MODEL SURVEY SCHEDULE FOR A SOCIO ECONOMIC SURVEY IN VILLAGE AREA (By Tanmoy Sarkar; gmail: srkrtanmoy@gmail.

com)

01. Name of the Respondent: ....................................................................... 02. Caste/Sub-Caste : ............................................ 03. BPL: Yes / No. 04. Education:

Sl. Identity

Illiterate
No. Educational Extra Proof

Only Sign
Age
Sex
Name Qualification Curriculum Case of Drop out & Cause & Address
Proof*

1
2
3
4
5
6
7
8
9
10
11
12
*1-Voter card, 2-Ration Card, 3-Aadhar Card, 4-PAN Card, 5-Passport.

05. Economy:

Sl. No./Name Age of Age of Income per Source of Place of Working Frequency of Previous Any Remark
Marriage Start Month Income work place Journey Work Bank
Income Distance Account

Page 1 of 5
 MODEL SURVEY SCHEDULE FOR A SOCIO ECONOMIC SURVEY IN VILLAGE AREA (By Tanmoy Sarkar; gmail: srkrtanmoy@gmail.com)

06. ONLY FOR EARLY MARRIED GIRL:

A. Reason of early marriage: Custom/Tradition Due to economic problem Higher education is not so necessary for women Personal reason

B. Education is continuing after marriage: Yes No

C. Co-operation of family to continue learning: Very Good Good Moderate Bad

D. Learning is continuing from: Own Father’s House House of Father-in law Separate house with Husband elsewhere

E. Age of first child born:

F. Gender preference at birth : Male child Female child

07. Sense of Security:

A. Your opinion on family safety: No Issues __________ Issues _________ ; If yes mention specific issues _______________________________________________________

B. Child security: No Issues __________ Issues _________ ; If yes mention specific issues ____________________________________________ ________________________

C. Cooperation of BSF: ___________________________________________________________________________________ ______________________________________

D. Co-operation of Local administration in any matter: Very Good____________ Good______________ Average_______________ Bad____________

E. Issues on Local Crime: Types:____________________ Frequency:___________________

F. Cross Border Terrorism: _____________________________________________

G. Do you afraid to go out of your home in the evening: Yes Always:__________ Not at All:_____________ Depends on situation: __________________

H. Any personal explanation:

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

Page 2 of 5
 MODEL SURVEY SCHEDULE FOR A SOCIO ECONOMIC SURVEY IN VILLAGE AREA (By Tanmoy Sarkar; gmail: srkrtanmoy@gmail.com)

I. Pattern of Investment and sense of security:

Ranking 1 2 3 4 5 6 7 8 9
Preferences Purchase of Purchase of Marriage of Improvement Vehicles & Business Other self Investment Any other
agricultural livestock children of house & agricultural employment outside block
land in the household implements (like fishery) or district
village assets
Respondent

J. Possession of Assets & Sense of Security:

Assets Agricultural land House Shop Factory/ small Live stock Agricultural Car/ motor vehicle
entrepreneurs impliment
Yes/ No

08. GENERAL INFORMATION ABOUT DRINKING WATER & HEALTH

A. Status of Health Infrastructure (Office Query):

PHCs Hospitals Sub heath No of Beds Bo of Doctors Patients Other No of

Centre treated Dispensaries Ambulance
Village
GP
Block

Page 3 of 5
 MODEL SURVEY SCHEDULE FOR A SOCIO ECONOMIC SURVEY IN VILLAGE AREA (By Tanmoy Sarkar; gmail: srkrtanmoy@gmail.com)

B. Source & Distanceof Drinking Water: Tap call________ Tube well________ Time Call_________ Pond _________ Purified Packed Water________
Panchayet Constructed Purified Water Centre___________ Others_________

C. Separate Kitchen: Yes_________ No_________ D. Separate Bathroom: Yes_________No__________

E. Bathroom Type: Sanitary (Self) __________ Open Space__________ Panchayet Constructed for Community__________

F. Last child born; Hospital......................................... Nursinghome ..........................Heatth Centre . ..................... Others ....................................

G. Information about any Govt. Supported Maternity Aids/Facilities; ................................................................................................................... ...................................................

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

H. Availability of Doctors; Adequate in Nos. ........... Moderately Available............ Rare to Available............... (d) Nearest Hospital place and
distance..................................................................................................................... ....................................................................................

I. Polio and other Immunization programme is necessary for each end every child; Yes ................. No .......... If no th en why.............................................................................

J. Opinion/Remark; ............................................................................................................. ............................................................................................................................. ....

K.

Major Diseases Child death Maternal death

Last 1 yr

Last 3 yr

Page 4 of 5
 MODEL SURVEY SCHEDULE FOR A SOCIO ECONOMIC SURVEY IN VILLAGE AREA (By Tanmoy Sarkar; gmail: srkrtanmoy@gmail.com)

Last 5 yr

More than 5 yr

9. Involvement in Govt. Scheme;

A. Do you know about BADP; ...............................................................................................................................................................................................................................

B. Do you or your family members are involved in any SHG? .............If Yes mention Name................................ Duration........................... ..Group Name
......................................Activities......................................Improvement in your opinion..................................................................................

C. Participation of women (in employment) under NREGS: Yes No Remark ...............................................................................................................

D. Participation of women in SGSY Scheme: Yes No Remark .................................................................................

E. Problems and Advices (in your opinion); .................................................................................. .............................................................................................................

Date; ...................................................................

---------------------------------------------------------------------

Signature of Surveyor

Page 5 of 5