Assured and Extended Minimum Facility

NAME OF POLLING STATION:………………………………………………………………………………………………..

POLLING STATION NO:……………………………………

SL No Polling Station Details Remarks
1 Pucca/Semi-
Building quality Pucca /Kuchcha

2
PS with less than 20 sqmts Yes/No

3
PS buildings is dilapidated or dangerous Yes/No

4
PS is in Govt building/Premises Yes/No

5
PS located in an Institution/religious place Yes/No
6
PS in School/College building Yes/No
7
PS in Ground floor Yes/No

8
PS having Seperate door for Entry and Exit Yes/No
9 Political Party Office Situated Within 200 meters of PS
premises Yes/No
10
PS having drinking water facility in the premises Yes/No
11
PS having Electricity Supply Yes/No
12
PS buildings having Proper lightings,Fixtures etc Yes/No
13
PS with Permanent ramp Yes/No
14
PS buildings with Adequate furniture Yes/No
15
PS with shade/shelter for protection from sun/rain etc. Yes/No
16
PS with proper road connectivity Yes/No
17 PS where voters have to cross river/vally/ravine or natural
obstacles to reach PS Yes/No

18
PS with Landline Telephone/Fax Connection Yes/No

19
PS with Mobile Connectivity Yes/No

20
PS with Internet Facility Yes/No

21
PS with Proper Sinage of Building name and Address Yes/No

22
PS with in LWE/insurgency affected area Yes/No

23
PS with Forest/semi-forest area Yes/No

24
PS in vulnerable Critical Location Yes/No

25
Sensitive/Hyper-Sensitive PS Yes/No
26 Current Voter as Per Draft Roll
27 If above 950 Space for Auxiliary Polling Station Yes/No

SIGNATURE OF THE SUPERVISOR