FOR ACTION AGAINST COVID-19 PANDEMIC

Sl.No Assessment item Status

I.Preventive measures for control of Coronavirus pandemic
Is the Village Health and Sanitation Committee constituted in your
1 Yes  
Gram Panchayat?
 2 Did the committee identify a nodal person among members? Yes  
Did the committee motivate and enrol volunteers to participate in
 3 Yes  
COVID-19 activities?

Did the committee ensure participation of Self-help groups and other

 4 Yes  
community- based organisations in COVID-19 activities?

5 Do the committee members and volunteers have knowledge regarding the following
5.1 Modes of transmission/spread of COVID-19? Yes  
 5.2 Importance of using mask/cotton cloth? Yes  
 5.3 Maintaining physical distance Yes  
 5.4 Thoroughly washing hands with soap and water Yes  
 5.5 Cough etiquettes Yes  
 5.6 Home quarantine Yes  
 5.7 Cleaning and disinfection of frequently used surfaces Yes  
 5.8 Cleaning and disinfection of public places Yes  
Local and State level corona helpline numbers (1075, 011-23978046, Yes  
 5.9
020- 26127394)
Did the Committee impart information about preventive and control
6 Yes  
measures against COVID-19 to the villagers?
Have the committee identified and used locally relevant modes of mass
 7 communication (e.g. Dawandi/ Announcement accompanied by beating Yes  
drums)?
8 How good is compliance of villagers with the following?
Very
8.1 Physical distancing Good  
Very
 8.2 Use of mask/handkerchief/ cotton cloth Good  
Very
 8.3 Washing hands with soap and water Good  
9 Is there a system to check the compliance with the above? Yes  
Did the committee identify places or events when the village gathers
 10 Yes  
e.g., weekly market, festival etc
Have measures been taken to control the such gatherings? If yes,
 11 Yes  
specify measures taken?
Have you enlisted the elderly and person with comorbidities in your
 12 Yes  
village?
Do the committee have plan to ensure adequate care of elderly and
  13 Yes  
persons with comorbidities
 II.Solidarity at community level and address any stigma associated with the disease
Does the committee have adequate representation of all sections of the Yes  
14
society (including minority groups)?

Did the committee make adequate efforts to reach out and address
 15 Yes  
concerns of all sections of the society (including minority groups)

Do the committee members/ villagers understand the importance of

 16 Yes  
supporting individuals and their families, in case they get the disease?

Does the committee take any steps to address stigma associated with
 17 Yes  
the disease?
III.Help in surveillance activities related to Coronavirus pandemic
18 Did the committee prepare a list of following?
18.1 Elderly above 60 years of age Yes  
 18.2 People with hypertension & diabetes Yes  
 18.3 Pregnant women Yes  
Does the committee have a plan to ensure adequate care of the above
 19 Yes  
groups of people?
Does the committee have a plan to keep a watch on the people suffering Yes  
 20
from cough, cold or fever?
Do the committee members help the ASHA/ AWW in conducting
 21 Yes  
survey for cough, cold or fever?

Does the committee keep vigilance on arrival of any outsider in the

 22 Yes  
village and take measures for prevention of COVID-19 transmission?

IV.Support quarantine/ isolation

Do the committee members keep a watch on the people who have been Yes  
23
quarantined in home?

Do the committee members advice and support the families having

 24 Yes  
home quarantined person/s to take necessary precautions?

Has the committee make provision for doorstep delivery of essential

 25 Yes  
items and services to the families with home quarantined person/s?

Has any arrangement been made for village level quarantine facility
 26 Yes  
wherever and whenever home quarantine is not possible?

V.Ensure continued provision of essential health services at village level

Are routine health care services at village level (including Village
 27 Yes  
Health and Nutrition Days) being conducted regularly
Are ASHA/ Anganwadi workers in regular contact with pregnant and
 28 Yes  
lactating women to ensure continuity of care?
Are ASHA/ Anganwadi workers in regular contact with all high-risk
 29 cases of communicable and non-communicable diseases to ensure Yes  
continuity of care?
 Does the village committee ensure adequate stock of medicines for all
 30 Yes  
individuals with hypertension and diabetes at village level?

