Questionnaire Of Human Development

HUMAN DEVELOPMENT STATUS OF RURAL KERALA: A CASE STUDY OF PUDUKKAD PANCHAYAT QUESTIONNAIRE A: GENERAL 1.Name of Panchayat 2. Ward No. 3. House Name & House No. 4.Name of the Head of Family 5.Religion: Hindu/Muslim/ Christian 6. Caste: Nair/Ezhava/Latin catholic/Scheduled Caste/Scheduled Tribe/………….

B: DEMOGRAPHIC DETAILS B.1 Details of Family members Serial No

Name

M Age / F

Education & Literacy

1 2 3 4 6 7 8

B.2 Details of mortality in the family since 1991

1

Occupation (Mark S for students)

Place of occupation (Tcr, Kerala, India, abroad)

Monthly income (salary/pensio n/other sources)

Serial No

Name

Relationship with the HOF

Age at death

Reason for death

C: ECONOMIC STATUS OF THE FAMILY C.1 Land and other assets 1. Area of land 2. Type of land 3. Other assets: Building/ Shopping complex/ 4. Financial Assets: shares/debentures/fixed deposits C.2 House 1.Ownership of house:

Owned/ rented

3. Roof:

Tiles/Sheet/concrete/concrete +sheet/tiles

4.Wall of house:

Mud/stone/brick/ Plastered/not plastered

5.Floor:

Mud/ cow dung/ cement/mosaic/ tiles/ marbles/ granite

6.Area of house:

….

7.Cooking fuel:

S.Feet Gas/ Kerosene / electricity / firewood

D: LIVING CONDITIONS 1. Source of drinking water: Own well/ Other’s well/ common tap/ pipe connection 2. Latrine facilities: yes/ No 3. House electrified: Yes/ No 4. Telephone Connection: Land phone/ Mobile 5. Cable connection: Yes/ No

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6. Internet connection: Yes/ No 7. Private vehicles: cycle/Motor cycle/car/jeep/

E: CONSUMER DURABLES 1. TV

2. Radio

6. Fridge

7. Gas stove

3. Video Cassette recorder 8. Air conditioner

4. Washing machine 5.Electric iron 9.Grinder/ Mixie

F: EDUCATION 1. Type of Schools in which children are studying: Govt/ Aided 2. Medium of instruction in the school: English/ Malayalam 3. Are children attending tuition classes: Yes/ No 4. Type of colleges in which children are studying : Government /Aided/ /self financing G: HEALTH 1. Types of diseases affecting the members of family: cold/ fever/ diabetes/pressure/………. 2. Types of hospitals attending: private/ Govt 3. Types Medical system used: Allopathy/Ayurveda/ Homeopathy 4. Do the family have medical insurance: Yes/No

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