This document appears to be a survey from the Department of Community Medicine at VMCH & RI in Madurai, India. The survey contains questions about a village, including its name, location, type of streets, drainage, water supply sources and type, refuse disposal, latrine usage, housing situation, presence of rodents and insects, total population, housing and land area, family composition, village planning, recreational areas, schools, and voluntary organizations working in the area. The questions include multiple choice responses to gather data about various infrastructure and sanitation aspects of the village.

1. 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

2. 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
Other comments: