Survey Questionnaire/Schedule

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DEPARTMENT OF GEOGRAPHY

SILIGURI COLLEGE

Survey Questionnaire/Schedule

 NAME OF THE VILLAGE………………………………………………………………………


 NAME OF THE GRAM PANCHAYAT…………………………………………………………
 NAME OF THE BLOCK…………………………………………………………………………
 NAME OF THE DISTRICT………………………………………………………………………
 NAME OF THE STATE…………………………………………………………………………..

A. GENERAL INFORMATION
Sl. Name of the Households Sex Age Education Caste Religion Marital Category
No (Starting from the head of Status
. the households ) (M/F) (BPL/APL)

B. SOCIO- ECONOMIC INFORMATION:


1. Family Type: Nuclear/Joint
2. Land Ownership details: i) Household…………… ii) Cultivable………………….
3. Type of House: Kuccha/Pucca/Semi-Pucca
4. Electric facility: Yes/No
5. Household Amenities: TV/Cycle/Mobile/Fan/Radio/Others……………………….
6. Sources of Drinking Water: Well/Tube Well/Plastic Tap/ Others………………….
7. Sources of Fuel: Wood/Coal/Kerosene/Gas/Others………………………………..
8. Toilet Facility: Yes/No
9. Drainage Facility: Yes/No
10. Primary occupation of the Family…………………………………………………..
11. Secondary occupation of the Family………………………………………………..
12. Number of Earning Member of the Family…………………………………………
13. Monthly Income of the Family……………………………………………………..
14. Monthly expenditure of the Family (Rs):
Maintenance…….….Developmental……………..Luxurious……………………

C. TOPIC RELATED QUESTIONS


I) AGRICULTURAL STATUS
15. Are You Involved in Agriculture? Yes/No
If Yes Then

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