Forms/Templates

Monthly Progress Reporting Form for Swajaldhara Project

As on
STATE				DISTRICT
Address				Tel No.
				Fax No.
				STD No.
				E-mail
Sanctioned Project Outlay Rs.		Crore		Project Sanctioned on
GOI ShareRs.		Crore		Instalment Released on	Rupees in Lakh
			1st
			2nd
			3rd
			4th
			Total

I. FINANCIAL PERFORMANCE

I A. Project Funding (Rupees in lakhs)

Sl. No

Activity

Start-up

IEC

HRD

Hardware

Admn

Total

1.

Project Outlay

2.

Expenditure incurred

Upto previous month

During the month

Total Expenditure

3.

Percent of Expenditure to Outlay (%)

II COMMUNITY CONTRIBUTION

II A. Partial Contribution for Capital Cost of Schemes (Rupees in lakh)

Sl. No.		Unit	Project Aim	Progress Achieved
1.	Panchayats	No.		Upto last month	During month	Total
		AmountCashKindLabour
2.	Community/Persons	No.
		AmountCashKindLabour
3.	Schools/Students	No.
		AmountCashKind
		Labour
4.	Total Contribution	No.
		AmountCashKindLabour

II B OPERATION & MAINTENANCE (O & M) of Schemes :

Sl. No.		Progress
1.	Schemes completed and taken over by community	No. of Panchayats
		No. of Schemes
2.	Community Contribution (Rupees in lakh)
		Due Remitted Balance

III NGO PARTICIPATION
1. No. of NGOs in DP / DWSM / DWSC
1. No. of NGOs transparently selected to participate in the:

IEC	HRD	Scheme implementation	Total

 

IV. PHYSICAL PERFORMANCE

Activities	Unit	Project Objective	Performance
			Upto previous month	During the month	Total
Awareness IEC Coverage	No.
Requests from Panchayats	No.

VWSC formed		No.
Accounts opened in Panchayat/VWSC		No.
Agree to do MOU signed		No.
PRA/PLA undertaken in Habitation		No.
Panchayats Water Supply Plan prepared and approved	VWSC	No.
	Panchayat	No.
	Gram Sabha	No.
Capacity Development Plan ZP/DWSM prepared and approved		No.
Contribution by Users/ Community/Schools/Panchayats		Amount
Schemes Taken up	For Users	No.
	For Schools	No.
	For other Institutions	No.
	Total	No.
Schemes Completed	For Users
	For Schools
	For other Institutions
	Total
Training Organised (i) Panchayat and Capacity Development Plan (ii) Execution of Water Supply Scheme (iii) O&M of Schemes		Programmes
		Persons
		Programmes
		Persons
		Programmes
		Persons
Sustainability Evaluation Examination (SEE) done		No.
(i) Healthy Home Survey Conducted(ii) Water Quality tested		No.
		No.
Taking Over of the Schemes		No.
(Atmarpan) by the Community

v. PROJECT IMPLEMENTATION SCHEDULE

Has project Implementation plan(PIP)been prepared and approved? (please tick)		YES	NO
If yes , please ensure that all aspects/ Activities have been incorporated. If No Please indicate the date by which the PIP Is expected to be approved by-	(i) DWSM
	(ii) SWSM
When the next instalment request is proposed to be filed with Government of India?
By what month mid project proposal review is expected from the project authorities and State Government ?	District
	State
What is the possible month of completion of the project?

This is to certify that project implementation is as per the Swajaldhara principles indicated in the Sanction Letters and Guidelines.

Endorsed bySignature with Date	Signature with DateMember SecretarySwajaldahra DP / DWSM
Secretary Deptt. Of Govt. of

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Up dated on Jan-2007