw;Wg;g[ug;gFjpfspy; . bjU thhpahf my;yJ FoapUg;g[ thhpahf . bghJthd ghJfhg;g[ Kiw - mikg;g[ ,Uf;fpwjh > (Fwpg;g[ /; cs;S:h; ghJfhg;gpw;fhf FoapUg;gth;fs; xj;JiHf;Fk; nghJ ,J nghd;w mikg;g[fs; ,Uf;Fk;)

Yes Mk; 01

No ,y;iy 02

98. Does this block have any recreational or cultural facilities? ,e;j gpshf;fpy; VjhtJ bghGJ nghf;F my;yJ fyhr;rhu tpHhf;fSf;fhd trjpfs; ,Uf;fpwjh >

Yes Mk; 01

No ,y;iy 02

99. Does this Block have a Community Hall? ,e;j gpshf;fpy ; xU rK:ff;Tlk; ,Uf;fpwjh>

Yes Mk; 01 No ,y;iy 02

100. No. of Cinema/ Video halls rpdpkh jpnal;lh; - gl’;fs; ghh;g;gjw;fhd Tl’;fspd; vz;zpf;if

Number vz;zpf;if

101. If no cinema/video hall, distance to nearest rpdpkh jpnal;lh; - gl’;fs; ghh;gjw;fhd Tlk; ,y;iybad;why; . mUfhikapy; cs;s rpdkh jpnal;lh; - gl’;fs; ghh;gjw;fhd Tlj;jpd; J}uk;

Distance in km to .00 J}uk; fpkPapy; /00

102. No. of sports clubs !;nghu;l;!; fpsg;g[fspd; vz;zpf;if

Number vz;zpf;if

103. If no sports club, distance to nearest !;nghu;l;!; fpsg;g[fs; ,y;iybad;why; . mUfhikapy; cs;sjpd; J}uk;

Distance in km to .00

J}uk; fpkPapy; /00

104. No. of stadiums, auditoriums tpisahl;lu’;Ffs; . mu’;f’;fspd; vz;zpf;if

Number vz;zpf;if

105. If no stadium auditorium, distance to nearest tpisahl;lu’;Ffs; . mu’;f’;fs;; ,y;iybad;why; mUfhikapy; cs;s tpisahl;lu’;Ffs; . mu’;f’;fspd; J}uk;

Distance in km to .00

J}uk; fpkPapy; /00

106. In this block are there any signs/sign boards with public facility directions? ,e;j gpshf;fpy ;bghJkf;fs; trjpf;fhf tHpfhl;LjYf;fhf VjhtJ milahs’;fs;;-milahs gyiffs; ,Uf;fpwjh>

Yes Mk; 01

No ,y;iy 02

107. In shopping areas of block or vicinity are there shops or buildings that are damaged or burnt? ,e;j gpshf;fpy ; filj; bjUf;fs;; cs;s gFjpapy; VjhtJ filfs; my;yJ fl;ol’;fs; ghHile;J my;yJ vupe;J fhzg;gLfpwjh>

Yes Mk; 01

No ,y;iy 02 108. In this shopping areas of this block or the vicinity of this block does one see shops that have

closed/gone out of business ,e;j gpshf;fpy ;; filj; bjUf;fs;; cs;s gFjpapy; VjhtJ filfs;; g{l;lg;gl;L- tpw;gid ,He;J fhzg;gLfpwjh>

Yes Mk; 01

No ,y;iy 02

109. Does the block have an operating library? ,e;j gpshf;fpy ;; xU E}yfk; ,a’;Ffpwjh>

Yes Mk; 01 No ,y;iy 02

110. If no, how far is the nearest library in kilometers?

,y;iy vdpy;. mUfpy; cs;s E}yfk; vt;tst[ Jhuj;jpy; cs;sJ> fpnyh kPl;lhpy; Distance in km to

.00

J}uk; fpkPapy; /00

Q. No

Question

01=yes, Mk; 02=no, ,y;iy 03=no observation / not present

ftdpf;f tpy;iy - m’;F ,y;iy

88. Is the air in this block generally polluted (for whatever reason)? ,e;j gpshf;fpy; cs;s fhw;W bghJthf khRgl;ljh> (ve;j fhuzj;jpdhyhtJ>)

89. Is there generally any exposed garbage pile visible along the roads? bghJthf rhiy Xu’;fspy; VjhtJ Fg;ig Ts’;fspd; Ftpay; fhzg;gLfpwjh>

90. Is there generally any exposed cattle manure pile in this block? ,e;j gpshf;fpy;; bghJthf VjhtJ fhy;;;;;;;;;;;;;;eilf; fHpt[fspd; Ftpay; fhzg;gLfpwjh>

91. Is there in general any blocked water duct or obstructed river/gutter in this block? ,e;j gpshf;fpy;; VjhtJ jz;zPu; milgl;l njf;fk;- my;yJ jilg;gl;l MW- tha;f;fhy; cs;sjh>

92. Are there standing pools of water in this block? ,e;j gpshf;fpy ; jz;zPu; Fl;ilfs; nj’;fp epw;fpwjh>

93. Are there generally any cattle visible in this block (no fowl) that are roaming around ? ,e;j gpshf;fpy;; kf;fs; trpf;Fk; ,l’;fspy; bghJthf M’;fh’;nf fhy;eilfs; (nfhHp nghd;w gwitfs; my;y ) jpupe;J bfhz;oUf;fpd;wdth>

94. Are the house yards in this block generally swept clean? ,e;j gpshf;fpy; tPl;L Kw;w’;fs; bghJthf Rj;jkhf bgUf;fp itf;fg;gl;Ls;sjh>

95. Is the grass growing in public squares in this block generally well cared for? ,e;j gpshf;fpy; bghJ ,l’;fspy; cs;s g[y; tsUk; jiufs; ed;F guhkupf;fg;gLfpwjh>

96. Are there in general many flies visible (near the food vendors)? bghJthf M’;fh’;nf mjpf <f;fs;. bfhRf;fs; fhzg;gLfpwjh> (czt[g; bghUl;fs; filfspd; mUnf)

URBAN BLOCK QUESTIONNAIRE – Part B 23

SOCIAL AND POLITICAL GROUPS WITHIN BLOCK/ WITHIN 10 MINUTE WALKING DISTANCE gpshf;fpy; my;yJ 10 epkpl eil Jhuj;jpy;gpshf;fpy; my;yJ 10 epkpl eil Jhuj;jpy;gpshf;fpy; my;yJ 10 epkpl eil Jhuj;jpy;gpshf;fpy; my;yJ 10 epkpl eil Jhuj;jpy; cs;s murpay; kw;Wk; rK:f mikg;g[f;fs;cs;s murpay; kw;Wk; rK:f mikg;g[f;fs;cs;s murpay; kw;Wk; rK:f mikg;g[f;fs;cs;s murpay; kw;Wk; rK:f mikg;g[f;fs;

S. no

TYPE OF GROUP

How many [……]exist in this block or within a 10 minute walking distance?

,e;j gpshf;fpy; my;yJ 10 epkpl eil Jhuj;jpy; [……] vj;jid FGf;fs; cs;sd> [ FGf;fspd; vz;zpf;if ? g{$;$pak; rhj;jpak; ] IF 00� NEXT ROW 00 �vdpy; mLj;j tupir

What are the names of all groups and organizations in the block or the vicinity?

gpshf;fpy; my;;yJ mUfhikapy; cs;s midj;J FGf;fs; kw;Wk; midj;J mikg;g[f;fspd; bgau;fs;

vd;bdd;d>

111. 112.

1.

Self help group(SHG) for women only (list name of the organization and Bank / MFI Linked to Group affiliated)

bgz;fSf;fhd Ra cjtpf; FGf;fs; (m’;fPfupf;fg;gl;l FGf;fSld; ,izf;fg;gl;Ls;s epWtd’;fs;-t’;fpfs; kw;Wk; FW epjp epWtd’;fspd; bgau;fisg; gl;oayplt[k;)

Group Name FGtpd; bgau;

Linked Bank /MFI

,izf;fg;gl;l t’;fp my;yJ FW epjp epWtdk;

CODE FwpaPL

2.

Other Self help group (SHG) kw;w Ra cjtpf; FGf;fs;

Group Name FGtpd; bgau;

Linked Bank or MFI

,izf;fg;gl;l t’;fp my;yJ FW epjp epWtdk;

CODE FwpaPL

3.

Mothers’ Committee /Magalir Sangam jha;khu;fs; mikg;g[ - kfspu; r’;fk;

4.

Non government organization (NGO) muR rhuh bjhz;L epWtdk; epWtdk; (list specific names) (bgah;fis tupirahf Fwpf;ft[k;)


S. no

TYPE OF GROUP

How many [……]exist in this block or within a 10 minute walking distance?

,e;j gpshf;fpy; my;yJ 10 epkpl eil Jhuj;jpy; [……] vj;jid FGf;fs; cs;sd> [ FGf;fspd; vz;zpf;if ? g{$;$pak; rhj;jpak; ] IF 00� NEXT ROW 00 �vdpy; mLj;j tupir

What are the names of all groups and organizations in the block or the vicinity?

gpshf;fpy; my;;yJ mUfhikapy; cs;s midj;J FGf;fs; kw;Wk; midj;J mikg;g[f;fspd; bgau;fs;

vd;bdd;d>

111. 112.

5.

Religious group Md;kPf FGf;fs; (list groups) (FGf;fis gl;oayplt[k;)

Name of group FGtpd; bgau;

Religion kjk;

CODE kjj;jpd; FwpaPL

6.

Political parties murpay; fl;rpfs; (list parties) (fl;rpfis gl;oayplt[k;;)

Name of Party fl;rpapd; bgau;

Party CODE fl;rpapd; FwpaPL

7.

Caste Associations $hjp r’;f’;fs;

Name of Group FGtpd; bgau;

Caste $hjp

Caste CODE $hjp (FwpaPL)

8.

Area or Residential Development Committee

Vupah my;yJ FoapUg;g[ nkk;ghl;Lf; FG

9.

Committees on Irrigation and water use or Water Users Association or Watershed Committee ghrdk; kw;Wk; jz;zPu; gad;ghl;ow;fhd fkpl;ofs; my;yJ jz;zPu; gad;gLj;Jnthupd; r’;fk; my;yJ ePh; gfph;t[f;fhd thl;lu;b&l; fkpl;o

10.

Cooperatives Tl;Lwt[r; r’;f’;fs; (list specific names) (Fwpg;gpl;l bgah;fisg; gl;oayplt[k;)

11.

Business associations tu;j;jf r’;f’;fs; (list specific names) (Fwpg;gpl;l bgah;fisg; gl;oayplt[k;)

12.

