SL Service delivered

SPOC Services
No. by/through
Growth Monitoring and
1 AWW (ICDS)
promotion
Breastfeeding and
AWW (ICDS) and
2 complementary feeding
ASHA
counselling
Counseling on nutrition AWW (ICDS) and
3
during pregnancy ASHA

Take home rations for

4 pregnant and lactating AWW (ICDS)
women and children under 3

5 Immunization ANM (NHM)

6 Vitamin A ANM (NHM)

ANM (NHM) and

7 IFA supplementation
AWW

Iron supplementation for

8 ANM (NHM)
children

9 Deworming ANM (NHM)

10 ANC checkups ANM (NHM)

Management of Acute
11 ANM (NHM)
Malnutrition

12 ANM (NHM)
Diarrhea Management
(ORS+Zn)
13 ANM (NHM)

14 ODF villages

Villages with safe drinking

15
water supply

SHGs to track no of children

16 sent to NRC, discharged
from the NRC
No of children supported
17 through VRFs with transport
to NRC /health facility
 IEC tools on health and
18 nutrition disseminated at
the village level.
Trainings and VHSND done
19 in Panchayat or community
centres
IFA supplementation for
20
adolescents

22 Deworming for adolescents

 Source/
Indicators to track progress Baseline (%)
Frequency
% of children 0 to 3 years who wereweighed ICDS-CAS/
during the previous month Monthly
% home visits to households with children 0 ICDS-CAS/
to 24 months to counsel on appropriate IYCF Monthly
% home visits to household with pregnant
ICDS-CAS/
mothers to counsel on appropriate
Monthly
practices during pregnancy

% PLW and children under 3 who received ICDS-CAS/

mandated THR in the previous month Monthly

% of children less than one year of age fully

Monthly
immunized
% of children 6 to 59 months who received
at least one dose of Vitamin A during the Quarterly
last 6 months
% of pregnant women who received IFA
Monthly
tablets in the previous month
% of children 6 to 59 months who were
provided recommended dose of the syrup Monthly
during the previous month
% of children 6 to 59 months who received
at least one albendazole tablet during the Quarterly
last 6 months
% of pregnant women in their third
Monthly
trimester who received at least 3 ANCs
% of SAM children treated appropriately at
Quarterly
the health facility/community level
% of children with diarrhea 0 to 60 month
who received ORS during the previous
month Monthly
% of children with diarrhea 0 to 60 who
received the recommended dose of zinc
tablets during the previous
% of ODF free villages Quarterly

% of villages with safe drinking water

Quarterly
supply

% of SHGs trained on a package of basic

nutrition, health, sanitation and hygiene Quarterly
behaviours
% of SHGs trained on a package of basic
nutrition, health, sanitation and hygiene Quarterly
behaviours

% of adolescent girls who received IFA

Monthly
tablets in the previous month
% of adolescent girls who received at least
one albendazole tablet during the last 6 Quarterly
months
 Baseline Format: Comprehensive Village Template

I. Basic Data of the Village

S.No. Information

1 District

2 Block

3 Gram Panchayat

4 Village

5 No. of Hamlets

Hamlet Details

S.No. Name of the Hamlet

Total

6 Average Annual Rainfall (in mm)

7 Soil Type

II. Demographic Data

S.No. Category

1 All

2 SC

3 ST

4 Age Group-wise Distribution

i) 0-6 yrs.
 ii) 6-14 yrs.

iii) 14-18 yrs.

iv) 18-35 yrs.

v) 35-60 yrs.
vi) 60-80 yrs.
vii) > 80 yrs.
Total Working Age Population
Persons with Disabilities
i) Total
ii) Breakdown by Disability Type
i) Blind/ Low Vision
ii) Hearing impaired
iii) Locomotor Disability
iv) Leprosy- cured
v) Mentally Ill

