RESEARCH ON THE NEIGHBORHOOD CHARACTARSTICS:

Area Name :

Interviewer's Code No.:

Interview No. :

Date of Interview :

Time Started :

Time Finished :

Length of Interview (min.):

INSTRUCTIONS

1. This questionnaire takes just a few minutes to complete. Please take your time and read the
questions carefully before answering.

2. The questionnaire is in two parts. Part I refers to the entire household as a unit. It should be answered
by the head of the household, Part II deals with the household member who is selected for the
interview, and should be answered by that person, If the head of the household member selected for
the Interview. Both Part I and Part II, to be answered and skip questions that can be recorded with
observation.

3. The numbers in the right hand margins are for office use, to assist in machine processing. Do not fill
them while in interview.

4. If possible. Complete this questionnaire before the date set for your appointment with the
interviewer. If, however, you have difficulty with any of the questions pleas. feel free to ask the
interviewer to help you when he or she arrives.

PART I

HOUSEHOLD QUESTIONS (To be answered by the head of the household.)

1. How many persons live in this house? Please remember to include new babies or someone who
usually lives here but is away at the time of interview.--------- (NO OF PERSONS)

2. 4. What is the SEX of the head of the household? M F . AGE ------

3. The members of the family excluding the head of household.:

A)1-17 ----- B) 17-25 --- C) 25-50 ----- D) 50- 70 ------ E) 70 and above ----
1. AGE M/F/TG EDN. 2. AGE M/F/TG , EDN 3. AGE M/F/TG EDN 4. AGE ---- M/F EDN 5.
AGE-----M/F EDN

6. AGE --- M/F EDN 7. AGE------- M/F EDN 8. AGE----- M/F EDN 9. AGE ---- M/F EDN 10. AGE-----
M/F EDN

Notes 1 illiterate 2Primary school 3. 10+2 4. Degree 5. PG 6. vocational course 7. mention others

Space for additional households if any .

4. Whit is the present employment status of the head of household?

1.Working full time 2. Working part time 3. Unemployed 4. Retired, and At leisure 5. Keeping house
6. In school 7.Other (Please specify)---------------------

1 2 3 4 5 6 7 circle one

5. If employed: What kind of work does the head of household do? (EXAMPLE: teacher, sales clerk,
foreman)

Mention the work and industry type ---------------------------------------------EDN 1 2 3 4 5 6 7 8 (Circle higest

end. )

6.Average monthly income of the head of the household / earning member.-----------Income range per
month

1. 0-10000 2. 10000-20000 3. 20000- 40000 4. 40000- and above - mention if available

7. Other employed persons in the house:

1. AGE----M/F 2. AGE M/F 3.AGE---- M/F 4.AGE-----M/F mention monthly income if available.

8.House type: 1. Owned 2. Rented

9. if owned / rented : type of house

1. Independent, single family /multiple ( mention number of family members within and number of
floors ) 2. Row house 3. Semi detached 4. Apartment (up to 4 floors above 4 mention.) 5. Old
house 6. Dilapidated 7. Dupleix/ triplex 8. Any other

1. RCC 2. TILES ROOF 3. SHED 4. MUD HOUSE 5. LOAD BEARING STRUCTURE

10. Age of the structure mention by observation

1. 0-5 2. 5-10 3. 10-25 4. 25-50 5. 5-100 and more.

11. Open spaces with in :

Front ----- rear------ side1 ------side 2-------

11. Other land uses with in the premises :

Industry / floor mill / press/ sweet shop / food store / convenient store / clinic/ tailor/ atr related/ any
other mention.

12. Vehicle ownership of the house hold and other vehicles owned by the members:

1. Car 2. Bike 3. Trolley 4. 7 Seater 5. Bus. 6. Mini van 7. Tractor 8. Cart

Mention parking availability for the same – Ask the household how they mange parking .

13. What other form of transportation is available to household members?

Bus, Car pool, Friend's car, Private vehicles, Other (Please describe)

14. 18. How many minutes away (walking time' is the nearest bus stop?------------

Part two Survey Interview:

1. Please describe the residential area you live in.

(PROBE: What else?)

2. In what ways is your residential area a good place to live?

(PROBE: What else- What other ways)

3. All things considered is your residential area (CIRCLE NUMBER)

excellent 1 good 2 average 3 fair, 4 poor 5 as a place to live?

