SOCIO ECONOMIC SURVEY FORMAT

SOCIO ECONOMIC SURVEY FORMAT Name of Locality: _________________________Ward: ______________Total No of Member: _________ Full Name of family head: ________________________ Male: ____ Female: ____ Illiterate Member: ____ Caste: _____________________ Religion: _____________________ Minority Status: ________________ 1. HOUSEHOLD PROFILE 1. Migrated? Yes / No 2. If Yes, No. of Years? a) > 5 Year b) 5 to 10 Years c) 10 to 25 Years d) 25 to 50 Years e) < 50 Years 3. If migrated: a. Place of Origin: Within State / Outside State b. Migration type: Seasonal / Permanent c. Reason of migration: Education / Employment / Living Condition / Accessibility d. If Other, Specify ______________________________________________________________ 4. Are you willing to migrate to another place? a) Yes b) No c) Maybe If yes or maybe Place / Location: ________________________________________________________ 5. If No, Reasons for not going back to the native place? a) Earning Money b) Habituated c) Education If other, Specify: ____________________________________________________________________________ 6. After the covid-19 situation, are you willing to go back to your native place? Yes / No 2. HOUSING (Please Tag/Mark the house for plot area and build-up area) 1. Type of House? (Observe and Tick) a) Semi Pukka House b) Pukka House c) Kaccha House a) Individual House b) Apartment 2. Number of Floors. (Observe and Tick) a) Single Storied (G+0) b) Two Storied (G+1) c) 3 Storied (G+2) d) Multi Storied (G+3 and above) 3. Material used in Structure: (Observe & Tick) Wall: a) Brick/ Stone b) Mud blocks/Bamboo c) Others, Specify: _______________ Roof: a) RCC b) Tin c) Tiles d) Asbestos e) Others, Specify: _______________ 4. Age of House: a) 0 - 5 Yrs. b) 5 -15 Yrs. c) 15 – 25 Yrs. d) More than 25 yrs. 5. House Condition: (Observe & Tick) a)Good b) Average c) Poor 6. Ownership type: Self-owned / Rented if rented, amount (Can be Approx.):_____________________ 7. Land Ownership: Self-owned / Government 8. Approx. price range of land (per Katha): Rs.____________________ 9. Do you have any other land Property? Yes / No If yes, Where? _____________________________ If No, Are you willing to buy? Yes / No 10. Usage of Residential Building (Observe & Tick) a) Self Use b) Rent purpose c) Shop/Commercial d) Manufacturing Activity e) Government Office f) Private Office g) Other Specify: __________________________________ 11. Asset owned by Household: a) Refrigerator b) Telephone / Mobile Phone c) Computer / Laptop d) Television e) A.C f) Geyser g) Electric Mixer / Grinder h) Washing Machine i) Tape Recorder / CD player 12. Cooking fuel used in the kitchen. a) Cooking Gas / LPG b) Firewood c) Electric Induction d) Kerosene e) Cooking Coal If Other, Specify: _____________________________________________________________________