III. Housing

S.No. Information

1 No. of Families in the Village

2 Out of (1), No. of Families

i) Living in Pakka Houses

ii) Living in Kachcha Houses

iii) Total
 iv) Homeless

3 Out of Total No. of Houses, Those with

i) Electricity

ii) TV

iii) Sanitary Latrine

Total SC

Total ST

IV. Economic Status of Families/Households

S.No. Category

1 Total Families/Households

2 Out of (1),

i) SC Households

ii) ST Households

3 Out of (1),

i) BPL Households

ii) Households with NREGA Job-cards

4 Out of (1), Households primarily

dependent on:

i) Agriculture

ii) Dairy

iii) Fisheries

iv) Poultry and other Meat Production

v) Forestry

vi) Mining & Quarrying

vii) Rural Artisan

 viii) "Un-clean" Occupations

ix) Job Employment

x) Casual Wage Employment

V. Land-h

S.No. Category

1 Total Households

2 Out of (1), No. of

i) Landed Households

ii) Landless Households

3 i) Landed Households

ii) Landless Households

4 Break-up of Hous

i) < 01 Acre

ii) 1 - 2.5 Acres

iii) 2.5 - 5 Acres

iv) 5 - 10 Acres

v) > 10 Acres

5 Land Holding Pattern in Respec

Unirrigated

Irrigated

i) from Govt.

sources

ii) from Pvt.

sources

iii) Total
 Irrigated

Grand Total

(Irri. &Unirrigated)

VI. Agriculture

| S.No. | Category | Total Land Area

Baseline Format: Comprehensive Village Template

VI. Agriculture

S.No. Category

1 Total Cultivable Land Area

2 Irrigated Land Area

3 Rainfed Land Area

4 Type of Crops Grown

i) Food Crops

ii) Cash Crops

iii) Horticultural Crops

iv) Other Crops

5 Livestock

i) Cattle

ii) Buffalo

iii) Sheep

iv) Goat

v) Poultry

6 Fisheries
 i) Inland Fisheries

ii) Aquaculture

7 Agriculture Practices

i) Organic Farming

ii) Use of Fertilizers

iii) Use of Pesticides

VII. Infrastructure and Services

S.No. Category

1 Road Connectivity

i) Pucca Roads

ii) Kutcha Roads

2 Electricity Availability

i) Household Electrification

ii) Street Lighting

3 Drinking Water Availability

i) Tap Water

ii) Tube Well

iii) Hand Pump

4 Health Facilities

i) Primary Health Center

ii) Sub-center

iii) Health Workers

5 Education Facilities

i) Primary School

ii) Upper Primary School

 iii) Secondary School

6 Communication

i) Post Office

ii) Telecom Services

7 Banking Facilities

i) Bank Branch

ii) ATMs

VIII. Environment

S.No. Category

1 Forest Cover

i) Reserved Forest

ii) Protected Forest

iii) Unclassified Forest

2 Biodiversity

i) Wildlife

ii) Endangered Species

3 Pollution

i) Air Pollution

ii) Water Pollution

iii) Soil Pollution

IX. Vulnerability and Disaster Management

S.No. Category

1 Vulnerability
 i) Natural Disasters

ii) Man-made Disasters

2 Disaster Management

i) Disaster Preparedness

ii) Response Mechanisms

X. Government Schemes and Programmes

S.No. Category

1 Central Government Schemes

2 State Government Schemes

3 Local (Panchayat) Initiatives

XI. Socio-cultural Aspects

S.No. Category

1 Festivals

2 Customs and Traditions

3 Socio-religious Organizations

4 Gender Dynamics

Sl.
Type of institution/ Personnel
No.
1 Anganwadi
2 Mini- Anganwadi
3 Health Sub- Centre

4 Primary School (within the village)

5 Upper Prim. School (within 3 kms)

6 ASHA Worker

7 MNREGA Field Assistant

Sl.
Institution
No.
1 High School
2 Higher Secondary School
3 Degree College
4 ITI
5 Polytechnic
6 Primary Health Centre
7 Civil Hospital
8 Distt. Hospital
9 Police Outpost
10 Police Station
11 Gram Panchayat
12 Block HQs
13 Tehsil/Sub-Div. HQs.

S.No. Type of Institution

S.No. Type of Institution

Primary Agri.
1
Credit. Society

2 Coop. Marketing Society

Dairy/Poultry/ Fisheries Coop.

