Team Names: ___________________ ___________________

Form Number: ______________________

AUSAID Baseline School Assessment Tool

(Note: Please hold a broad based community meeting, contact teachers, Cluster Coordinators and Education Department for the following information. A photograph of each school selected and approval for school to be selected is required from Education Department.). A. General Profile of School

A1. School Name ________________________________________________________________

A2. EMIS Code

A3. District

A4. Tehsil/Taluka

A5. Union Council

A6. Name of Village/Town

A7. Name of Head Teacher

A8. Contact Ph no

A9. Type of School by

Education

1= Primary 1= Boys only

2= Middle

3= High

4=Higher Secondary 5=Other (maktab) 3= Mixed

A10. Type of school by

gender (as allocated)

2= Girls only

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A11. Total Number of rooms in school building _____________ A12 Was school operating before flood? 1=Yes, 2=No (Note: for selection, school must have been operational before flood) A13 Is school operating now? 1=Yes, 2=No WASH Facilities Q1. How many before flood? 1= Satisfactory 2= Needed Minor repair 3=Needed Major Repair 4= Needed Reconstruction/provision 5=n/a A14. Hand Pump A15. Water Tank A16. Latrine(s) A17. Hand Washing Facilities A18. Clean Drinking Water System Q2. Condition before flood Q3. How many after flood? 1= Satisfactory 2= Need Minor repair 3=Need Major Repair 4= Need Reconstruction/provision 5=n/a Q4. Condition after flood

A19. Are latrines cleaned daily? 1=Yes

2=No

3=n/a

A20. Are there separate latrines for boys and girls? 1=Yes A21. Do girls use latrine? 1=Yes

2=No

3=n/a

2=No

3=n/a

Students and Out of School Children a. A22. Male Students in School A23. Female Students in School A24. Total Number of Students in School A25. Out of school boys (age 5-9) A26. Out of school girls (age 5-9) A27. Total Out of school children (age 5-9) A28. Name of closest health facility____________________________________________ Before Flood b. After Flood

A29. Distance of school building from closest health facility ____________ B. Technical Detail of the Infrastructure

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B1. School building is: B2. Water Source: 1=Well, 2=Water Supply, 3=Spring, 4=Hand pump, 5=River, 6=No water source,

1=Partially Damaged

2=Fully Damaged

7=Other ______________ Items Available in the School Availability after flood 1= Available, 2= Inadequate Quantity Available 3= Completely Damaged/Not Available B3. Teacher Furniture B4. Student Furniture B5. Black Boards B6. Stock register B7. Log book/Visitor Book B8. School attendance B9. Register admission and withdraw/General Register (GR) B10. Children Result Register B11. SMC Meeting Register B12. Certificate register B13. National Curriculum B14. Teachers Diaries B15. Timetable B16. Scheme of work for P&D B17.Teachers Lesson plan B18. B19. B20. B21. B22. B23. Student Textbooks Student Stationary Items Student Recreational Items First Aid Kit Library Books Correspondence File

B24. List any current security threats to school infrastructure _________________________________________________ B25. List any current climate threats to school infrastructure ___________________________________________________ B26. Is the building currently safe for children?

1=Yes

2=No

B27. Do children participate in decision making in the school/classroom (such as arrangement of desks etc.)? 1=Yes 2=No

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B28. Is corporal punishment used to discipline children in the school? C. Education Assessment Class C1 . C2 . C3 . C4 . C5 . C6 . C7 . C8 . C9 . Total enrolled students in the month of May Q1. Boys Pre-I I II III IV V VI VII VIII
C10. Total Student Enrollment Before Flood

1=Yes 2=No

2010 Q2.Girls

Enrollment of students on the day of visit

Q4.Boys Q5.Girls

Q3. Total

Q6. Total

C11. Total Student Enrollment After Flood

C12. Total teachers officially appointed to school (by government)

a. Male b. Female

C13. Total teachers serving in school Before Flood

a. Male b. Female

C14. Total teachers serving in school After Flood

a. Male b. Female

C15 If any teachers are currently absent, reasons for teacher absenteeism: a. b. c. d. e. Flood/Migration School Fully Damaged Not receiving salary Lack of Interest 1=Yes 2=No 1=Yes 2=No 1=Yes 2=No 1=Yes 2=No

Other (specify)________________________________________

C16.If school is closed since flood, approximate number of days of classes missed __________________

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Number of Students Successfully Completing the Final Class (V) During the Last Academic Term C17. Boys C18. Girls C19. Total

D.

Children and Family Need Assessment

D1. Main source of income of parents (with children age 5-9) before flood__________________________ D2.. Main source of income of parents (with children age 5-9) after flood ___________________________ D3. School aged children and families mainly live in: 1= Tents/Temporary Structures 2=Solid Adobe Structures 3=Other ________________________________ D4. Are sufficient educational facilities available for girls in this location? 1= Yes 2=No D5. How willing are families to send girls to school? 1= Very willing 2= Willing 3= Hesitant 4= Not willing

D6. Issues that may hinder girls from going to school (More than one answer possible) 1= Distance from school 2= Lack of transportation 3= Non availability of educational facilities for girls in local area 4= Cultural constraints

E.Education Management Assessment E1. SMC Status 1= Not Yet formed 2= Functional 3= Non-Functional E2. Frequency of Meetings 1= Weekly 4=Every Two Months 2= Every Two Weeks 5= Every Four Months 3= Monthly 6= As needed

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E3. Total number of members

a. Male Members _______________ ___________

b. Female Members_______________

E4. Average no. of members who attend meetings

E5a. SMC Member 1 Name/Designation/Contact ___________________________________________________________ E5b. SMC Member 2 Name/Designation/Contact# __________________________________________________________ E5c. SMC Member 3 Name/Designation/Contact#___________________________________________________________ E5d. SMC Member 4 Name/Designation/Contact#___________________________________________________________ E5e. SMC Member 5 Name/Designation/Contact#___________________________________________________________ E5 f. SMC Member 6Name/Designation/Contact#___________________________________________________________ E5g. SMC Member 7 Name/Designation/Contact#___________________________________________________________ E6 When last meeting was conducted 1= 1 month ago 2= 2 months ago 3= 6 months ago 4= 12 months ago

E7. Has the School Council/Committee ever prepared a School Improvement Plan? 1 = Yes E8. Have the school council members ever received training on its functions? E9. Any initiative taken by SMC/SC? (multiple answers possible) 1= Awareness campaign on education 2= Resource mobilization 3= School related development 4= Procured student material 5= WASH facilities E10 a. Does Education Department conduct regular visits to the school? 1=Yes 2=No b. Date last visit conducted _________________ c. Purpose of last visit _____________________ 1= Yes

2= No 2= No

d. Type of support provided to school by Education Department ______________________________

E11. Does the school have a DRR Plan/School Safety Plan (steps to follow in case of a disaster?) 1= Yes E12. Does the school have a Long Term Development Plan? 2= No

2= No

1=Yes

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Additional Comments: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Source of Information E13. Respondent A Name/Designation/Contact Number ______________________________________________________ E14. Respondent B Name/Designation/Contact Number ______________________________________________________ E15. Respondent C Name/Designation/Contact Number ______________________________________________________ F. Enumerator

Enumerator

Data Entry

Name:____________________________

Name: ___________________________

Date: :_______________ (dd/mm/yy)

Date:_______________ (dd/mm/yy)

Sign: ____________________________

Sign: ____________________________

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