Others (Specify) kw;wit (Fwpg;gplt[k;)

13.



BANKS / MFIs – CODE t’;fpfs; - FW epjp epWtd’;fspd; ? FwpaPL

Options Code Allahabad Bank my\hghj; t’;fp 01 Andhra Bank Me;jpuh t’;fp 02 Bank of Baroda ng’;f; M`g; gnuhlh 03 Bank of India ng’;f; M`g; ,e;jpah 04 Bank of Maharashtra ng’;f; M`g; k\huh&;;l;uh 05 Canara Bank fduh ng’;f; 06 Central Bank of India brd;l;uy; ng’;f; M`g; ,e;jpah 07 Corporation bank fhh;g;gnu&d; ng’;f; 08 Dena Bank njdh t’;fp 09 ICICI IrpIrpI 10 Indian Bank ,e;jpad; ng’;f; 11 Indian Overseas Bank ,e;jpad; Xtu;rP!; ng’;f; 12 Karur Vysya Bank fU:u; it!;ah t’;fp 13 Oriental Bank of Commerce Xupaz;ly; ng’;f; M`g; fhku;!; 14 Punjab and Sind Bank g”;rhg; mz;l; rpe;J ng’;f; 15 Punjab National Bank g”;rhg; ne&dy; ng’;f; 16 State Bank of India !;nll; ng’;f; M`g; ,e;jpah 17 Syndicate Bank rpz;onfl; ng’;f; 18 Tamilnad Mercantile bank jkpH;ehL bku;f;fz;ily; ng’;f; 19 UCO bank a{nfh ng’;f; 20 Union Bank of India a{dpad; ng’;f; M`g; ,e;jpah 21 United Bank of India a[idl;bll; ng’;f; M`g; ,e;jpah 22 Vijaya Bank it!;ah ng’;f; 23 Other Bank (Specify) kw;w t’;fpfs; (Fwpg;gplt[k;) 24 Activist for Social Alternatives (ASA) rK:f khw;w’;fSf;fhd eltof;iff; FG 25 Bullock cart Workers Development Association(BWDA) khl;L tz;o bjhHpyhsu;fs; nkk;ghl;L mikg;g[ 26 Community Action for Rural Development(CARD) fpuhk nkk;ghl;L rK:f eltof;if 27 Ecumenical Church Loan Fund of India(ECLOF) vf;a{bkdpf;fy; ru;r; nyhd; `gd;L M`g; ,e;jpah 28 Guidance Society for Labour Orphans & Women(GLOW)

CHpau;fs;. mdhij kw;Wk; bgz;fSf;fhd tHpfhlLk; mikg;g[ (f;nsh)

29

Indian Association for Saving & Credit(IASC) nrkpg;g[ kw;Wk; flDf;fhd ,e;jpa mikg;g[ (IVv!;rp) 30 Integrated Village Development Project(IVDP) xU’;fpize;j fpuhk nkk;ghl;L jpl;lk; (Itpogp) 31 Kalanjiam Development Financial Services (KDFS) fs”;rpak; nkk;ghl;L epjp nrit 32 Kalrayan Hills ADP(KHADP) fy;tuhad; kiy gFjp nkk;ghl;Lj; jpl;lk; 33 League for Education & Development(LEAD) fy;tp kw;Wk; nkk;ghl;L xU’;fpize;j FG[ 34 MAHASEMAM k\hnrkk; 35 Micro Finance Consulting Group(MCG) FW epjp Mnyhrid FG 36 Nanayasurabhi Development Financial Services(NDFS) ehza Rugp nkk;ghl;L epjp nritfs; 37 NEW LIFE g[J thH;t[ 38 OAZOANE(The Society for Development of Human Abilities and Environment)

Xnrhd; (kdpj jpwikfisa[k; Rw;Wf; R{Hiya[k; nkk;gLj;Jk; r’;fk;)

39

PIONEER TRAD gadPu; onul; 40 PREPARE g;uPngu; 41 Samam Makalir Suyasarbu Iyakkam rkk; kfspu; Ra rhh;g[ ,af;fk; 42 Sarvodaya Nano Finance Ltd. (SNF) ru;nthjah ehndh epjp epWtdk; 43 Semam Micro Finance Investment Literacy & Empowerment Ltd. (SMILE)

nrkk; FW epjp fy;tp KjyPL kw;Wk; jpwd; btspg;ghL epWtdk;

44

Serva Jana Seva Kosh Ltd. (SJSK) nru;th $d nrth nfh&; ypl; 45 Seva Mahalir Sangamam nrth kfspu; r’;fk; 46 Thirumalai Charity Trust (TCT) jpUkiy rhupl;o ou!;l; 47 Other MFI (Specify) kw;w FW epjp epWtd’;fs; (Fwpg;gplt[k;) 48

Religion CODE kjj;jpd; FwpaPL Options Code Hinduism ,e;J kjk; 01 Islam ,!;yhk; 02 Christianity fpU!;Jtk; 03 Sikhism rPf;fpak; 04 Jainism i$dk; 05 Buddhism bgsj;jk; 06 Zoroastrianism (Parsi) ghh;rp 07 Others____________ kw;wit 08


Political party CODE murpay; fl;rp FwpaPLmurpay; fl;rp FwpaPLmurpay; fl;rp FwpaPLmurpay; fl;rp FwpaPL Options Code All India Anna Dravida Munnetra Kazhagam (AIADMK)

midj;jpe;jpa mz;zh jpuhtpl Kd;ndw;wf; fHfk; 01

Bharatiya Janata Party (BJP) ghujpa $djh fl;rp 02 Communist Party of India (CPI) ,e;jpa fk;a{dp!;l; fl;rp 03 Communist Party of India (Marxist) (CPI-M) khu;f;!pa fk;a{dp!;l; fl;rp 04 Dravida Munnetra Kazhagam (DMK) jpuhtpl Kd;ndw;w fHfk; 05 Indian National Congress (INC) ,e;jpa njrpa fh’;fpu!; 06 Marumalarchi Dravida Munnetra Kazhagam (MDMK)

kWkyu;r;rp jpuhtpl Kd;ndw;wf; fHfk; 07

Pattali Makkal Katchi (PMK) ghl;lhsp kf;fs; fl;rp 08 All India Forward Bloc (Subhasist) mfpy ,e;jpa `ghh;thu;l; gpshf; (Rgh&p!k;) 09 Democratic Forward Bloc. $dehaf `ghh;thh;l; gpshf; 10 Puthiya Tamilagam g[jpa jkpHfk; 11 Dalit Panthers of India (DPI) or Viduthalai Siruthaigal

tpLjiy rpWj;ijfs; 12

Muslim League K!;yPk; yPf; 13 Dhesiya Murtpokku Dravida Kazhagam (DMDK)

njrpa Kw;nghf;F jpuhtpl fHfk; 14

All India Samathuva Makkal Katchi midj;jpe;jpa rkj;Jt kf;fs; fl;rp 15 Others___________ kw;wit 16 Others___________ kw;wit 17


ELECTION SUMMARY: TOWN PANCHAYAT / MUNICIPALITY / M UNICIPAL CORPORATION ELECTION (To be asked for the WARD representing this Block) njh;jy; tptu’;fs; njh;jy; tptu’;fs; njh;jy; tptu’;fs; njh;jy; tptu’;fs; : efu g”;rhaj;J efu g”;rhaj;J efu g”;rhaj;J efu g”;rhaj;J ---- efuhl;rp efuhl;rp efuhl;rp efuhl;rp ---- khefuhl;rp khefuhl;rp khefuhl;rp khefuhl;rp njh;jy;njh;jy;njh;jy;njh;jy; (,e;j(,e;j(,e;j(,e;j gpshf;fpd;gpshf;fpd;gpshf;fpd;gpshf;fpd; thuthuthuthu;L;L;L;L gpujpepjpaplk; nfl;fg;gl ntz;Lk;)gpujpepjpaplk; nfl;fg;gl ntz;Lk;)gpujpepjpaplk; nfl;fg;gl ntz;Lk;)gpujpepjpaplk; nfl;fg;gl ntz;Lk;) When were the elections held?

njh;jy; vg;nghJ eilbgw;wJ> Total number of eligible voters in this ward

,e;j thu;oy; jFjp bgw;w thf;fhsu;fspd; vz;zpf;if vd;d>

Total Votes polled in this ward

gjpthd thf;Ffspd; bkhj;j vz;zpf;if

Mode of election in this ward (1=By direct election; 2=Unopposed) njh;jy; Kiw ( FwpaPLfs; ? 1 ? neuo njh;jy; . 2 ? nghl;oapd;wp njh;e;bjLf;fg;gLtJ

Year tUlk;

YYYY

Month khjk;

MM

113. 114. 115. 116. Elections Oct. 2006 mf;/ 2006 njh;jy;fs;

Elections 2001 – 2006 njh;jy;fs;; 2001 ? 2006


ELECTED 2006: TP President / Municipality Chairman / MC Mayor & Ward Member 2006 y; njh;t2006 y; njh;t2006 y; njh;t2006 y; njh;t[ bra;ag;gl;ltu; [ bra;ag;gl;ltu; [ bra;ag;gl;ltu; [ bra;ag;gl;ltu; : efu g”;rhefu g”;rhefu g”;rhefu g”;rhaj;J jiythaj;J jiythaj;J jiythaj;J jiyth ; ; ; ; ---- KdprpghyplKdprpghyplKdprpghyplKdprpghypl ;o nrh;kd;o nrh;kd;o nrh;kd;o nrh;kd ;; ;;---- khefuhlkhefuhlkhefuhlkhefuhl ;rp nkau;rp nkau;rp nkau;rp nkau ; kw; kw; kw; kw ;Wk;Wk;Wk;Wk ; tuh; tuh; tuh; tuh ;L ;L ;L ;L cWgcWgcWgcWg ;gpdu;gpdu;gpdu;gpdu ;; ;; October 2006 Elections mf;nlhghmf;nlhghmf;nlhghmf;nlhgh ;2006 njh;jy;2006 njh;jy;2006 njh;jy;2006 njh;jy ;; ;;

Within block support based on (///////) mog;gilapy; gpshf;fpy;;;;;

cs;stu;fspd; Mjut[ (

Multiple response possible Xd;Wf;F nkw;gl;l gjpy; tuyhk;

outside support based on(...) (///////) mog;gilapy; gpshf;fpw;F btspapy; cs;sth;fspd; Mjut[

Muliple response possible Xd;Wf;F nkw;gl;l gjpy; tuyhk;

Type of Reser-vation? [CODE)

xJf;fPL tifapd; FwpaPL

Position bghWg;g[

Candidate NAME nghl;oapl;lth;

bgah;