3
Society

Distt. Central
4
Coop. Bank (DCCB)

Distt. Coop. Land Dev. Board

5
(DCLDB)

Regional Rural
6
Bank

7 Nationalized Bank

Common Service
8
Centre

9 Elec. Sub-station (33/11 KV)

mat: Comprehensive Village Template

I. Basic Data of the Village

Details

[District Name]

[Block Name]

[Gram Panchayat Name]

[Village Name]

[Number of Hamlets]

Hamlet Details

II. Demographic Data

Population

Male Female

Age Group-wise Distribution

 ii) Breakdown by Disability Type

III. Housing

Details

[Number of Families]

[Number of Families]

[Number of Families]

[Total Number of Families]

 [Number of Homeless Families]

[Number of Houses]

[Number of Houses]

[Number of Houses]

[Number of Houses]

[Number of Houses]

IV. Economic Status of Families/Households

No. of Households Percentage (%)

 V. Land-holding Pattern

All SC

Break-up of Households by Size of Land Holding

Land Holding Pattern in Respect of Irrigated & Un-irrigated Agricultural Land

Template

VI. Agriculture

Details No. of Households

II. Infrastructure and Services

Nof. Of available service sources

 Details

nerability and Disaster Management

Details
 Details

Details

No. of rooms/personnels Drinking Water

Distance of Nearest inst. from Village
(KMs)

Nearest Institution
 Distance from Village
Location
(KM)
 ST Percentage (%)

ural Land
Percentage (%)
 Distance from the
Toilets Remarks
village (in KMs)
No. & Percentage of households which are Members/
Account holders
Numbers %
 Section Sub-section Category All

Break-up of area under

VI.4 agriculture as per
Cropping Pattern

i) Single Cropped area

ii) Double Cropped area

iii) Triple Cropped area

No. of Agricultural
VI.5
Machinery in the Village

i) Electric Motors All

SC
ST
ii) Diesel Pumps All
SC
ST
iii) Tractors All
SC
ST

iv) Harvesters All

SC
ST

v) Others (Pl. specify) All

SC
ST
VI.6 Fertiliser Use Pattern

S.No. Fertiliser Fertiliser Use (KG/Acre)

1N
2P
3K
4 Organic Manure
5 All

Main Crops & Their

VI.7
Productivity

Area under the Crop in

S.No. Crop
the prev. year (in Acres)

1
2
3
4
5

Animal Husbandry &

VII
Fisheries

1. No. of Milch Cattle in

A. DAIRY
the Village
 2. No. of Families owning
Milch Cattle

All
SC
ST

3. No. of Families not

owning Milch Cattle

All
SC
ST

4. Total Daily produce of

Milk in the Village

5. Out of (4),

i) Qty. consumed in the

Village

ii) Qty. sold outside the

Village

B. 1. No. of Govt. fish ponds

FISHERIES in the Village

1A. Area (in Acres)

1B. Estd. Annual

Production (in Quintals)
 2. No. of Pvt. fish Ponds
in the Village

2A. Area (in Acres)

2B. Estd. Annual

Production (in Quintals)

3. Total no. of fish ponds

(1+2)

3A. Total Area (in Acres)

(1A+2A)

3B. Total Estd. Annual

Production (in Quintal)
(1B+2B)

4. No. of families
engaged in fisheries

All
SC
ST

C.
POULTRY,
PIGGERY
1. No. of households
& OTHER
with
MEAT
PRODUCTI
ON

i) Poultry units
 ii) Goat/Sheep units

iii) Piggery units

2. Total daily production

of the village

i) Eggs

ii) Meat (in Quintal)

D.
PRODUCTI
VITY OF
DAIRY,
S.No. Produce Unit
FISHERIES
& MEAT
PRODUCTI
ON

1 Milk Head of Milch cattle

2 Eggs

3 Fish Per Acre of Pond area

4 Meat

VIII. Non-
Farm
Activities VIII.1. Present Status of
S.No. Non-Farm Activity
(NFA) & Non-Farm Activities
Their
Potential

1 Mining & Quarrying

2 Forestry
3 Sericulture
4 Vermiculture
5 Artisans
6 Trade
7 Services

(i) Transport
SC ST Details
India State District

All SC ST

Productivity (in Quintals

India State
Per Acre)

