Appendix -1

Population description and Literacy description format

Form No. 1

VDC:…………….. Ward No:.... Tole:…………… Date:…

HH no. residing
HH Head of 0-5 6-15 16-45 46-60 60 1-5 6-10 Illiterat Sick from long
Pop Collage outside their
No. house years year year year above class class e term Remarks
homes

F M Total F M F M F M F M F M F M F M F M F M

Name of the person filling the form

 Description of domestic animals, chemical fertilisers, pesticides and fuelwood use data collection form

Form no. 2

VDC........................ Ward no. .................. Date:........................ Tole: ......................

Rate of pesticide Use of

Head of the Buffal Shee Pigeo Other Rate of chemical fertiliser use use (yearly) fuelwood
S.N. Cow Ox Goat Horse Pig Duck Hen
House o p n s (yearly) which & how much? which & how
much? Bhari/per day

Name of the person filling the form

 Migration description (Only past 5 years)

Form no. 3

VDC........................... Ward no... ... ... ... ... .... ...

Year of arrival Year of departure

Head of the house Reason for
S.N.
migrating migrating
(From where) (Where)

Description of Health

Form no. 4

VDC:....................... Ward:.....................

Number
S.N
Description Femal
. Male
e

1 Number of people dying of curable disease within 1 year

2 Number of households not receiving the service of health post within 1 hour walking
distance
3 Number of children born with the help of rained health worker

4 Number of pregnant women receiving the two doses of titanus

toxide

5 Number of couples using the family planning means

6 Children under age 1 getting all the injections

7 Number of households getting the drinking water through pipe system

8 Number of households getting the drinking water from well, tap

9 Number of health services provided from the private sector

10 Number of households having permanent toilets

11 Number of households having temporary toilets

12 Number of households not having managed waste disposing pits

13 Number of schools not having managed toilets

14 Number of schools lacking provision of drinking water

15 Number of households not having their own house

16 Number of households residing illegally in the government land

17 Number of durable houses

18 Number of houses with tin roofs

19 Criminal events (murder, theft, women trafficking, prostitution, etc.) number

20 Number of households seriously affected by the natural disasters

(within past 5 years)

Schools' educational description form

Form no. 5
Name of the school:............... School type: Government/Private

Level:....... No. of teachers:... (Male teacher: ..... Female teacher :...........)

VDC:........... Ward no:.... Tole:............

Number of Students
S.N. Class Total students
Male Female
1 One
2 Two
3 Three
4 Four
5 Five
6 .......
Total
Pre-primary, Primary, Lower Secondary, Secondary, admission fee:
School leaving rate
Number of buildings and classrooms
Number of trained teachers
Rate of students leaving the school from class 1 to class 5
Occupational Form
Form No. 6
VDC:…………….. Ward No:.. ..Tole:…………… Date:…

S.N. H.H no. Name of participants Type of occupations Remarks

 Occupation types: Teacher, Police, army, pensioner, Service, Business, carpenter,
Bricklayer, technical training received person

Name of the person filling the form:

House hold Production of Food crops and cash Crops

Form No. 7

V.D.C…………… Ward no. ………………..

S.N. H.No. food crop Cash crop

Paddy Maize Millet Wheat Mustard Others Potato Zinger Milk Tea Broom Other
grass

Land Ownership description form

Form no. 8
VDC:............... Ward no: ................. Date:..........................

head of
Land (in ropani) Total Remarks
S the house
N Khet Bari Kharbari Amrisobari Cardamom Tea Private
Bari garden forest

Various institutions and groups, committee description form

Form no. 9

VDC:................ Ward no:................... Date:.................

S.N Type of
Established Present situation Remarks
. facility

1 Bank

2 Health post

3 Telephone

4 Police post

5 Post office

Group Committe
Groups or Establish no. e no. Yearly Income
committees Name ed date
F M F M

Physical Infrastructure Related Description form

Form no. 10
VDC:......................... Ward no:...........................

Description
Household number with electric lines

Number of households getting the facility of transportation after walking for more than
2 hours
Temporary and motorable road, no and length

……

Drinking water source/well and number

Household number using improved cooking stoves

Household number using kerosene stove

Household number using LP gas

 Household number using bio gas

Household number using solar energy

Irrigation and Drinking Water Project Form

Form no. 11
VDC:.................... Ward no:........................ Date:...........................

Duration of
Name of the providing Irrigation Benefited Present Environment
S.N. Type Opportunity
irrigation channel irrigation, periodic, area HH no. condition al condition
yearly
1
2
3
Name of the Benefited
Location and Present
drinking water Type Househol
ward condition
project d no.
1
2
3
Name of the person filling the form
 Situation of the sectoral development activities (Women, health, education, agriculture,
transportation/communication, energy/power) description form
Form no. 12
VDC:................. Ward no:......... Date:................
War
S. Name of the Benefited Establishe Donor Present Opportunit
d
N. project HH no. d date agency situation y
no.