Gender ghypdk;

Caste (Jati NAME]

$hjp (bgau;)

Jati CODE $hjp

FwpaPL

Social Group

[CODE] rK:f FG (FwpaPL)

Religion kjk;

CODE FwpaPL

Caste (jati) $hjp

Religion

kjk;

Political party

murpay;

fl;rp;

Caste (jati) $hjp

Religion kjk;

Political party

murpay; fl;rp M

Mz; F

bgz;

117. 118. 119. 120. 121. 122. 123. 124. 125. 126. TP President / Municipality Chairman / MC Mayor efu g”;rhaj;J jiyth ; - Kdprpghypl ;o nrh ;kd ;- khefuhl ;rp nkau ;

01 02

01 02 03 01 02 03

Ward Member thu;L cWg;gpdh;

01 02

01 02 03 01 02 03

ELECTED 2001: TP President / Municipality Chairman / MC Mayor & Ward Member ;; 2001 y; njh;t[ bra;ag;gl;ltu; 2001 y; njh;t[ bra;ag;gl;ltu; 2001 y; njh;t[ bra;ag;gl;ltu; 2001 y; njh;t[ bra;ag;gl;ltu; : efu g”;rhefu g”;rhefu g”;rhefu g”;rhaj;J jiythaj;J jiythaj;J jiythaj;J jiyth ; ; ; ; ---- KdprpghyplKdprpghyplKdprpghyplKdprpghypl ;o nrh;kd;o nrh;kd;o nrh;kd;o nrh;kd ;; ;;---- khefuhlkhefuhlkhefuhlkhefuhl ;rp nkau;rp nkau;rp nkau;rp nkau ; kw; kw; kw; kw ;Wk;Wk;Wk;Wk ; tuh; tuh; tuh; tuh ;L ;L ;L ;L cWgcWgcWgcWg ;gpd;gpd;gpd;gpduuuu ;; ;; 2001 Elections 2001 njh;jy2001 njh;jy2001 njh;jy2001 njh;jy ;; ;;

Within block support based on (..) Muliple response possible (///////) mog;gilapy ; gpshf;fp y; cs;stu;fspd; Mjut[ -- Xd;Wf;F nkw;gl;l gjpy; tuyhk;

outside support based on (...) Multiple response possible

(///////) mog;gilapy; gpshf;fpw;F btspapy; cs;sth;fspd; Mjut[ Xd;Wf;F nkw;gl;l gjpy; tuyhk;

Type of Reser-vation? [CODE)

xJf;fPL tifapd; FwpaPL

Position bghWg;g[

Candidate NAME nghl;oapl;lth;

bgah;

Gender ghypdk;

Caste (Jati NAME]

$hjp (bgau;)

Jati CODE $hjp

FwpaPL

Social Group

rK:f FG (FwpaPL

Religion kjk;

CODE FwpaPL

Caste (jati) $hjp

Religion

kjk;

Political party

murpay; fl;rp

Caste (jati)

$hjp

Religion kjk;

Political party

murpay; fl;rp

M Mz;

F bgz;

127. 128. 129. 130. 131. 132. 133. 134. 135. 136. TP President / Municipality Chairman / MC Mayor efu g”;rhaj;J jiyth ; - Kdprpghypl ;o nrh;kd ;- khefuhl ;rp nkau;

01 02

01 02 03 01 02 03

Ward Member thu;L cWg;gpdh; 01 02

01 02 03 01 02 03


ELECTED 2006: TP PRESIDENT / MUNICIPALITY CHAIRMAN / MC MAYOR & WARD MEMBER 2006200620062006 y; njh;t[ bra;ag;gl;ltu; y; njh;t[ bra;ag;gl;ltu; y; njh;t[ bra;ag;gl;ltu; y; njh;t[ bra;ag;gl;ltu; : efu g”;rhefu g”;rhefu g”;rhefu g”;rhaj;J jiythaj;J jiythaj;J jiythaj;J jiyth ; ; ; ; ---- KdprpghyplKdprpghyplKdprpghyplKdprpghypl ;o nrh;kd;o nrh;kd;o nrh;kd;o nrh;kd ;; ;;---- khefuhlkhefuhlkhefuhlkhefuhl ;rp nkau;rp nkau;rp nkau;rp nkau ; kw; kw; kw; kw ;Wk;Wk;Wk;Wk ; tuh; tuh; tuh; tuh ;L cWg;L cWg;L cWg;L cWg ;gpdu;gpdu;gpdu;gpdu ;; ;;

Sl. No.

tupir vz;

Position bghWg;g[

Number of candidates contested for this post ,e;j gjtpf;Fg; nghl;oapl;l tu;fspd; vz;zpf;if

Educational Qualification code given below

fy;;tpfy;;tpfy;;tpfy;;tpj;jFjpj;jFjpj;jFjpj;jFjp FwpaPL fPnH

bfhLf;fg;gl;Ls;sJ

Previously held same post?

Kd;djhf mnj gjtpia tfpj;jhuh>

Candidate at last local body election?

fle;j cs;shl;rp nju;jypy;

nghl;oapl;lhuh>

Member of previous local body?

fle;j cs;shl;rp mikg;gpy; cWg;gpduh>

Party affiliation (Refer party CODES] ve;j fl;rpa[ld; bjhlu;g[ cilatu; (fl;rp

FwpaPLfis ghu;f;f)

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

Party Name fl;rpapd; bgah;

Code FwpaPL

137. 138. 139. 140. 141. 142. 143. 1 TP President / Municipality

Chairman / MC Mayor efu g”;rhaj;J jiyth ; - Kdprpghypl ;o nrh;kd ;- khefuhl ;rp nkau;

01 02 01 02 01 02

2


01 02 01 02 01 02

ELECTED 2001: TP PRESIDENT / MUNICIPALITY CHAIRMAN / MC MAYOR & WARD MEMBER 2001 y; njh;t[ bra;ag;gl;ltu; 2001 y; njh;t[ bra;ag;gl;ltu; 2001 y; njh;t[ bra;ag;gl;ltu; 2001 y; njh;t[ bra;ag;gl;ltu; : efu g”;rhefu g”;rhefu g”;rhefu g”;rhaj;J jiythaj;J jiythaj;J jiythaj;J jiyth ; ; ; ; ---- KdprpghyplKdprpghyplKdprpghyplKdprpghypl ;o nrh;o nrh;o nrh;o nrh ;kd;kd;kd;kd ;; ;;---- khefuhlkhefuhlkhefuhlkhefuhl ;rp nkau;rp nkau;rp nkau;rp nkau ; kw; kw; kw; kw ;Wk;Wk;Wk;Wk ; tuh; tuh; tuh; tuh ;L cWg;L cWg;L cWg;L cWg ;gpdu;gpdu;gpdu;gpdu ;; ;;

Sl. No.

tupir vz;

Position bghWg;g[

Number of candidates contested for this post ,e;j gjtpf;Fg; nghl;oapl;l tu;fspd; vz;zpf;if

Educational Qualification code given below

fy;;tpj;jFjpfy;;tpj;jFjpfy;;tpj;jFjpfy;;tpj;jFjp FwpaPL fPnH

bfhLf;fg;gl;Ls;sJ

Previously held same post?

Kd;djhf mnj gjtpia tfpj;jhuh>

Candidate at last local body election?

fle;j cs;shl;rp nju;jypy;

nghl;oapl;lhuh>

Member of previous local body?

fle;j cs;shl;rp mikg;gpy; cWg;gpduh>

Party affiliation (Refer party CODES] ve;j fl;rpa[ld; bjhlu;g[ cilatu; (fl;rp

FwpaPLfis ghu;f;f)

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

Party Name fl;rpapd; bgah;

Code FwpaPL

144. 145. 146. 147. 148. 149. 150. 1 TP President / Municipality

Chairman / MC Mayor efu g”;rhaj;J jiyth ; - Kdprpghypl ;o nrh;kd ;- khefuhl ;rp nkau;

01 02 01 02 01 02

2


01 02 01 02 01 02


Reservation CODE OPTIONS CODE

SC Mjp jpuhtplu;

1

SC Female Mjp jpuhtplu; ? bgz;fs;

2

ST gH’;Foapdu;

3

ST Female gH’;Foapdu; ? bgz;fs;

4

BC / MBC gpd;j’;fpa tFg;g[ - kpft[k; gpd;j’;fpa tFg;g[

5

BC / MBC Female gpd;j’;fpa tFg;g[ - kpft[k; gpd;j’;fpa tFg;g[ ? bgz;fs;

6

Female bgz;fs; 7 Not Reserved ,l xJf;fPL ,y;iy

8

Education CODE OPTIONS CODE

No education gof;fhjtu; 1 Pre – school Muk;g gs;sp 2 Primary School only bjhlf;f gs;sp 3 Upper primary school only eLepiy gs;sp 4 Secondary/ Higher Secondary school only cau; epiy - nky; epiy gs;sp 5 College fy;Y}hp 6 Industrial Training bjhHpw; gapw;rp 7 Vocational Training ifj; bjhHpw; gapw;rp 8 Others (Specify) kw;wit (Fwpg;gplt[k;) 9


WORK DONE IN THIS BLOCK/ NEIGHBOURHOOD OCT 2006-CUR RENT gpshf; - mUfhik ,l’;fspy; bra;ag;gl;l ntiyapd; jd;ik ? mf;nlhgu; 2006 elg;g[ g”;rhaj;J (Undertaken from Oct 2006 to ___________________ [today’s date: dd/mm/YYYY]- either providing the service OR developing new facility / service OR maintenance activity) mf;nlhgu; 2006 Kjy; ???????????????????????? nkw;bfhs;sg;gl;l ntiyfs; ( ,d;iwa njjp ehs;-khjk;-tUlk;) ? nrit tH’;Ftjw;fhfnth my;yJ g[jpa trjpfs;- nritfis nkk;gLj;jnth my;yJ guhkupg;g[ ntiyfSf;fhfnth)

Type of Work ntiyapd; jd;ik

Was this [TYPE OF WORK] undertaken in this Block from Oct 2006 to till date? (ntiyapd; tif) ,e;j ntiy mf;nlhgu; 2006 ypUe;J ,d;W tiu ,e;j gpshf;fpy; nkw;bfhs;sg;l;ljh> 01 = Yes Mk;

02 = No ,y;iy ��NEXT ROW

mLj;j tupirmLj;j tupirmLj;j tupirmLj;j tupir

Was that provision / development of new facility / service or maintenance activity? mJ g[jpa trjpfs;-nritfis nkk;gLj;Jtjw;fhdjh-my;yJ guhkupg;g[ eltof;ifah> 01 = New facility / service developed; 01=Mk;. g[jpa trjpfs;-nritfs; nkk;gLj;jg;gl;lJ 02 = Maintenance activity taken place; 02=Mk;. guhkupg;g[ eltof;iffs; bray;gLj;jg;gl;ld 03 = Both - new facility / service developed & maintenance activity taken place

03=Mk;. ,uz;Lk; g[jpa trjpfs;-nritfis nkk;gLj;j kw;Wk; guhkupg;g[ eltof;iffs; bray;gLj;jg;gl;ld

Sl.no 151. 152.