3. ECONOMY & INDUSTRIES (If 1 or more earning member use separate sheet) 1. Type of employment engagement: a) Private b) Government c) If Others, Specify_____________________ 2. Occupation: a) Wage Labour b) Skilled Labour c) Shopkeeper / Business man d) Self Employed e) Government f) Private g) Retired h) Unemployed If Others, Specify: _______________________________________________________________________ 3. If Construction worker: a) Daily Wedged b) Weekly Wedged c) Engaged with Contractor 4. Is any of the Family members working as Part-time employees? Yes / No If yes, which type of Industry / Company / Office: _________________________________________________ 5. If Industrial worker, in which industry do you work? a) Small Scale b) Medium Scale c) Large Scale 6. After Covid-19 impact on job opportunity / Availability? a) Increase b) Decrease 7. Does the Industrial sector been affected after Covid-19? Yes / No 8. Suggestions for how Job opportunities can be made available? : ______________________________________ __________________________________________________________________________________________ 9. Does any Family member receive a pension? Yes / No If Yes, Specify which: ____________________ 10. What is your Monthly expenditure? a) Up to Rs 10,000 b) Rs 10,000 – Rs 20,000 c) Rs 20,000 and Above 11. Impact on monthly expenditure after Covid-19. a) Increased b) Decreased c) No Changes 12. How often you visit the market before Covid-19: a) Once in a week b) Twice in a week c) Once in a month d) Very often 13. How often you visit the market after Covid-19 a) Once in a week b) Twice in a week c) Once in a month d) Very often 14. Most preferred way of Shopping before Covid-19: a) Online shopping b) Offline Shopping 15. Most preferred way of Shopping before Covid-19: a) Online shopping b) Offline Shopping 16. How often do you do Online Shopping? a) Once in a week b) Twice in a week c) Once in a month d) Very rare 4. TRANSPORTATION 1. Are transportation and conveyance facilities satisfactory? Yes / No 2. Before Covid-19, the most preferred mode of transport? a) Public Bus b) Private Car c) Shared Car d) Auto e) Two wheeler f) Rickshaw g) If Others, ____________________________________ 3. After Covid-19, the most preferred mode of transport? a) Public Bus b) Private Car c) Shared Car d) Auto e) Two wheeler f) Rickshaw g) If Others, ____________________________________ 4. Self-Owned Vehicles? (If possible ask No. of vehicles) a) 2 Wheeler b) 4 Wheeler c) Cycle d) Light and Heavy Vehicles e) None f) If Others, Specify _________________________________________________ 5. Mode of Transportation prefer for different places? (Tick which is applicable and ask for every member) Rickshaw 2 Wheeler 4 Wheeler Cycle Bus Walk Distance School / College Market / Shopping Centre Hospital/Health Centre Parks, Cinema, Mall Railway Station / Bus Terminal

Airport Bank/ Post Office 6. How often do you travel Outstation? I. Within State II. Outside State a) Once in a year b) Once in 6 Months c) Once in 3 Months d) Every Month Preferred mode of transportation: __________________________________________________________ 7. Are there any signage’s provided? Yes / No 8. Is there any footpath provided? Yes / No 9. Is Zebra crossing provided near junctions? Yes / No 10. Availability of Cycle track and pedestrian pathway? (Observe and Tick) Yes / No 11. If yes, is the path shaded with trees? (Observe and Tick) Yes / No 12. Any Further suggestion for improvement: _______________________________________________________ __________________________________________________________________________________ ________________________________________________________________________________ 5. PHYSICAL INFRASTRUCTURE 5.1 Water supply 1. Source of Drinking Water/Potable Water. a) Well b) Hand pump c) Community Tap d) Municipal supply 2. Is connection available within premises? Yes / No 3. Frequency of Municipal Supply. a) Daily b) Twice in a day c) Alternate Days d) Once in three day 4. Duration of Supply. a) < 1 Hrs. b) 1 – 2 Hrs. c) 2 – 3 Hrs. d) > 4 Hrs. 5. Quality of water. a) Low b) Average c) Good d) Very Good 6. Are you satisfied with the drinking water supply? Yes / No 7. Type of Complaints? a) Quality b) Quantity c) No water d) Other, Specify: _______________ 8. Complaints redressed time. a) Within 24 Hrs. b) 24 – 48 Hrs. c) More than 48 Hrs. 5.2 Electricity 1. Source of electricity. a) Solar b) State supply connection 2. Electricity connection. a) Metered b) Non-Metered 3. Power cut duration. a) 0 Hrs. b) 0 – 1 Hrs. c) 1 – 2 Hrs. d) 2 – 3 Hrs. e) More than 3 Hrs. 4. Availability of street light. Yes / No If Yes, Working Condition / Non-Working Condition 5. Type of Street lights. a) LED b) Solar c) Halogen Bulb d) Other, Specify: _______________ 5.3 Sanitation, Waste Management & Storm Water b) Open Drainage c) No drainage 1. Availability of Drainage Line: a) Closed Drainage 2. Household waste water outlet. a) Soak Pit b) Municipal Drainage c) Open drained If Others, Specify _____________________________________________________________________ 3. Where is storm /Rain water collected? a) On site R.W.H b) Directly to public drains c) Discharged to river / Pond / Nalla 4. Where is household Solid waste disposed-off? a) Door to Door Collection b) Open Dumping c) Roadside Bin d) Disposed in Drain If Others, Specify: _____________________________________________________________________ 5. If door to door collection: a)Daily b) Alternate Days c) Once in three days d) Once in a week 6. Is Solid Waste Segregation at household level? Yes / No 6. SOCIAL INFRASTRUCTURE

