QUESTIONNAIRE Shajahan VM

No: BTS, IGNOU

Name of the respondent:

Age: ............... Gender: M/F Marital Status: ................................ Literacy: Literate/Illiterate

1.How many members are there in your family?............................................

Family Age Education Occupation If not working reason

members 1.No formal education 1.Farmer 1.student
(relation with 2.Primary 2.Agricultural labour 2.Too old/Young
family head) 3.Upper primary 3.Self employed 3.Illness/Handicapped
*Respondent 4.Secondary 4.Government service 4.Look after someone
5.Higher Secondary 5.Privet sector 5.Not interested to work
6.Graduation 6. Collecting forest resources.
7.Post Graduation 7.others
8.Technical 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/........................................................)

3.Do you have own land?.................. If yes how much?...................................................................................

4.Owner ship status of house? (Own/Rent/Govt.aided/Hut in encroached land)

No of FLOOR WALL ROOF WATER Sanitation Transportation Communication

Rooms 1.concrete 1.bricks 1.concrete SUPPLY Facility 1.Public and Information
2.Tiles and 2.plastic (D- transport 1.News paper
3.colored cement covered Domestic 2.Bye cycle 2.Television
soil/cow 2.briks 3.thatched use 3.Motor cycle 3.Mobile/Telephone
dung and mud with straw P-Drinking 4.Motor car 4.Radio
polished 3.wood 4.Asbestos water) 5.Others 5.Internet
4.rough 4.sheet 5.Tiled 1.Well
ground covered 2.Public
tap
3.River
4.Pond

4.Do you have electricity in your home? which electrical appliances in possession?...........................................................

................................................................................................................................................................................................

5.which 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

6.How much do you save monthly/Yearly?..................../.....................saved in(Bank/Movable property/Immovable

property/Gold/others specify.........................................................................................................................................)

7.Do 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)

8.Do any of the family members have permanent/chronic disease? If yes specify.......................................................

9.Which health facility do you prefer first?......................................................

10.Did you seek treatment for your condition immediately you felt sick(Yes/No)

11.Do 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