1. Purity of drinking water / supply of drinking water Fo jz;zPiuj; J}a;ikg; gLj;JtJ / FoePu; tpepnahfk;

2. Sanitation/ sewage Rfhjhuk;-fHpt[ ePufw;WtJ

3. Roads rhiy mikg;gJ

4. Communication Facilities (e.g. PCO, Post office) jfty; bjhlu;g[ trjpfs; (ck;/ gprpX. m”;ry; epiyak;)

5. Housing-[Subsidised / Free house construction or improvement/ maintenance, slum upgradation] tPl;L trjp ? (khdpak; tH’;FtJ-,ytrkhf tPL fl;oj; jUtJ my;yJ trjpfis nkk;gLj;JtJ- guhkjpj;jy;- Foirfisj; juk; cau;j;Jjy; nghd;wd)

6. Water harvesting ePu; tsj;ij nkk;gLj;Jjy;

7. Electrification/Electric supply kpd; ,izg;g[f;fs; tH’;FtJ - kpd; tpdpnahfk;

8. Street Light bjU tpsf;F


LOCATION AND CHARACTERISTICS OF SCHOOLS WITHIN THE BLOCK, OR WITHIN A TEN MINUTE WALKING RADIUS AROUND PERIMETER OF BLOCK gpshf;gpshf;gpshf;gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk;fpd; cs;ns my;yJ 10 epkpl elf;Fk;fpd; cs;ns my;yJ 10 epkpl elf;Fk;fpd; cs;ns my;yJ 10 epkpl elf;Fk; J}uJ}uJ}uJ}uj;jpw;Fs; . cs;s gs;spf;Tl’;fs; mike;jpj;jpw;Fs; . cs;s gs;spf;Tl’;fs; mike;jpj;jpw;Fs; . cs;s gs;spf;Tl’;fs; mike;jpj;jpw;Fs; . cs;s gs;spf;Tl’;fs; mike;jpUf;Fk; ,lk; kw;Wk; mjd; tptu’;[fs;Uf;Fk; ,lk; kw;Wk; mjd; tptu’;[fs;Uf;Fk; ,lk; kw;Wk; mjd; tptu’;[fs;Uf;Fk; ,lk; kw;Wk; mjd; tptu’;[fs; RECORD AS SEPARATE SCHOOL, IF 2 DIFFERENT SYLLABI FOLLOWED IN A SINGLE SCHOOL (LIKE MATRICULATION & CBSE SYLLABUS) xnu gs;spapy; ,uz;L ntW ghl jpl;l’;fs; elj;jpdhy; jdpj;jdp gs;spahf gjpt[ bra;at[k; (bkl;upf;Fny&d;. rpgpv!;, ghlKiw nghd;wit)

SC

HO

OL

FA

CIL

TY

ID

gs

;spa

pd; m

ilahs

vz

;

NAME OF THE SCHOOL

gs;spf;Tlj;jpd; gs;spf;Tlj;jpd; gs;spf;Tlj;jpd; gs;spf;Tlj;jpd; bgau;bgau;bgau;bgau;

GPS READING gs;spf;Tl’;fspd;

$pgpv!; uPo’;

If outside block, distance from block (km to .00) gpshf;fpw;F btspna vdpy;. gpshf;fpy; ,Ue;J vt;tst[ J}uk; (fpkP)

What type of

school is this?

,J ve;j tifahd gs;sp>

CODE FwpaPL

What was / is the educational system followed? gpd;gw;wg;gLk; fy;tp Kiw[ vd;dthf ,Ue;jJ - cs;sJ> CODE FwpaPL

School management

gs;sp

nkyhd;ik

CODE FwpaPL

Year established

YYYY

Jtf;fg;gl;l tUlk;

YYYY

Primary Language of instruction ( Spoken

language for teaching) (Codes given

below) fw;gpf;Fk;

Kjd;ikahd bkhHp (ngRk; bkhHpapy;

fw;gpj;jy;) (FwpaPLfs; fPnH

bfhLf;fg;gl;Ls;sd)

Language of textbooks

(Codes give below)

ghlg;

g[j;jf’;fspd; bkhHp (FwpaPLfs;

fPnH bfhLf;fg;gl;Ls;sd)

Do students learn a second

language khztu;fs; ,uz;lhtJ bkhHp gapy; fpd;whuh>

Second Language Taught fw;gpf;fg;gLk; ,uz;lhtJ

bkhHp What is the

second language studied?

(CODES) ,uz;lhtjhf vd;d bkhHp

fw;gpf;fg;gLfpwJ> (fPnH

Fwpg;gplt[k;)

What is time spent studying language per week? [TO NEAREST QUARTER

HOUR. thuj;jpw;F vj;jid

kzp neuk; ,uz;lhtJ bkhHpia fw;gjw;F brytplg; gLfpwJ> (kzpapy;)

Yes Mk

;

No ,y;iy

→→→→ 165

153. 154. 155. 156. 157. 158. 159. 160. 161. 162. 163. 164.

S1 N: 01 02

E:

S2 N: 01 02

E:

S3 N: 01 02

E:

S4 N: 01 02

E:

S5 N: 01 02

E:

S6 N: 01 02

E:


School CODE

Options Code

Pre – school Muk;gg; gs;sp 01 Primary School only

bjhlf;fg; gs;sp kl;Lk; 02

Primary with Upper Primary School

bjhlf;fg; gs;spa[k; eLepiyg; gs;spa[k; 03

Primary with Upper primary school and secondary/higher secondary school

bjhlf;fg; gs;sp.; eLepiyg; gs;sp. cau;; epiyg; gs;sp kw;Wk; nky; epiyg; gs;sp ,ize;jJ

04

Upper primary school only

eLepiyg; gs;sp kl;Lk; 05

Upper primary school with secondary/higher secondary school

eL epiyg; gs;sp. cau; epiyg; gs;sp kw;Wk; nky; epiyg; gs;sp ,ize;jJ

06

Secondary/ Higher Secondary school only

cau; epiyg; gs;sp - nky; epiyg; gs;sp kl;Lk;

07

College fy;Y}hp 08 Industrial Training

bjhHpw; gapw;rp 09

Vocational Training

ifj;bjhHpw; gapw;rp 10

Others (Specify) kw;wit (Fwpg;gplt[k; 11

Education – standard CODE

Options Code

Pre KG ghy;tho 01 Kindergarten (LKG/ UKG) kHiyau; gs;sp 02

1st standard 1Mk; tFg;g[ 03 2nd standard 2Mk; tFg;g[ 04 3rd standard 3Mk; tFg;g[ 05 4th standard 4Mk; tFg;g[ 06 5th standard 5Mk; tFg;g[ 07 6th standard 6Mk; tFg;g[ 08 7th standard 7Mk; tFg;g[ 09 8th standard 8Mk; tFg;g[ 10 9th standard 9Mk; tFg;g[ 11 10th standard / SSLC 10Mk; tFg;g[ - v!;v!;vy;rp 12

11th standard / Junior college 11Mk; tFg;g[- $Pdpau; fhny$; 13

12th std /HSC/ Junior college 12Mk; tFg;g[-v!;v!;vy;rp-$Pdpau; fhny$;

14

School management CODE

Options Code Department of education fy;tpj; Jiw 01

Tribal/social welfare dept gH’;Foapdu; - rK:f eythH;j;Jiw

02

Local body school cs;S:u; epu;thf gs;sp 03

Private aided muR cjtp bgWk; jdpahu; gs;sp

04

Private unaided school muR cjtp bgwhj jdpahh;gs;sp

05

Other recognized school kw;w m’;fPfupf;fg;gl;l gs;spfs;

06

Unrecognized schools – religious m’;fPfupf;fg;glhj gs;spfs; ? kjk; rhu;e;jit

07

Other Unrecognized schools kw;w m’;fPfupf;fg;glhj gs;spfs;

08

Others kw;wit 09

Language CODE

Options Code Tamil jkpH; 01 English M’;fpyk; 02 Hindi ,e;jp 03 Telugu bjY’;F 04 Kannada fd;dlk; 05 Malayalam kiyahsk; 06 Urdu cUJ 07 Others (specify) ____________


Education system CODE

Options Code State board khepyf; fy;tp thupak; 01

Matriculation bkl;upFny&d; 02

Central board (CBSE) kj;jpaf; fy;tp thupak; (rpgpv!;<)

03

Anglo Indian (AISC) M';fpnyh ,e;jpad; 04

Others (Specify) _______________ kw;wit (Fwpg;gplt[k;)

05


SCHOOLS: BASIC INFO CONT. gs;spf;Tl’;fs; ? mog;gilj; jfty;fs; ? bjhlh;r;rpgs;spf;Tl’;fs; ? mog;gilj; jfty;fs; ? bjhlh;r;rpgs;spf;Tl’;fs; ? mog;gilj; jfty;fs; ? bjhlh;r;rpgs;spf;Tl’;fs; ? mog;gilj; jfty;fs; ? bjhlh;r;rp S

CH

OO

L F

AC

ILT

Y ID

gs

;spf;T

l t

rjp m

ilahs

vz

;

Length of typical school day (exclude

extra classes, extracurriculars, etc.)

rhjhuz ehspy; gs;spf;Tlj;jpd; ntiy

neuk; (rpwg;g[ tFg;g[f;fis nru;f;f ntz;lhk;)

Specify no. of Hours

kzp neu’;fspd; vz;zpf;if

Time Check

In the past 30 days the school was supposed to be open, how many

days was it open?

fle;j 30 ehl;fspy; gs;sp

jpwe;jpUf;fg;gl ntz;oa ehl;fspy; vj;jid ehl;fs;

gs;spf;Tlk; jpwe;jpUe;jJ>

Are school uniforms required?

gs;spf;Tlj;jpw;F rPUil mky;

bra;ag;gl;Ls;sjh>

Do any students not possess

textbooks used for ONE or

MORE of their classes?

khztu;fs;

ahuhtJ ghlg; g[j;jf’;fs;

,y;yhky; xd;W my;yJ mjw;F

nkw;gl;l tFg;g[fSf;F tUfpwhu;fsh>

If yes, what percent of students do not have

access to needed textbooks?