Irrigated Un-irrigated Irrigated

All SC ST
Average yield per unit
India State
per day

All SCs' units STs' units

No. % All
 I. Basic Data of the Village
S.No. Parameter
1 District
2 Block
3 Gram Panchayat
4 Village
5 No. of Hamlets
_ 6 Details of Hamlets
7 Average Annual Rainfall
8 Soil Type
Details of Hamlets
S.No. Name of the Hamlet

Total

II. Demographic Data

Population Distribution
S.No. Category
1 SC
2 ST
3 All
Age Group-wise Distribution
Age Group Population
M
0-6 yrs.
6-14 yrs.
14-18 yrs.
18-35 yrs.
35-60 yrs.
60-80 yrs.
> 80 yrs.
Total Working Age
Employed
i) Round the year
ii) More than 100 days
iii) Less than 100 days
iv) Not at all
Persons with Disabilities
Category Number
Total
Blind/Low Vision
Hearing Impaired
Locomotor Disability
Leprosy-Cured
Mentally Retarded
Mentally Ill
Vulnerable Categories
Category Number
Orphans
Members of Female-Headed Households
Members of Child-Headed Households
Widows
Members of Seasonally-Migrating
Households
Destitute Senior Citizens
a) 60-70 years
b) 70-80 years
c) > 80 years
Total (a+b+c)

III. Housing
S.No. Parameter
1 No. of Families in the Village
2 Families living in:
i) Pakka houses
ii) Kachcha houses
iii) Homeless
3 Houses with:
i) Electricity
ii) TV
iii) Sanitary Latrine
Total SC ST

IV. Economic Status of Families/Households

S.No. Category
1 SC
2 ST
3 All
4 BPL Households
5 NREGA Job-Cards
6 Dependence on:
i) Agriculture
ii) Dairy
iii) Fisheries
iv) Poultry
v) Forestry
vi) Mining & Quarrying
vii) Rural Artisan
viii) Un-clean Occupations
ix) Job Employment
x) Casual Wage Employment

V. Land-holding Pattern
S.No. Category
Total Households
1 Landed Households
i) All
ii) SC
iii) ST
2 Landless Households
i) All
ii) SC
iii) ST
3 Population of Landed Households
i) All
ii) SC
iii) ST
4 Landholding Size
i) < 01 acre
 ii) 1 - 2.5 acres
iii) 2.5 – 5 acres
iv) 5 – 10 acres
v) > 10 acres
Irrigated & Un-irrigated Land
S.No. Type of Agricultural Land
1 Unirrigated
2 Irrigated
i) From Govt. Sources
ii) From Pvt. Sources
3 Grand Total

VI. Agriculture
Land Use Breakdown
S.No. Land Use Type
1 Agriculture
2 Housing/Abadi
3 Nistar/Common Lands
4 Water Bodies
5 Forest
6 Wasteland
7 Others (Specify)
Irrigation Status
S.No. Status
1 Irrigated
a) Govt. Sources
b) Pvt. Sources
2 Unirrigated
Cropping Pattern
S.No. Cropping Pattern
1 Kharif Crops
2 Rabi Crops
3 Zaid Crops
4 Other Crops (Specify)

VII. Education
Literacy Rates
S.No. Category
1 Total Population
2 SC
3 ST
Schooling Facilities
S.No. Type of School
1 Primary School
2 Middle School
3 Secondary School
4 Higher Secondary School
5 Pre-school/Anganwadi
VIII. Health and Sanitation
Health Facilities
S.No. Facility Type
1 PHC
2 CHC
3 Sub-centre
4 Private Clinics
Sanitation Facilities
S.No. Type
1 Household Latrines
2 Public Latrines
3 Open Defecation
4 Solid Waste Disposal

