PM POSHAN SPECIAL CAMPAIGN PROGRAMME

Assessment Format

1. Name of School / Institution : …………………………………………………

2. UDISE Code : …………………………………………………

3. Name of District : Purba Medinipur

4. Name of Block / Municipality : …………………………………………………

5. Name of Circle : …………………………………………………

6. Category of institution : …………………………………………………

[Primary / Upper Primary / Secondary / Higher Secondary /SSK/MSK]

7. Total number of student enrolled (up to Class 8) : ……………….

8. Total number of meals served during last month : ……………….
9. Total number school days during last month :………………..
10.Whether the statutory notices on the notice board or wall : Yes / No
of the school is displayed
11.Whether quality of supplied rice is good : Yes / No
12.Whether the food items are stored in hygienic condition : Yes / No
13.Whether UC submitted regularly : Yes / No
14.Cash balance (Bank PB is to be checked) : Yes / No
15.Whether Cash book is maintained properly : Yes / No
16.Food grain stock in Qtls. : Yes / No
17.Whether Food grain registrar is maintained properly : Yes / No
18.Whether one month’s buffer stock (Rice) is there : Yes / No
19.Whether Cook cum Helpers get honorarium regularly : Yes / No
20.Whether Food Tasting Register is maintained : Yes / No
21.Whether Weighing Machines is available : Yes / No
22.Whether Mid Day Meal Programme is discussed : Yes / No
Parent Teacher Committee Meeting
23.When de-worming tablets were consumed last time :…………

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 PM POSHAN SPECIAL CAMPAIGN PROGRAMME
Assessment Format

24.Average no. of students who consumes IFA tablets :……………….

25.No of health check-up programme done in last one year :……………….
26.Whether Hand wash is practiced before and after MDM : Yes / No
27.Whether having separate pucca Dining Hall : Yes / No
28.If no, whether sufficient Free Space is available within premises for
construction : Yes / No
29.If yes, whether the dining hall / space is cleaned regularly : Yes / No
30. Whether having Pucca Kitchen : Yes / No
31. Condition of kitchen :(Very Good/Usable/Need Repair)
32. Whether the kitchen is cleaned regularly : Yes / No
33. Whether cooking utensils are cleaned properly : Yes / No
34. Whether the school has functional fire extinguisher : Yes / No
35. If average number of students consuming MDM during last 7 days is less
than 85 % of enrolled students, what are the probable reasons : ……………...
……………………………………………………………………………………...

……………………………………………………………………………………...

36. Remarks (if any) : ……………………………………………………………….

……………………………………………………………………………………..

……………………………………………………………………………………..

…….……………………………………………………………………………….

Signature of the TIC / HM : ………………………………………………

Signature of the Inspecting person :……………………………………………….

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