Mk; vdpy; vj;jid rjtPj khztu;fs;

njitahd ghlg;g[j;jf’;fs;

itj;jpUg;gjpy;iy>

From what source(s) do most students in this school obtain textbooks? ,e;j gs;spf;Tlj;jpYs;;s bgUk;ghyhd khztu;fs; v’;fpUe;J g[j;jf’;fs; th’;Ffpwhu;fs;>

borrow from school gs;spf;Tlj;jpy; ,uty; 01

given free of charge from school gs;spf;Tlj;jpy; fl;lzkpd;wp ,ytrkhf jug;gLfpwJ

02

purchased from school gs;spf;Tlj;jpy; th’;fg;gLfpwJ 03

purchased from other source gpw ,l’;fspy; th’;fg;gLfpwJ 04

photocopy efy; vLf;fg;gLfpwJ 05

used sibling's or other already owned rnfhju rnfhjupfs; my;yJ Vw;fdnt brhe;jkhf itj;jpUe;jth;fsplkpUe;J

06

7 = other (Specify) kw;wit Fwpg;gplt[k;) 07

Time begun

Jt’;Fk; neuk;

Time ended

Koa[k; neuk;

AM fhiy

PM khiy

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

��172

Source 1

Mjhuk; 1 (kpft[k;

bghJthd)

Source 2 Mjhuk; 2

Source 3 Mjhuk; 3

165. 166. 167. 168. 169. 170. 171. 172.

S1 01 02 01 02

S2 01 02 01 02

S3 01 02 01 02

S4 01 02 01 02

S5 01 02 01 02

S6 01 02 01 02


List all fees that students are required to pay (e. g. school fee, term fee, admission fee, ID card fee) khztu;fs; fl;l ntz;oa vykhztu;fs; fl;l ntz;oa vykhztu;fs; fl;l ntz;oa vykhztu;fs; fl;l ntz;oa vy;yh fl;lz’;fisa[k; gl;oayplt[k;/ (ck;/ gs;spf;Tl fl;lzk; fhy;yh fl;lz’;fisa[k; gl;oayplt[k;/ (ck;/ gs;spf;Tl fl;lzk; fhy;yh fl;lz’;fisa[k; gl;oayplt[k;/ (ck;/ gs;spf;Tl fl;lzk; fhy;yh fl;lz’;fisa[k; gl;oayplt[k;/ (ck;/ gs;spf;Tl fl;lzk; fhytiuf;fhdtiuf;fhdtiuf;fhdtiuf;fhd fl;lzk;. mDkjpf; fl;lzk;. milahs ml;il fl;lzk; )fl;lzk;. mDkjpf; fl;lzk;. milahs ml;il fl;lzk; )fl;lzk;. mDkjpf; fl;lzk;. milahs ml;il fl;lzk; )fl;lzk;. mDkjpf; fl;lzk;. milahs ml;il fl;lzk; ) SCHOOL – 1 NAME____ ___ FACILITY ID: gs;sp ? 1 bgau; gs;spf;Tl trjp milahs vz; :

Classes tFg;g[f;f

s;

Tution Fees fy;tp fl;lz’;fs;

Uniforms rPUilfs;

Books & Stationary g[j;jf’;fs; kw;Wk; vGJ bghUl;fs;

Other Small Fees kw;w rpW fl;lz’;fs;



amoun

t (Rs.)

bjhif (U:)

IF “0” Fwpg;g[ ?;

“0” vdpy;;

→→→→ 175

How often paid? vt;tst[

mof;fo fl;lg;gL fpwJ>

amount (Rs.)

bjhif (U:)

IF “0” Fwpg;g[ :

“0” vdpy; →→→→177177177177



amount (Rs.)

bjhif (U:)


“0” vdpy; →→→→ 179



amount (Rs.)

bjhif (U:)


“0” vdpy; → → → → 181



amount (Rs.)

bjhif (U:)

IF “0” �NEXT

STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;

how often paid? vt;tst[


amount (Rs.)

bjhif (U:)

NOTE : IF “0”

�NEXT STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



Number of times vj;jid jlit

fs;

Per week – 1, Per month – 2, In a Year – 3

thuk;?1 khjk;?2 tUlk;?3

Number of times vj;jid jlit fs;

Per week – 1, Per month – 2, In a Year – 3 thuk;?1 khjk;?2 tUlk;?3

Number of times vj;jid jlit fs ;

Per week – 1,

Per month – 2, In a Year – 3





Number of times vj;ji

d jlit fs ;

Per week – 1, Per month – 2, In a Year - 3



Per week – 1, Per month – 2, In a Year – 3 thuk;?1 khjk;?2 tUlk;?3

Std. 173. 174. 175. 176. 177. 178. 179. 180. 181. 182. 183. 184.

1st Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

2nd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

3rd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

4th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

5th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

6th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

7th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

8th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

9th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

10th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03


SCHOOL – 2 NAME____ ___ FACILITY ID: gs;sp ? 2 bgau; gs;spf;Tl trjp milahs vz; :

Classes tFg;g[f;f

s;


Uniforms rPUilfs;





amount (Rs.)

bjhif (U:)

if 00 ��187



amount (Rs.)

bjhif (U:)

if 00 ��111189898989



amount (Rs.)

bjhif (U:) ;

if 00 ��191



amount (Rs.)

bjhif (U:)

if 00 ��193193193193



amount (Rs.)

bjhif (U:)

IF “0” �NEXT

STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



amount (Rs.)

bjhif (U:) IF “0”

�NEXT STD

Fwpg;g[ : “0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



Number of

times vj;jid jlit

fs ;



Number of

times vj;jid jlit fs ;




P Per week – 1,







d jlit fs ;


thuk;?1 khjk;?2

tUlk;?33

Number of times vj;jid jlit fs ;;



Std. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196.

1st Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

2nd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

3rd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

4th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

5th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

6th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

7th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

8th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

9th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

10th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03



Classes tFg;g[f;f

s;


Uniforms rPUilfs;





amount (Rs.)

bjhif (U:)

if 00 ��199



amount (Rs.)

bjhif (U:)

if 00 ��201



amount (Rs.)

bjhif (U:) ;

if 00 ��203



amount (Rs.)

bjhif (U:)

if 00 ��205



amount (Rs.)

bjhif (U:)

IF “0” � NEXT STD


tFg;gpw;F bry;yt[k;



amount (Rs.)

bjhif (U:) NOTE : IF “0” SKIP TO NEXT

STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



Number of

times vj;jid jlit

fs ;



Number of


P Per week – 1,










d jlit fs ;






Std. 197. 198. 199. 200. 201. 202. 203. 204. 205. 206. 207. 208.

1st Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

2nd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

3rd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

4th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

5th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

6th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

7th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

8th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

9th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

10th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03



Classes tFg;g[f;f

s;


Uniforms rPUilfs;





amount (Rs.)

bjhif (U:)

if 00 ��211



amount (Rs.)

bjhif (U:)

if 00 ��213



amount (Rs.)

bjhif (U:) ;

if 00 ��215



amount (Rs.)

bjhif (U:)

if 00 ��217



amount (Rs.)

bjhif (U:)

IF “0” � NEXT STD


tFg;gpw;F bry;yt[k;



amount (Rs.)

bjhif (U:)

�“0” SKIP TO NEXT

STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



Number of

times vj;jid jlit

fs ;



Number of


P Per week – 1,





thuk;?1 khjk;?2

tUlk;?33


P Per week – 1,




d jlit fs ;






Std. 209. 210. 211. 212. 213. 214. 215. 216. 217. 218. 219. 220.

1st Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

2nd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

3rd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

4th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

5th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

6th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

7th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

8th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

9th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

10th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03



Classes tFg;g[f;f

s;


Uniforms rPUilfs;





amount (Rs.)

bjhif (U:)

if 00 ��223



amount (Rs.)

bjhif (U:)

if 00 ��225



amount (Rs.)

bjhif (U:) ;

if 00 ��227



amount (Rs.)

bjhif (U:)

if 00 ��229



amount (Rs.)

bjhif (U:)

IF “0” �NEXT STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



amount (Rs.)


STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



Number of

times vj;jid jlit

fs ;



Number of











d jlit fs ;






Std. 221. 222. 223. 224. 225. 226. 227. 228. 229. 230. 231. 232.

1st Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

2nd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

3rd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

4th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

5th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

6th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

7th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

8th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

9th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

10th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03



Classes tFg;g[f;f

s;


Uniforms rPUilfs;





amount (Rs.)

bjhif (U:)

if 00 ��235



amount (Rs.)

bjhif (U:)

if 00 ��237



amount (Rs.)

bjhif (U:) ;

if 00 ��239



amount (Rs.)

bjhif (U:)

if 00 ��241



amount (Rs.)

bjhif (U:)

IF “0” �NEXT

STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



amount (Rs.)


STD Fwpg;g[ :

“0” vdpy; mLj;j

tFg;gpw;F bry;yt[k;



Number of

times vj;jid jlit

fs ;



Number of











d jlit fs ;






Std. 233. 234. 235. 236. 237. 238. 239. 240. 241. 242. 243. 244.

1st Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

2nd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

3rd Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

4th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

5th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

6th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

7th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

8th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

9th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03

10th Std 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03 01 02 03


ENROLLMENT AND TEACHER DETAILS khztu; nrh;f;if kw;Wk; Mrpupau; gw;wpa tptu’;fs;khztu; nrh;f;if kw;Wk; Mrpupau; gw;wpa tptu’;fs;khztu; nrh;f;if kw;Wk; Mrpupau; gw;wpa tptu’;fs;khztu; nrh;f;if kw;Wk; Mrpupau; gw;wpa tptu’;fs;

School number

gs;spf; Tl vz;

Details of Enrolled Students gs;spapy; nru;e;J gof;Fk; khztu;fspd;;; tptu’;fs;

Number of teachers Mrpupau;fspd; vz;zpf;if

Headmaster jiyik Mrpupah;

number of male students

Mz;;Mz;;Mz;;Mz;; khztu;fspd; vz;zpf;if

(2008 – 2009)

number of female students

bgz;;;bgz;;;bgz;;;bgz;;; khztpfspd;

vz;zpf;if (2008 – 2009)

what percent of enrolled students are in school on a

typical day?

gs;spapy; nru;e;J gof;Fk; khztu;fspy; vj;jid rjtPjk; ngu; xU ruhrup

ehspy; gs;spf;F tUfpwhu;fs;> (2008 – 2009)

enrollment for previous school year

Ke;ija Mz;oy; khztu; nru;f;if

(2007 – 2008)

Sex ghypdk;

Qualification fy;tpj; jFjp

high school diploma

cau;epiy fy;tp- gl;lag; gog;g[

01

graduate degree ,sepiy gl;ljhup

02

post-graduate degree

KJepiy gl;ljhup

03

Male

Mz; Female

bgz; Male

Mz; Female

Bgz;

245. 246. 247. 248. 249. 250. 251.