IX. Water Supply

Sources of Water
S.No. Source
1 Handpumps
2 Wells
3 Piped Water Supply
4 Tube Wells
5 Others (Specify)
Water Quality
S.No. Quality Parameter
1 Safe
2 Contaminated
3 Requires Treatment

X. Infrastructure and Electricity

Infrastructure
S.No. Infrastructure Type
1 Roads
2 Bridges
3 Drainage
4 Street Lighting
Electricity Supply
S.No. Parameter
1 Household Connections
2 Street Lighting
3 Power Cuts
4 Voltage Stability

These templates should give you a structured approach to collecting and organizing the survey data

Drinking Water Supply

S.No. Category
1 Source(s) of Drinking Water Supply
2 Piped Water Supply
i)
ii)Year
No. &of%Completion
of Houses with Tap
Number
Connectionof Drinking Water Hand
3
Pumps
 Hamlets/Bastis with No Piped
4 Water Supply, Standing Posts, or
NamePumps
Hand of Hamlet/Basti
1
2
3
4
5
Total
5 Quality of Water
Degree of Drinking Water
Stress in Summer
6
Months

A.4 Availability of Public Facilities

S.No. Category
1 Gram Panchayat Headquarters
Year of Construction of Panchayat
2
Building
3 Community Hall
Year of Construction of
4
Community Hall
5 Library/Reading Room
6 Public Playground
7 Other Public Facilities
A.3 Drinking Water Supply
Sources
Source(s) of Drinking Water Supply
Handpumps
Piped Water Supply
Open Wells
Handpumps
Borewells
Solar Pumps
Piped Water Supply
i) No. of Houses with Tap Connection

Hamlets/Bastis with No Piped Water Supply, Standing Posts, or Hand Pumps

Name of Hamlet/Basti

Degree of Water Stress in Summer Months

No Water Stress Moderate Water Stress

A.4 Availability of Public Facilities

S.No. Category
1 Gram Panchayat Headquarters
Year of Construction of Panchayat
2
Building
3 Community Hall
Year of Construction of
4
Community Hall
5 Library/Reading Room
6 Public Playground
7 Other Public Facilities

This format uses clearly defined columns and checkboxes or spaces for answ
e Village
Details

Distance from Main Hamlet (KM) Population (2010) Remarks

M F

Population 2001 Census 2010

M F

2001 Census 2010

F T
 Number

2001 Census 2010 Survey

No. %

2001 Census 2010

 Total Area SC Land ST Land Others

Area (Acres)

Area (Acres)

Area (Acres)

2001 Census 2010 Survey

M F

Number
 Number

Number

ater
Number

Status

Status

Status

and organizing the survey data

Supply
[ ] Handpumps [ ] Piped
DetailsWater Supply [ ]
Wells [ ] Open Wells [ ] Surface Water [ ]
Other (Specify): ________________
Total Houses: ___________ Number with
___________________________
Tap Connection: ___________ Percentage:
Total Number:%___________
___________
 Population

[ ] Safe [ ] Contaminated [ ] Requires

[Treatment
] No Water[ ]Stress [ ] Moderate
Not Tested Water
Additional
Stress [ ] Severe
Comments: Water Stress Additional
________________
Comments: ___________

Details building? [ ] Yes [

Is there a pakka Panchayat
]Year:
No ___________________________
Does the village have a pakka Community
Hall?
Year: [ ] Yes [ ] No
___________________________
Does the village have a Library and/or
Does
Pleasethe
Reading village [have
Room?
specify: ] Yesa[public
] No playground
available to all? [ ] Yes [ ] No
____________________________________
________________
Supply
No. of Available Sources
ater Supply

pply
ii) % of Houses with Tap Connection

Standing Posts, or Hand Pumps

Population

ummer Months
Severe Water Stress

Details building? [ ] Yes [

Is there a pakka Panchayat
]___________________________
No
Does the village have a pakka Community
Hall? [ ] Yes [ ] No
___________________________
Does the village have a Library and/or
Does
Pleasethe
Reading village [have
Room?
specify: ] Yesa[public
] No playground
available to all? [ ] Yes [ ] No
____________________________________
________________