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Canal/River/Stream


                                Groundwater



                   b) Is there water pollution?

                               Yes                        Sources:…………………………………


                               No



                   c) Is there is air  pollution

                               Yes                        Sources:…………………………………


                               No


                   d) What are the main sources of food ?

                               Agriculture


                               markets


                               Peddlers

                               Food shops



                   e) Is there is food contamination?

                               Yes                        Sources:…………………………………


                               No

                   f)  Is  there  is  a  sewerage/drainage  system  in  the  village for  the  disposal of

                      waste water?

                                Yes


                                No


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