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Union of India - Section
Section 15 in The Prohibition of Employment as Manual Scavengers and their Rehabilitation Rules, 2013
15. A bottle of suitable surgical antiseptic solution.
| Photo of the personengaged in manualscavenging |
| Family Photo of the person engaged in manual scavenging(Picture post card size photograph6" x 4") |
| 1.| Name of the person engaged in manual scavenging :_______________________|- | 2.| Name of father / Mother / Spouse :_______________________|- | 3.| Age :_______________________|- | 4.| Sex : MaleFemale|- | 5.| Educational Status : (Put a √ mark in the appropriate box)|- | | (i) a) Literateb) Not literate|- | | (ii) If Literate level of education :-|- | | a) Studied : Class 1-5 :Class 6-10 :Class 11-12 :Class above 12 :|- | 6.| Occupation :|- | (i)| Carrying / disposing / cleaning of human excreta manually from insanitary latrine|- | (ii)| Cleaning untreated human excretamanuallyfrom : (a) open drain|- | | (b) Railway Track(c) Pit Latrine|- | 7.| Status of Employment :|- | | I. Employed in :|- | | (a) Private :- |
| | (i) Individual Household(ii) Community/ Group of Households | ||||||||||||||
| | (iii) Contractor(iv) Institution like hospital, office etc. | ||||||||||||||
| | (v) Others (specify) ____________________________ | ||||||||||||||
| | (b) Central Government(c) State Government | ||||||||||||||
| | (d) Municipal Corporation | ||||||||||||||
| | II. Employed on :|- | | (a) Permanent basis(b) Temporary basis | |||||||||||||
| | (c) Contract basis(d) Jajmani | ||||||||||||||
| 8.| How long you have been in this Occupation : ________________________|- | 9.| Social Background :|- | (a)| Whether SC/ST/OBCs/Others|- | (b)| Caste(c) Sub Caste|- | (d)| Religion|- | 10.| (a) Have you received any benefit from the government rehabilitation schemes?|- | | (Put a √ mark in the appropriate box) |
| Yes | No |
| | (b) If yes, name of the scheme (Put a √ mark in the appropriate box) : |
| Name of the Schemes | Rupees | |
| (1) | National Scheme for liberation and rehabilitation ofscavengers (NSLRS) | |
| (2) | Self Employment Scheme for rehabilitation for manualscavengers (SRMS) | |
| (3) | Any other(Please specify the name of Scheme(s)) |
| | (c) If yes, whether project funded through above scheme is running : |
| Yes | No | If yes, monthly income(Rs.) |
| | (d) Not known|- | 11.| (a) Are you engaged in any occupation other than scavenging? : YesNo|- | | (b) If you specify : __________________|- | 12.| Any other skills you possess :|- | | (i) Construction(ii) Carpentry|- | | (iii) Driving(iv) Cooking|- | | (v) Tailoring(vi) Any other (specify) _______________________|- | 13.| Alternative Occupation Proposed (Please specify) : _______________________ |
| Name and Address of the person engaged in manual scavenging :--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Pincode--------------------- | |
| Contact Telephone/ Mobile No.---------------------- | Signature of Data Entry Operator, ------------------- |
| Signature/ Thumb Impression of the person engaged inmanualscavenging ----------------------------- | Name and date (with code No.):--------------------------------------------- |
| Name and date: ---------------------------------------- | |
| Sihnature of Enumerator, ----------------------------- | Signature of supervisor, ------------------------------- |
| Name and date: (with code No.):--------------------------------------- | Name and date (with code No.):----------------------------------------- |
| Details of Insanitary Latrine|- | 1.| Details of Individual Insanitary Latrine (IIL) : |
| Sl. No. | Name of the owner of Insanitary Latrine | Location of the | Monthly Salary/ wages of the Manual Scavenger(Rs.) | ||
| Dry latrine | Latrine from which excreta is being flushedinto open drain | In cash | In food grains etc. | ||
| Total Number of the Individual Insanitary Latrines being cleaned by the person engaged in manual scavenging :|- | (Note: Please give detailed description of the Individual Insanitary Latrine Cleaned by the person engaged in manual scavenging. In case you need to write extra information kindly photocopy this page and attch with the survey form)|- | 2.| Details of Community Insanitary Latrine (CIL) : |
| Sl. No. | Name of the owner (Organisation/ Agency) of Community Insanitary Latrine | Location of the | Monthly Salary/ wages of the Manual Scavenger(Rs.) | ||
| Dry latrine | Latrine from which excreta is being flushedinto open drain | In cash | In food grains etc. | ||
| 3.| Detail of Open Drains(OD)/Railway Tracks/other spaces : |
| S. No. | Location of Open Drains/Railway tracks/otherspaces in which excreta from the insanitary latrines is beingflushed | Salary/wages of the manual scavengers | |
| In cash (Rs.) | In kind (Rs.) | ||
| (Note: If the number of involved manual scavengers in OD is more than one then please fill up a separate form for each of the person engaged in manual scavenging) |