S1

01 02

S2 01 02

S3 01 02

S4 01 02

S5 01 02

S6 01 02


SCHOOLS FACILITIES AND PROGRAMS gs;spf;Tl’;fs; ? trjpfs; kw;Wk; jpl;l’;fs;gs;spf;Tl’;fs; ? trjpfs; kw;Wk; jpl;l’;fs;gs;spf;Tl’;fs; ? trjpfs; kw;Wk; jpl;l’;fs;gs;spf;Tl’;fs; ? trjpfs; kw;Wk; jpl;l’;fs;

SL

Source of drinking

water CODE

FoePUf; fhd

Mjhuk; FwpaPL

Does the school have

electricity? gs;spf; Tlj;jp;y; kpd; trjp ,Uf;fpw

jh>

Does your school have a library? c’;fs;

gs;spapy; xU E}yfk; cs;sjh>

If yes, approximately how many books does it have? \ Mk;

vdpy; . njhuha khf mjpy;

vj;jid g[j;jf’;f

s; cs;sd>

Does the school provide midday meals? gs;spapy; kjpa czt[ tH’;fg;

gLfpwjh> 01 = yes, to all

students Mk;/

vy;nyhUf;Fk; 02 = yes, only to

some students Mk;. rpy

khztu; fSf;F kl;Lk; 03 = no

,y;iy

Does school have a parents' committee or PTA? gs;spapy; bgw;nwhu; mikg;g[ my;yJ bgw;nwhh; Mrpupau; fHfk; cs;sjh>

If yes, how many times has it met in the previous

year?

Mk; vdpy;. mJ fle;j tUlj;jpy; vj;jid Kiw To cs;sJ>

vz;zpf;if

How many [ . . .] does your school have? c’;fs; gs;spapy; vj;jid /////// cs;sJ>

Does the school have [ . . .]? 1 = yes; 2 = no [ . . .]gs;spapy; ,Uf;fpwjh> 1=Mk;. 2=,y;iy

Computers for students khztu;fs; gad; gLj;j fk;g;a{l;lu;fs;

Functional Lavatories cgnahfhj;jpy; ,Uf;Fk; fHpg;giwfs;

Black boards fUk; gyif fs; vz;zpf;if NOs. vz;zpf;vz;zpf;vz;zpf;vz;zpf;ifififif

Classroomfor teaching. ghlk; elj;Jk; tFg;giwfspd; vz;zpf;if NOs. vz;zpf;ifvz;zpf;ifvz;zpf;ifvz;zpf;if

Laboratory gupnrhjidf;

Tlk;

Playground / sports field

tpisahl;L ikjhdk

FURNITURE FOR

TEACHERS Mrpupau; fSf;fhd ehw;fhyp nkirfs;

connected to internet ,d;lu;; bel; ,izg;g[ld; vj;jid cs;sd> NOs. vz;zpf;ifvz;zpf;ifvz;zpf;ifvz;zpf;if

not connected ,d;lu; bel; ,izg;g[ ,y;;yhky; vj;jid cs;sd> NOs. vz;zpf;ifvz;zpf;ifvz;zpf;ifvz;zpf;if

girls only khztpfSf;F kl;Lk; NOs. vz;zpf;ifvz;zpf;ifvz;zpf;ifvz;zpf;if

Common toilet ,UghyUf;fhd fHptiw NOs. vz;zpf;ifvz;zpf;ifvz;zpf;ifvz;zpf;if

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

→ → → → 256256256256

Yes Mk;

No ,y;iy

→→→→ 259259259259

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

252. 253. 254. 255. 256. 257. 258. 259. 260. 261. 262. 263. 264. 265. 266. 267.

S1 01 02 01 02

01 02

01 02 01 02 01 02

S2 01 02 01 02

01 02

01 02 01 02 01 02

S3 01 02 01 02

01 02

01 02 01 02 01 02

S4 01 02 01 02

01 02

01 02 01 02 01 02

S5 01 02 01 02

01 02

01 02 01 02 01 02

S6 01 02 01 02

01 02

01 02 01 02 01 02


ALL HEALTH CARE PROVIDERS OFFERING MEDICAL CARE/SER VICE WITHIN A 10-MINUTE WALKING RADIUS AROUND PERI METER OF THE BLOCK gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk; gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk; gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk; gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk; J}uJ}uJ}uJ}uj;jpw;Fsj;jpw;Fsj;jpw;Fsj;jpw;Fs;;;; mike;Js;s mike;Js;s mike;Js;s mike;Js;s kUj;Jt nrit tpsk;gu milkUj;Jt nrit tpsk;gu milkUj;Jt nrit tpsk;gu milkUj;Jt nrit tpsk;gu milahahahahsk; bfhz;l sk; bfhz;l sk; bfhz;l sk; bfhz;l Rfhjhu nrit Rfhjhu nrit Rfhjhu nrit Rfhjhu nrit mspf;Fk; midj;Jk; mspf;Fk; midj;Jk; mspf;Fk; midj;Jk; mspf;Fk; midj;Jk;

HE

AL

TH

PR

OV

IDE

R

ID

R

fhjh

u nr

itaspg;gt

u; m

ilahs

vz

; LIST NAMES OF ALL

PROVIDERS, WITH A SIGN,

WITHIN A 10 MINUTE

WALKING DISTANCE OF

BLOCK

ngl;oahsu; = gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk; tpl;lj;jpw;Fs; mike;Js;s kUj;Jt nrit tpsk;gu milahsk; bfhz;l Rfhjhu nrit mspf;Fk; midj;Jk; nrit fisa[k; gl;oayplt[k;

GPS Reading $p gp v!; fzf; bfLg;g[

What year was the facility

established?

,e;j ikak; ve;j Mz;L

Jtf;fg; gl;lJ>

YYYY

What type of health facility is this? [CODE]

,J vd;d

tifahd trjp (fPnH

bfhLf;fg;gl;Ls;s FwpaPLfis gad;gLj;Jf)

FACILITIES PROVIDED (READ OUT) Multicoding Possible

tH’;fg;gLk; kUj;Jt trjpfs; (gof;ft[k;)

gy gjpy;fs; rhj;jpak;

Prenatal check-ups

Kd; ngU fhy gupnrhjid

Delivery gpurtk;

Family Planning FLk;gf; fl;Lg;ghL - FHe;ij gpwg;g[

fl;Lg;ghL

Immuniza ions

jLg;g{rpfs;

First Aid KjYjtp

Nutritional Suppliments Cl;lr; rj;J

tH’;fy;

Medicines kUe;J

General Health Education /

Advice bghJ cly; eyf; fy;tp - mwpt[iu

268. 269. 270. 271. 272.

H1 N 01 02 03 04 05 06 07 08

E

H2 N 01 02 03 04 05 06 07 08

E

H3 N 01 02 03 04 05 06 07 08

E

H4 N 01 02 03 04 05 06 07 08

E

H5 N 01 02 03 04 05 06 07 08

E

H6 N 01 02 03 04 05 06 07 08

E


HE

AL

TH

PR

OV

IDE

R

ID

R

fhjh

u nr

itaspg;gt

u; m

ilahs

vz

;

LIST NAMES OF ALL

PROVIDERS, WITH A SIGN,

WITHIN A 10 MINUTE

WALKING DISTANCE OF

BLOCK

ngl;oahsu; = gpshf;fpd; cs;ns my;yJ 10 epkpl elf;Fk; tpl;lj;jpw;Fs; mike;Js;s kUj;Jt nrit tpsk;gu milahsk; bfhz;l Rfhjhu nrit mspf;Fk; midj;Jk; nrit fisa[k; gl;oayplt[k;

GPS Reading $p gp v!; fzf; bfLg;g[

What year was the facility

established?

,e;j ikak; ve;j Mz;L

Jtf;fg; gl;lJ>

YYYY

What type of health facility is this? [CODE]

,J vd;d

tifahd trjp (fPnH

bfhLf;fg;gl;Ls;s FwpaPLfis gad;gLj;Jf)

FACILITIES PROVIDED (READ OUT) Multicoding Possible

tH’;fg;gLk; kUj;Jt trjpfs; (gof;ft[k;)

gy gjpy;fs; rhj;jpak;

Prenatal check-ups

Kd; ngU fhy gupnrhjid

Delivery gpurtk;

Family Planning FLk;gf; fl;Lg;ghL - FHe;ij gpwg;g[

fl;Lg;ghL

Immuniza ions

jLg;g{rpfs;

First Aid KjYjtp

Nutritional Suppliments Cl;lr; rj;J

tH’;fy;

Medicines kUe;J

General Health Education /

Advice bghJ cly; eyf; fy;tp - mwpt[iu

268. 269. 270. 271. 272.

H7 N 01 02 03 04 05 06 07 08

E

H8 N 01 02 03 04 05 06 07 08

E

H9 N 01 02 03 04 05 06 07 08

E

H10 N 01 02 03 04 05 06 07 08

E


Health facilityCODE Rfhjhu Rfhjhu Rfhjhu Rfhjhu trjpfs; FwpaPLtrjpfs; FwpaPLtrjpfs; FwpaPLtrjpfs; FwpaPL

Public Medical Sector bghJ kUj;Jtj;JiwbghJ kUj;Jtj;JiwbghJ kUj;Jtj;JiwbghJ kUj;Jtj;Jiw

Private Medical Sector jdpahh; kUj;Jtj;Jiwjdpahh; kUj;Jtj;Jiwjdpahh; kUj;Jtj;Jiwjdpahh; kUj;Jtj;Jiw

Govt./Municipal Hospital murh';f-Kdp!pgy; kUj;Jtkid 01

Private Hospital; jdpahh; kUj;Jtkid 13

Govt. Dispensary murh';f kUe;jfk; 02

Private Doctor / Clinic jdpahh; kUj;Jtu; - kUe;jfk; 14

UHV/UHP/UFWC a[b\r;tp - a[b\r;gp - a[v`g;rplgps;a[rp 03

Private mobile clinic jdpahh; bkhigy; kUe;jfk; 15

CHC/Rural Hospital/PHC rpb\r;rp- fpuhkg;g[w kUj;Jtkid- Muk;g Rfhjhu ikak;

04

Ayurvedic doctor [Vaidya/Hakim/Homeopath]