Sectoral Forms for Health, Drinking Water, Irrigation, Agriculture, Livestock,

Transportation, communication, Energy, Forest and soil conservation.
Form No. 13
V.D.C…………… Ward no. ……………….. Date …

Area Problems Cause of Solution Opportunity Remarks

Problem
 Environmental Related Problems' Description Form
Form No.14
V.D.C…………… Ward no. ……………….. Village/Tol ………………………. Date ………

S.N. Problem Name of Cause Effect in the Preventive Remarks

Place community measures
1. Soil erosion
2. Flood
3. Landslide
4. Theft of timber
5. Deforestation
6. Waste
7. Others

Forest related facts collection form

Form no. 15
Forest condition:

Present Forest management

Practices.........................................................................................................................

Major wild fauna and flora

Flora Fauna
Tree species Shrub species Grass species Medicinal plants Mammals Aves Reptiles

Wealth ranking done in order to determine focussed group form

Form no. 16
VDC....................Ward............. Name of the respondent.......................... Date...............

Level House no. Indicators

Approximated yearly income of the VDC

Form no. 17
 Yearly
S.N. Source Remarks
income

1 HMG/N Development grant

2 Land revenue

3 Lease tax

4 Application charge

5 Land evaluation charge

6 Recommendation charge

7 Telephone

8 DDC grant

9 Others

Crop system description collection form

Form no. 18
VDC................... Ward no......................

Hill River basin Foothill

Khet Bari Khet Bari Khet Bari
SETTLEMENT LEVEL DATA COLLECTION PROJECT DAT PLOT
E: NO.:
FORM ID:

SETTLEMENT LOCATION SURVEYOR:

DEV. REGION ZONE: DISTRICT: VDC: WARD: PHYS. REGION: SETTLEMENT

DIAGRAM

GENERAL LOCATION (from road, from settlement area, from stream, etc.):

MAP NO.: LAT/NORTH: LONG/EAST: UTM ZONE: X CO: Y AERIAL PHOTO NO.:
CO:

SETTLEMENT INFORMATION
SIZE OF THE SETTLEMENT: SETTLEMENT NAME: SLOP SL SLOPE ELEV.
E PO: ASPECT (O): (m):
(%):

ROAD HOUSE WASTE SEWAGE COOKING MAJOR CROPS GROWN:

ACCESS: PATTERN: DISPOSAL DISPOSAL HABIT:
SYSTEM: SYSTEM:

ACESS TO FACILITIES
SCHOOL ‫ٱ‬ HEALTH POST DAIRY
‫ٱ‬ ‫ٱ‬
USER GROUP ‫ٱ‬
POLICE ELECTRICITY

RANGEPOST ‫ٱ‬ ‫ٱ‬ ‫ٱ‬

PIPE WATER IRRIGATION

BANKING ‫ٱ‬
‫ٱ‬ ‫ٱ‬
OTHERS ‫ٱ‬ MARKET NGO
‫ٱ‬ ‫ٱ‬

AGRICULTURE SERVICE LIVESTOCK SERVICE ‫ٱ‬

‫ٱ‬

SETTLEMENT MANAGEMENT
CONSTRAINTS: POTENTIALS:

NOTES:

FOREST LEVEL DATA COLLECTION FORM PROJECT DATE PLOT

: NO.:
ID:

SITE LOCATION SURVEYOR:

DEV. REGION ZONE: DISTRICT: VDC: WARD: PHYS. REGION: SITE
DIAGRAM

GENERAL LOCATION (from road, from settlement area, from stream, etc.):

MAP NO.: LAT/NORTH: LONG/EAST: UTM ZONE: X Y CO: AERIAL PHOTO NO.:
CO:

SITE INFORMATION

ALT. CLASS.: FOREST TYPE: FOREST FOREST AREA SLOP SL SLOPE ELEV.
NAME: (ha): E PO.: ASPECT (O): (m):
(%):

FOL. COV.ER STOCKING: REGEN. FIRE USE PATERN: MAJOR WILDLIFE

(%): STATUS: INCIDENCE: SPECIES:

DRAINAGE: WATER SOIL MOIS. SOIL NUT. HUMUS

TABLE: REG.: REG.: FORM:

SOIL COLOR: COARS FRAG. SOIL TEX.: SOIL STRUC.: SOIL CLASS.:
(%):

MAJOR VEGETATION SPECIES

TREES; SHRUBS: HERBACIOUS:

SITE MANAGEMENT
SITE CONSTRAINTS: SITE POTENTIALS:

NOTES:

AGRICULTURE LEVEL DATA COLLECTION PROJECT DATE: PLOT

NO.:
FORM
ID:

