Surveypoint

A01

Name

A02

Code

A03

State

A04

District

A05

Block

A06

Village

A07

Type

P

C

A08

Structure No.

A09

HH No.

A10

Name of the head of the household

A11

Religion

HINDU

MUSLIM

CHRISTIAN

SIKH

BUDDHIST/NEO-BUDDHIST

JAIN

JEWISH

PARSI/ZOROASTRIAN

NO RELIGION

SARNA

OTHER (SPECIFY)

A12

Caste

SCHEDULED CASTE

SCHEDULED TRIBE

OTHER BACKWARD CASTE

GENERAL

OTHER (SPECIFY)

A13

Mobile number

A14

What is the name of the adolescent girl?

A15

What is the age of the adolescent girl?

A16

RECORD WHETHER ADOLESCENT GIRL’S WEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.

MEASURED

ADOLESCENT GIRL’S ABSENT

ADOLESCENT GIRL’S REFUSED

MOTHER/FAMILY MEMBERS REFUSED

ADOLESCENT GIRL’S DEFORMED

ADOLESCENT GIRL’S ILL

OTHER (SPECIFY)

A17

RECORD WEIGHT (KG)

A17A

FIRST MEASUREMENT

A17B

SECOND MEASUREMENT

A18

RECORD WHETHER ADOLESCENT GIRL’S HEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.

MEASURED

ADOLESCENT GIRL’S ABSENT

ADOLESCENT GIRL’S REFUSED

MOTHER/FAMILY MEMBERS REFUSED

ADOLESCENT GIRL’S DEFORMED

ADOLESCENT GIRL’S ILL

OTHER (SPECIFY)

A19

RECORD HEIGHT (cm)

A19A

FIRST MEASUREMENT

A19B

Anthro Adolescent Girls -Form Fill

Name

Code

State

District

Block

Village

Type

Structure No.

HH No.

Name of the head of the household

Religion

Caste

Mobile number

What is the name of the adolescent girl?

What is the age of the adolescent girl?

RECORD WHETHER ADOLESCENT GIRL’S WEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.

RECORD WEIGHT (KG)

FIRST MEASUREMENT

SECOND MEASUREMENT

RECORD WHETHER ADOLESCENT GIRL’S HEIGHT WAS TAKEN OR NOT AND REASON WHY NOT.

RECORD HEIGHT (cm)

FIRST MEASUREMENT

SECOND MEASUREMENT