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model check list for returning officers and assistant returning officers

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12<br />

S.No. No &<br />

name<br />

of<br />

Polling<br />

Station<br />

Mention, if<br />

there is<br />

more than<br />

one Polling<br />

Station in<br />

the<br />

building,<br />

Name<br />

of<br />

Building<br />

Format-"A"<br />

Format <strong>for</strong> Inspection of Polling Stations<br />

Particulars of<br />

the Building<br />

(Govt./Semi<br />

Govt./<br />

Private)<br />

No Of<br />

Voters in<br />

Polling<br />

Station<br />

Mention, if the<br />

Polling Station<br />

is situated in<br />

the religious<br />

place, Police<br />

Station,<br />

Hospital<br />

Physical<br />

Condition<br />

of the<br />

Polling<br />

Station.<br />

If Polling<br />

Station is<br />

damaged, is<br />

there any<br />

appropriate<br />

building near<br />

by, mention<br />

name.<br />

Whether area<br />

of Polling<br />

Station is<br />

minimum 20<br />

sq./m or not.<br />

1 2 3 4 5 6 7 8 9<br />

Condition of<br />

approach road<br />

<strong>for</strong> the Polling<br />

station.(Distance<br />

in km if P.S. is to<br />

be covered on<br />

foot.)<br />

Appropriate<br />

proposal if<br />

auxiliary<br />

Polling<br />

Station is to<br />

be<br />

established<br />

Drinking<br />

Water<br />

Whether these facilities are available in the<br />

Polling Station or not<br />

Toilet Shed Light Furniture Exit<br />

door<br />

Whether<br />

permanent<br />

Ramp is<br />

available<br />

or not<br />

Remark<br />

(If any<br />

section)<br />

10 11 12 13 14 15 16 17 18 19 20

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