Ma[h;ntj kUj;Jth; (itj;jpau;-\f;fpk;-n\hkpnahgjp

16

Sub Centre Jiz ikak ; 05

Traditional Healer ghuk;gupa itj;jpau; 17

Govt. Mobile Clinic murh';f elkhLk; fpspdpf; 06

Pharmacy/ Dispensary kUe;J fil-kUe;J tH’;Fkplk; 18

Camp Kfhk; (nfk;g;) 07

Dai (TBA) brtpypj;jha; (ogpV) 19

Anganwadi/ICDS center m';fd;tho-Irpov!; brd;lh; 08

Other private sector health facility kw;w jdpahh; Jiw Mnuhf;fpa trjpfs; 20

Other Public sector health facility kw;w bghJj;Jiw Mnuhf;fpa trjpfs; 09

Other kw;wit 21

Other Government/ Public medical facility kw;w murh’;f-bghJ kUj;Jt trjpfs; 10

Don’t know bjupahJ 11 NGO or Trust Hospital/Clinic

vd;$pX my;yJ mwf;fl;lis kUj;Jtkid-fpspdpf; 12

Birth Control CODE Options Code Female sterilization bgz;fSf;fhd fUj;jil mWit rpfpr;ir

01

Male sterilization Mz;fSf;fhd fUj;jil mWit rpfpr;ir

02

Pills fUj;jil khj;jpiufs; 03

Injectables / Implants Crp K:yk; brYj;jg;gLtJ-clYf;Fs; bghUj;jg;gLtJ

04

IUD / Loop Ia[o- Y}g; 05

Condom Mqiw 06

Diaphragm (lnah`ghk;) bgz;fSf;fhd fUj;jil rhjdk;

07

Foam / jelly `nghk; - b$y;yp 08

Emergency contraception mtru fhy fUj;jil rhjdk; 09

Induced abortion J}z;lg;gl;l fUf;iyg;g[ 10

Others (specify) kw;wit (Fwpg;gplt[k;) 11


HEALTH PROVIDERS: STAFF AND FACILITIES RfhjhuRfhjhuRfhjhuRfhjhu nritaspg;gtu;nritaspg;gtu;nritaspg;gtu;nritaspg;gtu; ? mYtyu;fs; kw;Wk; trjpfs;? mYtyu;fs; kw;Wk; trjpfs;? mYtyu;fs; kw;Wk; trjpfs;? mYtyu;fs; kw;Wk; trjpfs;

HE

ALT

H P

RO

VID

ER

ID

Rfh

jhu nr

itaspg;gt

u; m

ilahs

vz

; Is the head of this facility a

medical doctor?

,e;j kUj;Jt ikaj;jpd; jiytu; xU kUj;Jt lhf;luh>

01 = yes 02 = no 01=Mk;

02=,y;iy

How many hours a

week does this head of this facility work here?

,e;j kUj;Jt ikaj;jpd; jiytu; thuj;jpy; vj;jid

kzp neuk; ,';F ntiy bra;fpwhu;>

Number of full time staff (don't include head)

KG neu mYtyu;fspd; vz;zpf;if (jiytiur; nru;f;f ntz;lhk;)

Number of part time staff (don't include head)

gFjp neu mYtyu;fspd; vz;zpf;if (jiytiur; nru;f;f ntz;lhk;)

How many patients are

treated in this facility in a typical day? xU ruhrup

ehisf;F ,e;j ikaj;jpy; vj;jid

nehahspfs; rpfpr;ir

bgWfpwhu;fs;>

Number of beds available for treatment and

delivery rpfpr;ir kw;Wk; gpurtj;jpw;F fpilf;Fk;

gLf;iffspd; vz;zpf;if

Is every patient that enters the facility examined by an Medical Doctor

(MBBS / MD / MS, etc)?

,e;j ikaj;jpw;Fs; EiHa[k; xt;bthU nehahspiaa[k;

lhf;lu; gupnrhjpf;fpwhuh>

01 = yes 02 = no 01=Mk;. 02=,y;iy

Does the facility have electricity?

,e;j ikaj;jpy; kpd;trjp cs;sjh>

01 = Yes 02 = No 01=Mk;.

02=,y;iy

Doctors lhf;lu;fs;

Nurses eu;Rfs;

Other F-T employees

kw;w KGneu gzpahsh;fs;

Doctors lhf;lu;fs;

Nurses eu;Rfs;

Other P-T employees

kw;w gFjp neu gzpahsh;fs;

Male Mz;

Female bgz;

Male Mz;

Female bgz;

273. 274. 275. 276. 277. 278. 279. 280. 281. 282. 283. 284.

H1 01 02

01 02 01 02

H2 01 02

01 02 01 02

H3 01 02

01 02 01 02

H4 01 02

01 02 01 02

H5 01 02

01 02 01 02

H6 01 02

01 02 01 02

H7 01 02

01 02 01 02

H8 01 02

01 02 01 02

H9 01 02

01 02 01 02

H10 01 02

01 02 01 02


HEALTH PROVIDERS: STAFF AND FACILITIES - FUNCTIONIN G HOURS

Rfhjhu nritaspg;gtu; ? mYtyu;fs; kw;Wk; trjpfsRfhjhu nritaspg;gtu; ? mYtyu;fs; kw;Wk; trjpfsRfhjhu nritaspg;gtu; ? mYtyu;fs; kw;Wk; trjpfsRfhjhu nritaspg;gtu; ? mYtyu;fs; kw;Wk; trjpfs;;;; = ,a’;Fk; neuk= ,a’;Fk; neuk= ,a’;Fk; neuk= ,a’;Fk; neuk

HE

AL

TH

FA

CIL

ITY

ID

Rf

hjhu

trj

pfs; m

ilahs

vz

; Sunday “hapW

Monday jp’;fs;

Tuesday brt;tha;

Wednesday g[jd;

Total Hours kept open

jpwe;jpU f;Fk;

bkhj;j neuk;

Tim

e o

pen

jpwf

;Fk n

euk;

AM

fh

iy

PM

khi

y

Tim

e cl

osi

ng

K:Lk; n

euk;

AM

fh

iy

PM

khi

y


jpwe;jpU f;Fk;

bkhj;j neuk;

Tim

e o

pen

jpwf

;Fk; n

euk;

AM

fh

iy

PM

khi

y

Tim

e cl

osi

ng

K:Lk; n

euk;

AM

fh

iy

PM

khi

y


jpwe;jpU f;Fk;

bkhj;j neuk;

Tim

e o

pen

jpwf

;Fk; n

euk;

AM

fhi

y

PM

kh

iy

Tim

e cl

osi

ng

K:Lk; n

euk;

AM

fh

iy

PM

khi

y


jpwe;jpU f;Fk;

bkhj;j neuk;

Tim

e o

pen

jpwf

;Fk; n

euk;

AM

fh

iy

PM

khi

y

Tim

e cl

osi

ng

K:Lk; n

euk;

AM

fhi

y

PM

khi

y

285. 286. 287. 288. 289. 290. 291. 292. 293. 294. 295. 296.

H1 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H2 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H3 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H4 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H5 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H6 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H7 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H8 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H9 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02

H10 01 02 01 02 01 02 01 02 01 02 01 02 01 02 01 02


H

EA

LTH

FA

CIL

ITY

ID

cly; e

y t

rjpfs;

mi

lahs

vz

;

Thursday tpahHd;

Friday bts;sp

Saturday rdp


jpwe;jpUf;Fk;

bkhj;j neuk;

Time open

jpwf;Fk; neuk;

AM

fh

iy

PM

khi

y

Time closing K:Lk; neuk;

AM

fh

iy

PM

khi

y


jpwe;jpUf;Fk;

bkhj;j neuk;

Time open

jpwf;Fk; neuk;

AM

fh

iy

PM

khi

y


AM

fh

iy

PM

khi

y


jpwe;jpUf;Fk;

bkhj;j neuk;

Time open

jpwf;Fk; neuk;

AM

fh

iy

PM

khi

y


AM

fh

iy

PM

K

hiy

297. 298. 299. 300. 301. 302. 303. 304. 305.

H1 01 02 01 02 01 02 01 02 01 02 01 02

H2 01 02 01 02 01 02 01 02 01 02 01 02

H3 01 02 01 02 01 02 01 02 01 02 01 02

H4 01 02 01 02 01 02 01 02 01 02 01 02

H5 01 02 01 02 01 02 01 02 01 02 01 02

H6 01 02 01 02 01 02 01 02 01 02 01 02

H7 01 02 01 02 01 02 01 02 01 02 01 02

H8 01 02 01 02 01 02 01 02 01 02 01 02

H9 01 02 01 02 01 02 01 02 01 02 01 02

H10 01 02 01 02 01 02 01 02 01 02 01 02


FORMAL AND INFORMAL FINANCIAL INSTITUTIONS FOR SAVI NGS, CREDIT, INSURANCE

nrkpg;g[ . fld; . fhg;gPl;ow;fhd Kiwahd kw;Wk; Kiwnrkpg;g[ . fld; . fhg;gPl;ow;fhd Kiwahd kw;Wk; Kiwnrkpg;g[ . fld; . fhg;gPl;ow;fhd Kiwahd kw;Wk; Kiwnrkpg;g[ . fld; . fhg;gPl;ow;fhd Kiwahd kw;Wk; Kiwrhuhrhuhrhuhrhuh epjp epWtd’;fs;epjp epWtd’;fs;epjp epWtd’;fs;epjp epWtd’;fs;

CODE/

TYPE

FwpaPLFwpaPLFwpaPLFwpaPL---- tiftiftiftif

Agency epWtdk;

[…] in this block, or within a 10 minute walkable distance of this

block? ,e;j […] gpshf;fpd; cs;ns my;yJ 10

epkpl eilJhuj;jpy; cs;sjh>

If YES, Number in the vicinity ?

Mk; vdpy;. mg;gFjpaps;

cs;s vz;zpf;if

� NEXT ROW � mLj;j thpir

If NO, distance of nearest to this (km.to.00)

,y;iy vd;why; . mUfhikapy; cs;sjw;F vt;tst[ J}uk;> (fp kP .00)

Yes Mk;

No ,y;iy

��308 CODE 306. 307. 308.

