dfdsdf Base Line Survey

1. Did we providfdsfsdfdsdsfdsgge free books for all students?

a. Yes b. No

2. Is any toilet facility provided for tdsfdsdfsdfsddsgsdgdgdshe students in the school?

a. Yes b. No

3. Are separate tosdsadsasadsasafailet facilities provided for girls and boys?

a. Yes b. No

4. We are provided the free midday meal or free food for all children’s?

a. Yes b. No

5. Does the school have Blackboard in every classroom?

a. Yes b. No

6. Are chairs and desks been providing to all students in the school?

a. Yes b. No

7. Does the school provide free books for all students?

a. Yes b. No

8. Does this school have its own water supply?

a. Yes b. No

9. Are free uniforms been providing to school children?

a. Yes b. No

10. Are students required to wear uniforms to this primary school?

a. Yes b. No

11. Does this school have electricity facility?

a. Yes b. No

12. Will you Conduct the Trainings Skills to students?

a. Yes b. No

13. We Provide Hostefsafsedaafasfsagdsegdsgasdshfbcxl Buildings to students?

a. Yes b. No

14. Is there any Spl. School buildings to Physically Challenged Persons?

a. Yes b. No
 1. How many House Hold members are there in a family?

a. 2 b. 4 c. 6 d. above than 6.

2. Are you using Toilets?

a. Yes b. No

3. Have you facilitated western/Indian commode?

a. Yes b. No

4. Have you find any difference using western/Indian commode?

a. Yes b. No

5. Is toilet clean and hygene?

a. Yes b. No

6. Have you recognized that your surroundings are improved?

a. Yes b. No

7. Is proper drainage provided for waste water?

a. Yes b. No

8. Is this comfortable to your women and adolescent girls regarding their menstrual hygiene
management?

a. Yes b. No

9. Is proper Training given to persons with disabilities on the use of toilets to avoid soiling their clothes and
the floor?

a. Yes b. No

10. Is this useful for elderly and disabled family persons?

a. Yes b. No

11. Is this shameful as like earlier open toilets?

a. Yes b. No

12. Is there any seasonal effect (rainy day, summer & winter) as like earlier open toilets?

a. Yes b. No

13. Do you feel that your family members are free of illness after using these toilets?

a. Yes b. No
\

Health
1. Age groups?

0 -18

19-45

46-60

61 and Above

2. What is your sex?

Male Female

3. What is your blood group?

A positive B positive AB positive O positive

A negative B negative AB negative O negative I don’t Know

4. Previously whether your village was covered by any Mobile Health Clinic?

a. Yes b. No

5. If the facility does not have an ambulance, can patient transfer by ambulance is arranged?

a. Yes b. No

6. Are there any community activities to support no communicable disease (NCD) services provided at
primary health care (PHC) facilities?

a. Yes b. No

7. Do you have a bed where you can stabilize a very ill patient before transfer to a referral institution?

a. Yes b. No