FORMAT FOR THE FEED BACK REPORT BY MICRO OBSERVERS TO BE SUBMITTED TO THE CONSTITUENCY OBSERVER AFTER THE POLL Based on the ANNEXURE -L of GUIDELINES FOR OBSERVERS, 2009 issued by ECI 1. Name of the Micro Observer 2. Designation 3. No. & Name of the polling station allotted 4. Date & time of arrival at the polling station 5. Name of the presiding officer 6. Total No. of voters 7. Whether mock poll was conducted (Y/N) 8. Whether mock poll result was cleared (Y/N) 9. Time of mock poll 10. Whether EVM ID/Machine No. shown to agents by Presiding Officer? (Y/N) 11. No. of polling agents present 12. Whether any party (candidate) not represented by polling agent 13. Whether entry pass system for Agents followed (Y/N) 14. Time of commencement of poll 15. No. of people standing at the queue at the time of commencement of poll 16. Whether voters were identified by verifying EPIC or other valid documents before permitted to vote (Y/N) 17. Whether the polling staff were filling details in the 17A register with reference to each voter 18. The time of first visit by the sector officer 19. How many times the sector officer visited the polling station during poll hours 20. Whether CPF deployed at the polling station (Y/N) 21. If yes, whether CPF jawan was observing the proceeding in the polling station while standing at the door 22. Was there any incident of violence/argument /threat etc. took place 23. Did you notice any incident of polling staff going to voting compartment to guide the voters (Y/N) 24. Did any voter/agent complaint about voting process/polling staff? 25. Whether hourly total was compared between EVM total and 17A? (Y/N) 26. Whether flow of voters was regular or intermittent? 27. How many voters were standing at the queue at 3.00 PM/4.00 PM/5.00 PM 28. How many voters were given token by the presiding officer at 5.00 PM 29. How many voters had cast their vote at 5.00 PM 30. How many voters cast their vote after 5.00 PM 31. What time the poll was actually closed 32. Total No. of votes polled 33. % of votes polled 34. No. of voters voted using documents other than EPIC 35. No. of absentee/shifted voters voted 36. Whether EVM was sealed properly in the presence of agents 37. Whether signatures of agents obtained in the Part I of 17C? 38. Whether copy of 17C given to agents (Y/N) 39. What time the pickup party came to the polling station for escorting the polling staff? Signature of Micro Observer : Name (in full) : Designation : Phone No. : Date & Time
