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Community Health Survey Report

This community health survey report collects information about families in a municipality including the head of household's name and address, family member details, housing characteristics like ownership status and roof/wall type, availability of facilities like ventilation, latrines, drainage, electricity, water supply, monthly income, and remarks. It aims to assess living conditions and access to basic amenities to identify needs in the community.

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hemihema
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11K views2 pages

Community Health Survey Report

This community health survey report collects information about families in a municipality including the head of household's name and address, family member details, housing characteristics like ownership status and roof/wall type, availability of facilities like ventilation, latrines, drainage, electricity, water supply, monthly income, and remarks. It aims to assess living conditions and access to basic amenities to identify needs in the community.

Uploaded by

hemihema
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Community Health Survey Report

Municipality:
1) Name of the Head of the family

2) Address

3) Family members details Name Relationship


1)
2)
3)
4)
5)
6)
4) House Own/ Rent

5) Roof Thatched/ Tiled/ Concrete

6) No. of the Rooms

7) Ventilation Adequate/ Inadequate

8) Latrine Water seal/ Open field

9) Usage of latrine Yes / No

10) Drainage Open/ Closed

11) Disposal of waste Pit/ Burning/ Dumping

12) Electrical Supply Yes / No

13) Water Supply Municipality / other source ( )

14)
Monthly Family Income (Rs.)

15) Remark

HOD of Community Health Nursing: Student:


PRINCIPAL

Door no:

Family Religion:
no:

Street Corporation/
name: municipality/
Town
Panchayat/
Panchayat

Urban
/Rural :

Name of
Locality

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