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QUESTIONNAIRE
QUESTIONNAIRE
QUESTIONNAIRE
Details of Respondent:-
General knowledge:-
2. Age:-
3: Gender:-
4. Education:-
F. ☐Others
5. Occupation:-
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6. Religion:-
7. Race:-
A. ☐ GENERAL B. ☐ SC C. ☐ ST D. ☐ OBC
8. Martial Status:-
Family information:-
1. Total family member: - .............................................................................
4. Total land:-....................................................................................................
7. Types of house: -
A. ☐Kacha house B.☐ Semi-pacca house C.☐Pacca house
8. Type of House:-.............................................................................................
Yes☐ No☐
Yes☐ No☐
3. To what extant do you believe that you are informed about water pollution?
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4. To what extant do you believe that local environmental issue related to water pollution?
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5. To what extant do you believe that you are aware ecological knowledge?
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6. To what extant do you feel personally can influence the solution to the water pollution?
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7. To what extant do you feel that local governing body or any other agencies are working to control
the water pollution?
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9. Last two year in your family any member effected chronic disease?
Yes☐ No☐
10. What is your monthly/Annual expenditure related to chronic disease in last two year?
A. B
11. Last two year any death cases in your locality for this problem?
Yes☐ No☐
12. During rainy season are you facing like-
13. Last two year in your family any member are affected?
Yes☐ No ☐
Yes☐ No☐
Yes☐ No☐
Yes☐ No☐
WASTE MANAGEMENT
Yes☐ No☐
2. How often waste management team visit your locality for waste collection or disposable.
A. Every day☐ B. Once in week☐ C .Once in two week☐ D .Once in month☐ E. Never ☐
7. Do you have any knowledge on the effect on Municipal Solid Waste (MSW) on public health in
the environment?
Yes☐ No☐
Explain it
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Yes☐ No ☐
12. How your local Govt. or NGO are participating to control solid waste
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13. Give your suggestion regarding pollution control and waste management process
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