Survey-Soil health Card
Reference Period

Schedule No:

Enumerator's Name

Date

State

District

Taluk

Gram Panchayat

Village

Respondents Details

Name of Family Head/Respondent

Gender

Farming Experience (in years)

Contact number

Category (SC/ST/OBC/GEN)

Are you a member of any local body

Family income per Annum

land holding details

own farmland irrigated in acres

own farmland dry land in acres

own farmland total land in acres

leased in irrigated land in acres

leased in dry land in acres

leased in total land in acres

leased out irrigated land in acres

leased out dry land in acres

leased out total land in acres

operational irrigated land in acres

operational dry land in acres

operational total land in acres

Awareness

Are you aware of soil health scheme

Are you aware of Model Village Program (MVP)

specify above

Do you know the reasons for soil testing?

specify above

Extension Participation

Have you attended the MVP Demonstration in your village

specify

if yes when (date/month/year)

How many MVP demonstrations have you attended?

How many farmers visited your field for seeing demonstration

Have you attended any Farmer Trainings related to soil health card or fertilizer application?

if yes when, date

How many such training programmes have you attended till date?

Did the training program is helped you?

specify

Did you receive any information related to Soil fertility/status frequently? if yes mention source

How frequently you receive information?

specify above

Mode of information

Benefits

have you received SHC?

specify

When did you received SHC?

specify

Did you received SHC after sowing of crops?

specify

if yes, mention number of days delayed

distance of soil testing centre from your home in kms

Are you a Demonstration (demo) farmer in the MVP?

if yes, how many acres of your land have you allotted as the demonstration plot (acres)

if yes, what is the benefits you received as Demo farmer in kg

did you continue this input combination from the demo in the next crop season

Skill development and adoption

Do you know the procedure for soil sampling

Specify

Are you aware of soil testing centres/lab?

if yes mention and specify

Are you able to read and understand the information in SHC?

specify

If No, did anyone explained the information of SHC?

specify

Are you aware of your soil nutrient status?

specify

For how many crops recommendation is given in your SHC

specify

Did you grow recommended crop in the SHC?

specify

If Yes, have you followed the recommended doses of fertilisers and nutrients?

if yes mention

Did you receive any information related to Soil fertility/status frequently?

if yes mention the source

Assessment

Due to SHC, the total fertilizer usage has increased or decreased?

if increased, % or amount

if decreased, % or amount

Do you feel due to SHC the cost of cultivation decreased?

mention percentage/amount

Do you feel due to SHC there is an increase in soil fertility?

Do you feel due to SHC there is an increase in crop yield?

mention percentage/amount

Constraints and suggestions

major constraints in receiving SHC (list the reasons)

Major constraints in adoption of SHC recommendations

Suggestion for improving SHC scheme

Overall Rating of the Performance of SHC scheme

Overall Rating of the Performance of SHC scheme

Stakeholder – Implementing Agencies

Name of the officer

dept. name

District

Taluka

Contact details:

Designation

Budget details (Rs.) allocated

Budget details (Rs.) released

Budget details (Rs.) utilizations

Reasons for variations:

Targets

Achieved

Balance

Soil nutrient status in you region before (N:P:K)

Soil nutrient status in you region after (N:P:K)

Quantity of work done in related to SHC scheme

No. of soil samples collected

No. of soil samples tested

No. of SHC printed

No. of SHC distributed

No. of demonstration plots identified

No. of demonstration given

No. of farmers attended demonstration

No. of training programs conducted

No. of farmers attended training programs

Quantity of fertilizer and micro-nutrient distributed under SHC scheme (micro-nutrient)

Quantity of fertilizer and micro-nutrient distributed under SHC scheme (bio-fertilizer)

Quantity of fertilizer and micro-nutrient distributed under SHC scheme (Manure)

Number of village covered

Number of village covered in %

How much total area of cultivation of your region was soil tested: Area (in Ha.)

How much total area of cultivation of your region was soil tested in %

Feedback and constraints

Mentions the major feedbacks obtained from the farmers

Mentions the major constraints in collection of soil sample

Mentions the major constraints in soil testing

Mentions the major constraints in card distribution

Mentions the major Constraints in conducting training program / demonstration/ identification of Model village:

Overall Rating of the Performance of SHC scheme (tick the appropriate):