6.1 Education (If more than one student use separate sheet) Government / Private 1. Which type of school / Education Infrastructure do you prefer? 2. Type of Education availability and their distance: a) Anganwadi: ______ b) Primary School: ______ c) Higher Secondary: ______ d) College: ______ 3. Most preferred mode: a) Public b)Private c) School Bus d) Other, Specify: _______________ 4. Do you think that your region has good opportunities in Education facilities? Yes / No 5. Any further suggestions / issues for improvement: ___________________________________________ _________________________________________________________________________________________ 6.2 Health a) Private b) Government c) Clinic d) PHC / CHC 1. Most Preferred health facility? 2. Distance: a) Pvt. Hospital: ________ b) Govt. Hospital: ________ c) PHC / CHC: ________ 3. Do you think that your area/region has good opportunities in Health facilities? Yes / No Any Suggestions for improvement: _____________________________________________________________ 4. Availability of Parks, Playground or other recreation spaces. Yes / No 5. Do you or your family members go to a park or playground? Yes / No 6. If yes, how regular? a) Once in a week b) Twice in a week c) Alternate days in a week d) Regular 7. Any Further suggestion / Issues for improvement: _________________________________________________ _____________________________________________________________________________________________ ___________________________________________________________________________________________ 6.3 Schemes 1. Do you receive any grant from any State Govt. flagship scheme? a) Kanyashree b) Rupashree c) Nijo Griha Nijo Bhumi d) Somobyathi e) SaboojSathi f) Akanksha g) Karmatirtha h) Shilpa-Sathi 2. If availing any other schemes please specify: _____________________________________________________ _________________________________________________________________________________________ 7. SLUMS 1. Does this place is allotted to you by any authority? Yes / No 2. Status of land: Government / Private If Government land: Patta Holder / Non-Patta Holder 3. How long have you stayed here? a) > 5 Year b) 5 to 10 Years c) 10 to 25 Years d) < 25 Years 4. Types of work in which you are engaged? a) Construction labourer b) Rack picker c) Driver d) Daily wage labour If Other, Specify: ___________________________________________________________________________ 5. Are You Skilled Labour? Yes / No If yes, Skill Type (Carpenter, Electrician etc.) _____________________________________________________ 6. Due to the Covid-19 has the income and job been affected? Yes / No 7. Do you get any ration assistance from the government? Yes / No 8. Type of Ration Card you avail: _________________________________________________________________ 9. Do you get any financial assistance from the government? Yes / No 10. Do you get any benefits from any State / Central housing schemes? Yes / No 11. Have you been allotted any house under the slum rehabilitation project of the government? Yes / No 12. If government provides a house, would you move to that place? Yes / No 13. Do you get any benefit of “Swasthya Sathi” for health assistance? Yes / No 14. Are you willing to go back to the native place if suitable jobs are made available? Yes / No 15. What do you say about life in slum areas?

a) Not so bad b) No other way c) Other___________________________________________ 16. What kind of problems do you face? a) Drainage b) No proper ventilation c) Drinking water d) Electricity e) Health If Others, Specify___________________________________________________________________________ 17. Do you face any problems from industries around you? Yes / No 18. Whether all children enrolled in the school? Yes / No If more than 1 student fill this table below: Boy/ Type of School If Not going, Dropout age Reason Girl Student 1 Student 2 Student 3 Student 4 19. If yes, which type of school? a) Government b) Private c) Others: _____________________ 20. If Not going to school, Drop-out Age: ___________________________________________________________ 21. Reason of Drop- Out: ________________________________________________________________________ 22. Alternative Economic activities for livelihood: ____________________________________________________ 23. Any Further suggestion / Issues for improvement: _________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 8. COASTAL 1. Do you have boats? Yes / No 2. If yes, the purpose of using boats? a) Fishing b) Passenger Movement c)Goods Movement If other, Specify: ___________________________________________________________________________ 3. Are you associated with fishing-related activities? Yes / No If yes, then specify as seller, catcher, supplier or other: _____________________________________________ 4. Have you been engaged in other activities apart from Fishing? Yes / No If yes, Specify: _____________________________________________________________________________ 5. Do you think living in a coastal region is a threat or an opportunity? a) Risk b) Opportunity 6. How do you get the information related to natural threats? a) Newspaper b) TV c) Radio d) Local Administration Announcement e) NGO If other, Specify: ___________________________________________________________________________ 7. Safe place during natural events. a) Home b) Govt. disaster shelter 8. After a natural disaster, how many days does it take to come to normal condition? a) >10 days b) 10-30 days c) <30days 9. Major damages during natural calamities? a) Roads b) Electric Poles c) Mobile Towers d) Life stocks e) Houses If Others, Specify: __________________________________________________________________________ 10. Availability of Ration during the natural disaster? a) Self stock b) Govt. aided supply c) NGO supply 11. Whether any fund area granted for the flood-prone area? Yes / No 12. Does this region have any tourism opportunities? Yes / No 13. Any Further suggestions / Issues: _______________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

