KSRWSP FORM R-1

KARNATAKA SUSTAINABLE RURAL WATER SUPPLY PROGRAMME

(To be filled by Contractor and submitted to ES DTSU)

Scheme Details

Scheme ID

Name of Village

Taluka

Name of GP

District

Type of Scheme

Name of Source MVS (Write NA if not applicable)

Total No of FHTCs

Date of Site Visit

Name of Contractor

Name of PDO

EHS UPDATES

SN	Site	Context	EHS Measures implemented

E&S ISSUES/CONCERNS OF SIGNIFICANCE NOTICED DURING REPORTING MONTH

SN	Site	Issue Category	Description of issue/concern	Support/Action(s) sought from DTSU, if any

ANY ISSUES RELATED TO COORDINATION, MANPOWER, ADMIN SUPPORT, ETC.

OVERALL SUPPORT/ACTIONS/INTERVENTIONS SOUGHT FROM DTSU

Signatures

Signature of Contractor Date:

Signature of Environment Specialist, DTSU Date:

Signature of Social Specialist; DTSU Date: