Surveypoint

Q01

Name of District

Q02

Name of Block

Q03

Name of Gram Panchayat

Q04

Name of Village

Q05

Date of observation

Q06

Result of the visit

COMPLETED

OTHERS (SPECIFY)

Q07

Name of the respondent

Q08

Contact number

Q09

District Code

Q10

Block Code

Q11

Gram Panchayat Code

Q12

Village Code

Q13

Code of Observer

A01

Have you attended last gram sabha meeting?

Yes

No

A02

Were the Gram Sabha members informed about the last Gram Sabha meeting by the Panchayat?

Yes

No

A03

Was any agenda set before the last Gram Sabha meeting?

Yes

No

A04

Who set the agenda for the meeting?

From janpad panchayat

Sarpanch

Secretary

sarpanch/ secretary/ panch together

members of gram

others

Don’t know

A05

Did the Gram Sabha identify beneficiaries (households/families/individuals) for different schemes during the last Gram Sabha meeting?

Yes

No

Don’t know

A06

Was the decision taken during the last Gram Sabha meeting shared with the community?

Yes

No

Don’t know

A07

Did the Gram Sabha members approve the decisions in the last Gram Sabha meeting?

Yes

No

Don’t know

A08

Are the Gram Sabha decisions/documents accessible on request?

Yes

No

Don’t know

A09

Did the Gram Sabha appoint any committee to conducts social audits?

Yes

No

Don’t know

A10

Did the committee undertake social audit?

Yes

No

Don’t know

A11

Were the findings of social audits shared with Gram Sabha?

Yes

No

Don’t know

A12

Has any sub-committee been formed in the Gram Sabha?

Yes

No

Don’t know

A13

How many sub-committees have been formed in the Gram Sabha?

A14

Which sub-committees have been formed?

Gram Nirman Samiti

Gram Vikas Samiti

Nigrani Samiti

Other

A15

Has the Gram Sabha prepared it’s annual plan (VDP)?

Yes

No

Don’t know

A16

Whether Gram Sabha discussed the issues to be included in the Annual Plan?

Yes

No

A17

Was the plan developed through participation of the members of all the hamlets?

Yes

No

A18

Did the plan address issues from each of the hamlets in the village?

Yes

No

A19

Were the needs of the marginalized communities considered in the plan?

Yes

No

A20

Was the plan developed by prioritising the needs of the community?

Yes

No

A21

Gs Template -Form Fill

Name of District

Name of Block

Name of Gram Panchayat

Name of Village

Date of observation

Result of the visit

Name of the respondent

Contact number

District Code

Block Code

Gram Panchayat Code

Village Code

Code of Observer

Have you attended last gram sabha meeting?

Were the Gram Sabha members informed about the last Gram Sabha meeting by the Panchayat?

Was any agenda set before the last Gram Sabha meeting?

Who set the agenda for the meeting?

Did the Gram Sabha identify beneficiaries (households/families/individuals) for different schemes during the last Gram Sabha meeting?

Was the decision taken during the last Gram Sabha meeting shared with the community?

Did the Gram Sabha members approve the decisions in the last Gram Sabha meeting?

Are the Gram Sabha decisions/documents accessible on request?

Did the Gram Sabha appoint any committee to conducts social audits?

Did the committee undertake social audit?

Were the findings of social audits shared with Gram Sabha?

Has any sub-committee been formed in the Gram Sabha?

How many sub-committees have been formed in the Gram Sabha?

Which sub-committees have been formed?

Has the Gram Sabha prepared it’s annual plan (VDP)?

Whether Gram Sabha discussed the issues to be included in the Annual Plan?

Was the plan developed through participation of the members of all the hamlets?

Did the plan address issues from each of the hamlets in the village?

Were the needs of the marginalized communities considered in the plan?

Was the plan developed by prioritising the needs of the community?

Remarks