QUESTIONNAIRE Shajahan VM
No: BTS, IGNOU
Name of the respondent:
Age: ............... Gender: M/F Marital Status: ................................ Literacy: Literate/Illiterate
[Link] many members are there in your family?............................................
Family Age Education Occupation If not working reason
members [Link] formal education [Link] [Link]
(relation with [Link] [Link] labour [Link] old/Young
family head) [Link] primary [Link] employed [Link]/Handicapped
*Respondent [Link] [Link] service [Link] after someone
[Link] Secondary [Link] sector [Link] interested to work
[Link] 6. Collecting forest resources.
[Link] Graduation [Link]
[Link] education
2..Have you/any of your family member migrated to anywhere in the past 6 months?.................. if yes reason?
(Look for job/Education/Escape from climate/avoid wild animal attacks/........................................................)
[Link] you have own land?.................. If yes how much?...................................................................................
[Link] ship status of house? (Own/Rent/[Link]/Hut in encroached land)
No of FLOOR WALL ROOF WATER Sanitation Transportation Communication
Rooms [Link] [Link] [Link] SUPPLY Facility [Link] and Information
[Link] and [Link] (D- transport [Link] paper
[Link] cement covered Domestic [Link] cycle [Link]
soil/cow [Link] [Link] use [Link] cycle [Link]/Telephone
dung and mud with straw P-Drinking [Link] car [Link]
polished [Link] [Link] water) [Link] [Link]
[Link] [Link] [Link] [Link]
ground covered [Link]
tap
[Link]
[Link]
[Link] you have electricity in your home? which electrical appliances in possession?...........................................................
................................................................................................................................................................................................
[Link] fuel used for cooking purpose?
[PTO]
Income of the house hold
Income source Monthly/Yearly Total
Wages
Salary
Farming
Livestock rearing
Forest resources collection
Trading
Self employed
Service
Expenditure of the house hold
Monthly Expenditure Yearly Expenditure
Food Non-Food Food Non-Food
Rice/Cereals Housing Rice/Cereals Housing
appliances appliances
Meat/Fish/Eggs Health Meat/Fish/Eggs Health
Milk and by Communication Milk and by Communication
products products
Oil Clothing and Oil Clothing and
shoes shoes
Fruits and Entertainment Fruits and Entertainment
Vegetables Vegetables
Sugar Sugar
Alcohol Alcohol
[Link] much do you save monthly/Yearly?..................../.....................saved in(Bank/Movable property/Immovable
property/Gold/others specify.........................................................................................................................................)
[Link] you have any debits, loans(if yes specify....................................................................)
Health Status
Person Disease (Last month) Disease Treatment Total Expenditure
(Relation with family (For the previous year) received Monthly Yearly
head)
[Link] any of the family members have permanent/chronic disease? If yes specify.......................................................
[Link] health facility do you prefer first?......................................................
[Link] you seek treatment for your condition immediately you felt sick(Yes/No)
[Link] you receive other form of alternative treatment like herbal medicine?(Yes/No)
12. How is your relationship with Non Tribals. a) Good b) Satisfactory c) Not good
13. Do you have any membership in any society or Association: a) Yes b) No
14. What is in your opinion Main problem of your Colony i. Housing ii. Land iii, Water iv. Liquor v. No work (Seasonal
Unemployment) vi. No power