9. ENVIRONMENTAL RELATED 1. Does anyone in your family or nearby person suffered from diseases in the last few years? Yes / No 2. If Yes, which diseases specify: _________________________________________________________________ 3. Do you / family member face any problem in breathing? Yes / No 4. Major cause of Pollution? a) Transportation b) Industries c) Mining d) Other If Other, Specify: ___________________________________________________________________________ 5. Do you face any issues during the rainy season? Yes / No If Yes, Specify: _____________________________________________________________________________ 6. Whether the area is prone to flooding due to rains? Yes / No 7. If Yes, How many days it takes to normal condition? a) Within 3 Days b) Within a Week c) 7 – 15 Days d) More than 2 weeks 8. During flooding, is rehabilitation centres available? Yes / No 9. Whether any funds granted to you for such disaster or destruction? Yes / No 10. Do hoardings / advertisements create any visual disturbance while driving/movement? Yes / No 11. Does traffic movement and noise an issue for your locality? Yes / No If yes, Suggestion for improvement: ____________________________________________________________ 12. Whether the waste disposed-off in a nearby river or water body? Yes / No 13. Any Further suggestion for improvement: _______________________________________________________ __________________________________________________________________________________________ ________________________________________________________________________________________ 10. CULTURAL AND HERITAGE 1. Popular Festival / Occasion. a) Durga Puja b) Holi c) Eid d) Rath Yaatra e) Diwali f) Muhaaram If Other, Specify: ___________________________________________________________________________ 2. Does this place have any significant heritage site, structure / precinct? Yes / No 3. Visitors during the festivals/ occasion. a) Within the state b) Outside the state 4. Problem faced during the festivals and occasion? a) Traffic Issue b) Over Crowded c) Lots of Noise d) Cleanliness If other Specify: ____________________________________________________________________________ 5. Does festive occasion/heritage presence help you in the economic generation? Yes / No If Yes, Specify: _____________________________________________________________________________ 6. Do tourists visit this place regularly or during festivals? Yes / No 7. Any Further suggestion / Issues for improvement: _________________________________________________ _____________________________________________________________________________________________ ___________________________________________________________________________________________ 11. TOURISM 1. Do tourists come to this region regularly? Yes / No 2. Best season for tourist to visit & Why? _________________________________________________________________________________________ 3. Are you involved in tourist’s related activities? Yes / No 4. Which type of activities you’re involved in? ______________________________________________________ 5. Any other work engagement apart from tourist activity? ____________________________________________ a) During tourist season: ____________________________________________________________________ b) Lean season: ___________________________________________________________________________ 6. No. of person / family member engage in such activity? ____________________________________________

7. If Handicraft, what items do you sell? ___________________________________________________________ 8. Whom do you sell your products to most often? __________________________________________________ 9. Do you participate in any fair/ mela for product showcase and sell? Yes / No 10. If Yes, Where and how often do you visit? a) Local Mela/ Fair/ Hat or within District: ____________________ b) Kolkata Fair or Inter-State: ____________________ c) Intra-State or outside state: ____________________ 11. Availability of training centre and exhibition centre? Yes / No 14. Sell of products, Before Covid-19: _________________________ After Covid-19: ____________________ 15. Do you think tourism sector will help in economic growth of this region? Yes / No Any Suggestions for improvement: _____________________________________________________________ 16. Do you think the tourism sector will help in the economic growth of this region? Yes / No 17. Any Further suggestion for improvement: _______________________________________________________ __________________________________________________________________________________________ ________________________________________________________________________________________ Name of Interviewer: _____________________ _____________________ Contact No: _____________________________ Signature