Department of Community Medicine VMCH & RI, Madurai

Village health Survey

S.No. Question Options

1. Name of the village

2. Location 1. Near main road 2. Away from main road

3. Streets

1. Pucca 2. Kutcha 3. Mixed

4. Drainage 1. Underground drains 2. Open drains 3. No drains

5. Major source water supply

1. Wells 2. Hand pumps 3. Tubewells 4. Ponds 5. Taps 6. Others

6. Water supply type 1. Individual 2. Community type

7. Refuse disposal

1. Within house 2. Thrown

indiscriminately 3. Public dust bin 4. Community waste

disposal

8. Latrine usage

1. Community latrines 2. House latrines 3. Fields 4. Streets 5. Ponds 6. Others

9. Houses situation 1. Compact 2. Clustered 3. Widely scattered

10. Rodents and insects

a. Flies

1. Summer 2. Winter 3. Rain

11. b. Mosquitoes

1. Summer 2. Winter 3. Rain

12. c. Rats

1. Summer 2. Winter 3. Rain

13. d. Cockroaches

1. Summer 2. Winter 3. Rain

14. Total number of houses

15. Total area of the village (in Sq.ft)

16. Total Population

17. Total no. of Males

18. Total no. of Females

19. General composition of families 1. Single 2. Joint 3. Extended

20. Planning of the village 1. Planned 2. Unplanned

21. Recreational places

1. None 2. Park 3. Community centre 4. Others___________

22. School 1. Yes 2. No

23. Type of school 1. Government 2. Private

24. Voluntary agencies working in the area

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