GAIL CSR Impact Assessment Project For the year 2005-06 & 2006-07 Name of the Village/Area/district Date

of visit SC/ST/OBC/ G/PHY

S.No

Name of the members/beneficiary

Age

Sex

Address

Contact No

Signature

Remarks

Signature of the Evaluators

GAIL CSR Impact Assessment Project for the year 2005-06 & 2006-2007 S.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Check List Project related docments Need Assessment Data /Survey records Project Proposal Sanction letter of the project MOU of the Project Roles & Responsibilities of the staff engaged in the project /contract letter etc Meeting minutes Monthly /Quarterly/Halfyearly /Annual reports Newsletter/Publication materials if any Photographs Feedback reports on the projects from visitors /donors /any other List of Beneficiaries Community members/volunteers team List of monitoring perrson/team with contact details Monitoring reports/records Evaluation reports Any other records like workshop/training /FGD/ seminar Acheivement records /case study / appreciation Any other informaton Project completion Report Financial Records Purchase committee details Quotation Work order Invoice/Challan /Bills Bank statement Bank account no address etc Local contribution Audit Report Asset Records Implementing Agency Records Registration of the implementing agency Registration of 12 AA( incometax) Exemption of Tax ( 80G) PAN Card of the implementing agency Tan card of the implementing agency List of Exeuctive members /Governing Memberrs address/post/contact details Structure /Organagram of the implementing agency

1 2 3 4 5 6 7 8 9

1 2 3 4 5 6 7

Remarks

GAIL CSR Impact Assessment Project for the year 2005-06 & 2006-2007 Date: Place: Name of the person :

Agenda:

Meeting minutes

Name of the Implementing agency GIDF

Villages /Block

Activities

chenpura Dongar Ikodia Bhaisana Aheerkhedi Badarpur

Health care/Medical Mobile van Health care/Medical Health care/Medical Health care/Medical Health care/Medical

Ahmedapur Chenpura Bhoomlakhedi Belka

Health care/Medical Health care/Medical Health care/Medical Health care/Medical

Vijaipur Fatehgarh Bhoda Mandir Mahar Ki Mohar

Health care/Medical Health care/Medical/mobile van Health care/Medical Health care/Medical

GIDF to Govt School GIDF to Govt College GIDF to Sanskriti Vidyalaya

Raghogarh Raghogarh Avan Raghogarh Raghogarh

Guna District Hospital

GIDF

GIDF

District Collector Guna

Raghogarh block-school Raghogarh block-school Raghogarh Avan ,Bajarang Garh, Maina Gokulgram Medical equipement s at primary health care center health care/ Medical /providing furniture/medical equipments in sub health center

Aganwadis Majre Tolo

Distribution of Sattu to malnourished children

Medical Services Department .GAIL ,Vijaipur

Govt .College Guna Govt Girls College Guna Nishulk Chikitsa Kendra

Consultation of medicines nearby villages Free distribution of medicines to the neary by villages Health camp in vijipur with the help of inhouse doctors and prominent superr specialist Family planning and eye camp with the help of local//state district govt authorities

Nishulk Chikitsa Kendra

Vijaipur

Vijaipur

Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation

Envionement protectionrain water and harvesting

Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation Educational Aid /Playground equipements Drinking water /Sanitation

Environment protection /treeplanatatio Envionement protectionrain water and harvesting

Educational Aid /Playground equipements

Drinking water /Sanitation Drinking water /Sanitation Drinking water /Sanitation Drinking water /Sanitation

Educational Aids/Furniture /Recrational Aid /Books Educational aids to science laboratory Educational aid /school furniture etc Educational aid/training for school teachers Drinking water & Sanitation /Installation of Aquargard in various school Drainage /Sanitation/Maintenace of district hospital Guna

Literacy enhancement /empowernment ( Sanitation/Cleanliness Programme sewing machine/training on papad making /Training on widows underprivlaged section Enviornment protection/rennovaton of waer storage structures for storage of rain water Education aid /furniture to high school /higher secondary school Educational aids to science laboratory Recreationalaid /Furniture /books to the govt school of Raghogarh

Distribution of Toys and Utensils children of hamlets Literacy enhancement /empowernment (training /packaging products to 300 women members ofSHG) Library /book banks /educational aid Dinking water /Sanitation

protection /treeplanatation/beautification (dongar road bharsula chowk A.B Road)