1 Commercial Banks – Public Sector Bank (e.g., SBI) tzpf hPjpapyhd t’;fpfs; ? bghJj;Jiw t’;fpfs; (cjhuzk; v!;gpI) 01 02

2 Commercial bank: Gramya banks (e.g.,RRBs) tzpf hPjpapyhd t’;fpfs; ? fpuhkpa t’;fpfs; (cjhuzk; Mu;Mu;gp) 01 02

3 Commercial Bank – private commercial banks (ex: ICICI) tzpf hPjpapyhd t’;fpfs; ? jdpahh; tzpf hPjpapyhd t’;fpfs; (cjhuzk; ? IrpIrpI)

01 02

4

Commercial Bank – Foreign Bank (ex: HSBC) tzpf hPjpapyhd t’;fpfs; ? btspehl;L t’;fp (cjhuzk; b\r;v!;gprp) 01 02

6 Cooperative Commercial Bank Tl;Lwt[ tzpf t’;fp 01 02

7 Agricultural credit societies tptrhaf; fld; cjtp r’;f’;fs; 01 02

8 Non-agricultural credit societies tptrhak; my;yhj kw;w fld; cjtp r’;f’;fs; 01 02

9 Other credit societies kw;w fld; tH’;Fk; r’;f’;fs; 01 02

10 Insurance agent fhg;gpl;L Kftu; 01 02

11 Post Office m”;ry; epiyak; 01 02

12 Other (specify)

kw;wit (Fwpg;gplt[k;) 01 02

Informal institutions Kiwrhuh epWtd’;fs; /;Kiwrhuh epWtd’;fs; /;Kiwrhuh epWtd’;fs; /;Kiwrhuh epWtd’;fs; /;

13 Self help Groups (SHGs) Ra cjtp FGf ;fs ; 01 02

14 Micro Finance Institutions (MFIs) FW epjp epWtd’ ;fs ; 01 02

15 Other Non-banking financial institutions (like Nidhi companies, etc) kw ;w t’ ;fprhuh epjp epWtd’ ;fs ; (cjhuzk ; epjp epWtd’ ;fs ; ,ju) 01 02

16 Professional money lenders tl;of;F gzk; bfhLg;gtu; 01 02

17 Chit funds rpl; `gz;L fk;bgdpfs; 01 02


FINANCIAL INSTITUTIONS WITHIN THE BLOCK, OR WITHIN A 10-MINUTE WALKABLE DISTANCE OF THIS BLOCK: DETAIL S ,e;j ,e;j ,e;j ,e;j gpshf;fgpshf;fgpshf;fgpshf;fpy; my;yJ ,e;j py; my;yJ ,e;j py; my;yJ ,e;j py; my;yJ ,e;j gpshf;fpgpshf;fpgpshf;fpgpshf;fpypUe;J ypUe;J ypUe;J ypUe;J 10 epkpl 10 epkpl 10 epkpl 10 epkpl eil J}uj;jpy; cs;s epjp epWtd’;fs; xt;bthd;iwa[k; gw;wpa tpupthd jfty;fs; eil J}uj;jpy; cs;s epjp epWtd’;fs; xt;bthd;iwa[k; gw;wpa tpupthd jfty;fs; eil J}uj;jpy; cs;s epjp epWtd’;fs; xt;bthd;iwa[k; gw;wpa tpupthd jfty;fs; eil J}uj;jpy; cs;s epjp epWtd’;fs; xt;bthd;iwa[k; gw;wpa tpupthd jfty;fs;

Fin

anci

al in

stu

titio

n F

AC

ILIT

Y I

D

epjp e

pWtdj;j

pd; m

ilahs

vz

; LIST ALL INSTITUTIONS –

vy;yh epWtd’;fisa[k; gl;oayplt[k; ? KGg; bgaiua[k; vGjt[k; [note: i. If there are 2 Commercial Banks it would be

listed as separate institutions ii. If person, Record Name of the Person and the Institution associated)

(Fwpg;g[ ? 1 ) ,uz;L tu;j;jf t’;fpfs; ,Ue;jhy;;. jdpj;jdp epWtd’;fshf vGjt[k;/ 2) ? jdp egu; vdpy; mtupd; bgaiu Fwpg;gpl;L mtu; rhh;e;jpUf;Fk; epWtdj;ij Fwpg;gplt[k;

Agency Type (from previous page, first column)

CODE Vb$d;rp FwpaPL tif (Ke;ija gf;fj;jpy; Kjy; tupirapypUe;J)

GPS Reading

$p gp v!; fzf;bfLg;g[

Year of establishment Jtf;fg;gl;l

tUlk;

YYYY

Is this institution a branch of some other institution

,e;j epWtdk; ntW epWtdj;jpd; fpisah>

Take deposits itg;g[ epjpfs; vLj;Jf; bfhs;sg; gLfpwjh>

Avg. Interest on deposits (%)? KjyPl;Lf;fhd ruhrup tl;o (%)?

Give Loans. fld;fs; jug;gLfpwjh>

Average Interest on Loans (%)? fld;fSf;fhd ruhrup tl;o (%)?

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

��316

Yes Mk;

No ,y;iy �NEXT ROW

mLj;j thpir

309. 310. 311. 312. 313. 314. 315. 316. 317.

FI

N:

01 02 01 02

01 02

E:

F2

N:

01 02 01 02

01 02

E:

F3

N:

01 02 01 02

01 02

E:

F4

N:

01 02 01 02

01 02

E:

F5

N:

01 02 01 02

01 02

E:

F6

N:

01 02 01 02

01 02

E:

F7

N:

01 02 01 02

01 02

E:


Fin

anci

al in

stu

titio

n F

AC

ILIT

Y I

D

epjp e

pWtdj;j

pd; m

ilahs

vz

;

LIST ALL INSTITUTIONS –

vy;yh epWtd’;fisa[k; gl;oayplt[k; ? KGg; bgaiua[k; vGjt[k; [note: i. If there are 2 Commercial Banks it would be

listed as separate institutions ii. If person, Record Name of the Person and the Institution associated)

(Fwpg;g[ ? 1 ) ,uz;L tu;j;jf t’;fpfs; ,Ue;jhy;;. jdpj;jdp epWtd’;fshf vGjt[k;/ 2) ? jdp egu; vdpy; mtupd; bgaiu Fwpg;gpl;L mtu; rhh;e;jpUf;Fk; epWtdj;ij Fwpg;gplt[k;

Agency Type (from previous page, first column)

CODE Vb$d;rp FwpaPL tif (Ke;ija gf;fj;jpy; Kjy; tupirapypUe;J)

GPS Reading

$p gp v!; fzf;bfLg;g[

Year of establishment Jtf;fg;gl;l

tUlk;

YYYY

Is this institution a branch of some other institution

,e;j epWtdk; ntW epWtdj;jpd; fpisah>

Take deposits itg;g[ epjpfs; vLj;Jf; bfhs;sg; gLfpwjh>

Avg. Interest on deposits (%)? KjyPl;Lf;fhd ruhrup tl;o (%)?

Give Loans. fld;fs; jug;gLfpwjh>

Average Interest on Loans (%)? fld;fSf;fhd ruhrup tl;o (%)?

Yes Mk;

No ,y;iy

Yes Mk;

No ,y;iy

��316

Yes Mk;

No ,y;iy �NEXT ROW

mLj;j thpir

309. 310. 311. 312. 313. 314. 315. 316. 317.

F8

N:

01 02 01 02

01 02

E:

F9

N:

01 02 01 02

01 02

E:

F10

N:

01 02 01 02

01 02

E:

52 URBAN QUESTIONNAIRE B- Block Approach

UFS BLOCK APPROACH INFORMATION SHEET

1. Name of Town fpuhkj;jpd; bgau;

2. Taluk jhYf;fh

3. District khtl;lk;

4. Place of stay j’;Fkplk;

5. Distance from the UFS Block

6. Mode of Transport nghf;Ftuj;J trjp

Car hire thlif fhh; 01

Public Transport bghJ nghf;Ftuj;J 02

7. If hired car, what is the Common public Transport available thliff;F fhu; mku;j;jpf; bfhz;lhy;. m’;F

bghJthf gad;gLj;jg;gLk; nghf;Ftuj;J

trjp vd;d>

8. Central Point of Block

9. GPS location at Central point of Block

N: . .

E: . .

10. Elevation gug;gst[

Meters

53 URBAN QUESTIONNAIRE B- Block Approach

11. Bus Facility ngUe;J trjp

Bus Route Nos / Other Transport facility* ngUe;J tHpj;

jl’;fspd; vz;fs; -

kw;w nghf;Ftuj;J

trjpfs;

Bus en route ngUe;J tHpj;jlk;

Where should we v’;F ehk;

Distance to Block from the place we got down (KMs) (If at Block, Record as 00)

Time of First service in a day Kjy; nritapd;

neuk;

Time of Last service in a day filrp

nritapd; neuk;

No. of times a day xU ehspy;

vj;jid

nritfs;

Starting Point Muk;gpf;Fk;

,lk;

Destination nrUkplk;

get in? (Place) Vwntz;oa (,lk;)

get down? (Place) ,w’;fntz;oa (,lk;)

* Specify the Transport facility (like Van, Share auto, Trucker, Tempo, etc) nghf;Ftuj;J trjpia Fwpg;gpLf (ntd;. n&u; Ml;nlh. ouf;fu;. blk;ngh ,ju)

12. If need to take another Bus… ntW xU ngUe;ij vLf;f ntz;oapUe;jhy;///

Bus Route Nos / Other Transport facility* ngUe;J tHpj;

jl’;fspd; vz;fs; -

kw;w nghf;Ftuj;J

trjpfs;

Bus en route nghf;Ftuj;J tHp

Where should we v’;F ehk;

Distance to block from the place

we got down (KMs) (If at Block, Record as 00)

Time of First service in a day Kjy; nritapd;

neuk;

Time of Last service in a day filrp

nritapd; neuk;

No. of times a day xU ehspy;

vj;jid

nritfs;

Starting Point Muk;gpf;Fk;

,lk;

Destination nrUkplk;

get in? (Place) Vwntzoa (,lk;)

get down? (Place) ,w’;fntzoa (,lk;)

* Specify the Transport facility (like Van, Share auto, Trucker, Tempo, etc) nghf;Ftuj;J trjpia Fwpg;gpLf (ntd;. n&u; Ml;nlh. ouf;fu;. blk;ngh ,ju)

54 URBAN QUESTIONNAIRE-Key Informant Data

RECORD NAMES OF KNOWLEDGEABLE PERSONS AND OFFICIALS (WITH DESIGNATION) CONTACTED FOR OBTAINING DATA IN URBAN SCHEDULE.

SL.

SECTION NO. bjhFjp vz;

SUB.SECT. NO. Jizj; bjhFjp

vz;

SECTION NAME [SPECIFY] bjhFjp bgau; (Fwpg;gplt[k;)

RESPONDENT NAME WITH INITIAL gjpyspg;gtupd; bgau; ,dp&paYld;

DESIGNATION [SPECIFY] gjtp (Fwpg;gplt[k;)

1 2 1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

tamil nadu panel survey urban questionnaire : part …€¦ · urban block questionnaire: part a...

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