4. Hand over a sheet of paper and ask respondent to sketch his neighborhood.

5. How would you go to get to the farthest edge of this map? Would you

Walk 1 Take an automobile 2 , Take a bicycle 3 , Take a motorcycle 4 Take a bus 5

6. How long would It take you in minutes to get to the farthest edge of the map? _______________ _

7. How important is It for you to live In a place that you consider a neighborhood?
Is It (CIRCLE NUMBER) 1. very important2.fairly important 3. Not Important at all.

PROBE: Why do you say that?

8. The following questions pertain to your residential area. Please answer "Yes" or "No" as I read each
question.

A. Is it an area known by a certain name? (CIRCLE) Y/N

(IF YES) What is that name? ___________ _

B. Is it an area bounded by certain streets? (CIRCLE ) Y/N

If yes what are those – pl note the street names/ numbers .

C. Is it an area whi.ch has certain natural or man-made features, landmarks, or other characteristics?

YES//No – Specify :

D. Is it an area served by certain schools? (CIRCLE ) Y / N

SPECIFY: (a) Elementary (b) Junior High (c) Senior High (d) College or University (e) others

E. Is it an area which has a certain shopping area? Y/N

F. The location of convenient store from house please check on map.

G. Is the area where people share common concerns or problems?

List out concerns:

H. Are there hospitals and small clinics in the neighborhood? If Yes specify with distances and list.

I. Access to Work:

A 1 Within 5 minutes walk Within 2. 10 minutes walk 3. Within 15 minutes of walk or more specify.

B. Drive – 5 10 15 20 25 30 ---specify mode BUS/ CAR/ BICYCLE ETC.

J. Access to friends and relatives with In neighborhood and beyond.

A. Walk – 5 10 15 20 25 specify
B. Drive 5 10 15 20 25 specify

C. Bus 5 10 15 20 specify.

K. Adequacy of dwelling space:

1Lots of extra space 2. Some extra space 3. Just enough space 4. Not enough space 5. Extremely
cramped

L. Access t Open spaces and parks:

a. Walk 5 10 15 20 25

b. Are they clean and maintained scale 1-10 1 best 10 worst .

M. Access to schools for children:

A. Within 5 minutes walk B. Within 15 minutes walk C. Within 10 minutes drive D. Within 20 minutes
drive E. Within 30 minutes drive F. Within 4S minutes drive G. Within 1 hour drive H. Within 15 minutes
bus ride 1.' Within 30 minutes bus ride J. Within 1 hour bus ride

N. Access to entertainment facilities:

A. Within 5 minutes walk B. Within 15 minutes walk C. Within 10 minutes drive D. Within 20 minutes
drive E. Within 30 minutes drive F. Within 4S minutes drive G. Within 1 hour drive H. Within 15 minutes
bus ride 1 Within 30 minutes bus ride 2 Within 1 hour bus ride

O. Access to shops:

A. Within 5 minutes walk B. Within 15 minutes walk C. Within 10 minutes drive D. Within 20 minutes
drive E. Within 30 minutes drive F. Within 4S minutes drive G. Within 1 hour drive H. Within 15 minutes

P. Safety to person and property:

1. Extremely Safe 2. Safe 3. Somewhat Safe 4. In Between 5.. Somewhat Unsafe 6. Unsafe 7..
Extremely Unsafe

Q. Type of neighbors around:

1. Extremely Desirable 2. Desirable 3. Somewhat Desirable 4. Between 5. Somewhat Undesirable 6.

Undesirable 7. Extremely Undesirable

9. Social aspects :

a. How often you meet relatives

1. Daily 2. Weekly 3. Once a Month 4. Never 5. Other specify

b. How do you feel between modern neighborhoods or this one?

Describe

c. what is great in this neighborhood ?

Describe

d. How is the access to work place?

e. Do you attend neighborhood meetings?

f. How often you meet in the neighborhood meetings ?

g. Are they useful?

h. How you solve neighborhood problems?

I. How do your children interact with the other members I the community?

j. How do you differ this from traditions olden day’s neighborhoods?

k. Do you feel this new life style different from traditional neighborhoods?

l. How best do you use neighborhood spaces with in block and within neighborhood?