Is transport facility available in village for referral in case of

 31 Yes  
emergency?

Are the committee aware about the government ambulance services i.e.
 32 108 for COVID-19 patients and 102 and other ambulances for other Yes  
essential health services as the case may be?

33 Is the committee aware about the following COVID 19 related Services?

33.1 Referral facility for suspected COVID 19 Patients Yes  
Helpline Number/ Nodal persons for availability of beds for COVID 19 Yes  
 33.2
Patients?
COVID 19 Testing Centres facility. Ambulance services for Covid 19
 33.3 Yes  
Patients
 33.4 Ambulance services for Covid 19 Patients Yes  

VI.Prompt response, in case Coronavirus positive case/s are detected (This section needs to be filled, only if
containment or micro-containment zones are declared OR there are large number of cases in the village)
 34 Is there single entry/ exit for the containment zone? Yes  
 35 If Yes, are adequate IEC materials displayed at the entry? Yes  
Did the team ensure villagers are getting right information regarding
 36 Yes  
risk?

Are traditional cremation ground/ burial attendants trained and

 37 Yes  
equipped for safety precautions during all deaths during this period?

Does the village have a plan to ensure the safety and well-being of
 38 Yes  
everyone during the process of last rite?
Has the committee ensured effective communication with the
 39 community for eliciting their support in ensuring required protocol Yes  
management during containment?

Has the committee ensured that required house to house active case
 40 Yes  
search is conducted by the special teams formed for the purpose?

Has the committee helped the surveillance efforts through providing

 41 Yes  
required volunteers from the community?
VII. Ensure Hygiene and sanitation in the Gram Panchayat
Is there adequate facility for washing hands with water and soap in
 42 primary school/ upper primary schools/ educational institutions/ market Yes  
places, and Other public places
Is regular fumigation of the village also being undertaken by the Gram
 43 Panchayat to prevent breeding of mosquitoes? If yes, indicate Yes  
periodicity and chemical used? If not, why not?
Is the Gram Panchayat taking steps to ensure collection and disposal of Yes  
 44
solid waste? If yes, specify system put in place?
 45 Are the drains cleaned regularly in the village? Yes  

Has the Gram Panchayat taken steps to ensure that there are no stagnant Yes  
 46
pools of water in the village? If yes, specify measures taken?

Has the community undertaken voluntary service to keep the village

 47 Yes  
and its environment clean? If yes, please provide details.

VIII. COVID 19 Vaccination

Have the committee identified and used locally relevant modes of mass
48 communication for creating awareness regarding vaccination (e.g. Yes  
Dawandi/ Announcement accompanied by beating drums)?

Does the committee prepare line list of eligible individuals from the
 49 Yes  
community?

Did the committee members try to motivate individuals who are

 50 Yes  
eligible for vaccination and have not taken it till now for vaccination?

Did you make special arrangement for the needy person to take him to Yes  
 51
vaccination site?

Did the committee seek support from influential person in

 52 Yes  
society/religious leaders or groups for supporting the vaccination drive?

IX.If the lockdown has been implemented in district/ state

Has the committee ensured effective communication with the
 53 community for eliciting their support in ensuring required protocol Yes  
management during lockdown?

Has the committee ensured that the relief measures provided by

 54 Yes  
government are reaching to the most needy in the community?

Does the Committee have plans to deliver essential commodities to the Yes  
 55
needy people?
 56 If yes, do you have identified resources to execute that plan? Yes  
Has the committee made any arrangement for accommodation and
 57 Yes  
other essential services for migrants?
Has the committee made any plan to give work to the laborers under the Yes  
 58
schemes like MGNREGA?
In case of any migrant workers returning to the village, having any
notifiable disease like TB etc., or any other comorbid conditions, has
 59 Yes  
committee provided required support to them in consultation with
Health officials?
 Status Remarks
demic
No

No

No

No

following
No
No
No
No
No
No
No
No

No

No

No

Good   Very Poor

Good   Very Poor

Good   Very Poor

No

No

No

No

No
d with the disease
No

No

No

No

andemic

No
No
No

No

No

No

No

No

No

No

No

village level
No

No

No
 No

No

No

No

No

No

No

tion needs to be filled, only if

mber of cases in the village)
No
No

No

No

No

No

No

No

hayat

No

No

No
 No

No

No

No

No

No

No

No

state

No

No

No

No

No

No

No