SITE LOCATION SURVEYOR:

DEV. REGION ZONE: DISTRICT: VDC: WARD: PHYS. REGION: SOIL DIAGRAM

GENERAL LOCATION (from road, from settlement area, from stream, etc.):

MAP NO.: LAT/NORTH: LONG/EAST: UTM ZONE: X Y AERIAL PHOTO NO.:

CO: CO:

SITE INFORMATION
CROPING PATERN: CROPING INTENSITY: SLOP SL SLOPE ELEV.
E PO: ASPECT (O): (m):
(%):

FIELD TYPE: SOIL WATER DRAINAGE: ROOTING MAJOR CROPS GROWN:

FERTILITY SOURCE: CLASS: DEPTH:

ESTIMATE:

EROS. EV: TERRACE SOIL DEPTH: PEST. & SOIL Ph:

COND: MANNU.:

SOIL COLOR: COARS FRAG. SOIL TEX.: SOIL STRUC.: SOIL CLASS.:
(%):

SITE MANAGEMENT
SITE CONSTRAINTS: SITE POTENTIALS:

NOTES:

WARD LEVEL DATA COLLECTION FORM PROJECT DATE: PLO

T
ID: NO.:

WARD LOCATION SURVEYO

R:

DEV. REGION ZONE: DISTRICT: VDC: WARD: PHYS. REGION: SOIL

DIAGRAM

GENERAL LOCATION (from road, from settlement area, from stream, etc.):

MAP NO.: LAT/NORTH: LONG/EAST: UTM ZONE: X CO: Y AERIAL PHOTO NO.:
CO:

WARD INFORMATION
WARD SIZE: AVERAGE SLOPE AVERAGE SLOPE AVERAGE AVERAGE
(%) : POSITION : SLOPE ELEV.(m):
ASPECT (O):
LANDUSE TYPES: MARKET DOMINATED MAJOR PRODUCTS MAJOR CROPS USED:
SALED:
Bari (non irrig.) Forestry
% ‫ٱ‬
Khet (irrig.)
conventional agriculture
%
‫ٱ‬
Forest
% Cash crop
‫ٱ‬
Pasture
%
Services

Tea field ‫ٱ‬

%
Store
Barren land ‫ٱ‬
%

SETTLEMENT MANAGEMENT
SETTLEMENT CONSTRAINTS: SETTLEMENT POTENTIALS:

NOTES:
Communities' socio-economic and biophysical data collection methods and formats used
participatory rural appraisal (PRA) tools and techniques
S. N. Tools Objectives

1 Social and It is an important procedure of PRA. It is about the location of social

resource and natural things located in the community. In this map forest, jungle,
map source of water, land, farmland, rivers, residential area, road,
household, terrace, school, forest, shop, health, port, temple, service
centre etc. The main objective of it is to visualize the social and natural
resources condition for the discussion in the map.
The main objective of the moving map is to show it to greater number of
2 Mobility map people in the community. This shows what kind of work, where, how much,
how long about the jobs. It also shows the employment, entertainment,
market, treatment, education and etc.

3 Preference The desires of each person of the community are different. The desire of the
ranking majority should be given priority in course of running the program.
Therefore, this procedure finds out what are the courses of the
superiority of a desire with comparative analysis for the decision. It also
shows what are the desires, which desire gets the priority and why.
Therefore, before starting a program on should know the causes of the
certain desires. It helps to run the program efficiently.
The economic condition of the community people is different. That
4 Wealth ranking economic difference influences the respect, manner, and livelihood, of a
person. This procedure is used to find out the economic condition of the
household, occupation and the source of income. This procedure finds out
the cause of economic difference. Also, it helps to launch appropriate
programs.

5 Flow diagram The works are counted in order in the community. This procedure makes it
easy to analyse the relationship and interference of those programs.
Also it shows the time factor, problems and the responsibilities of the
person on work.

6 Time line Timeline is the procedure to look at the past events, effects and impacts of
the history.
This procedure is the in-depth analysis of change that occurred timely in
7 Trendline some places. Its purpose is to achieve the information about social,
economic, environmental and cultural change. This procedure gives a great
deal of information in the preparation of planning.

8 Problem tree This procedure is used to know the root cause of the problems in the
analysis community. It also helps to know which are the root problems, its cause
and its effect. It is an important procedure.

9 Venn diagram This procedure helps to get information about the idealist of the institutions,
their influence of the community, their access, real works and so on. As
a result, who can give what kind of help for the program
10 Semi- This procedure is used in order to come to the point and to forward the
structured discussion in course of information collection. The lively discussion
questionna depends on the systematic and ordered questionnaire of the worker.
ire

11 Focus group The purpose of this procedure is to hold discussion among concerned people
discussion and organization.

12 Seasonal This procedure is to take information about the activities of the people in the
Calendar community.