IMPROVEMENT OF LIVING CONDITION OF EARTHQUAKE EFFECTED

FAMILIES IN DALCHOKI VDC.

HOUSEHOLD ASSESSMENT/MONITORING- I

House: Fully damaged [ ] Partially damaged [ ]

District: Lalitpur District code:44700

VDC/Municipality: Dalchoki House code:DAL-……………………..

Tole: ………………….... Earthquake ID no. …………………….

Ward no:……………….. Citizenship No:……………………….

A. DEMOGRAPHIC INFORMATION

1. Head of the Household Name …………………………………………………………

Sex: Male / Female Age: ……….......

Contact person……………… contact no……………..

2. Number of family members based on their age group:

a. Below 5: ……….. b. Between 5-14: ……….. c. Between 15-64 …… d. Above 65: …….

Total no of family………………….

3. How many disable/pregnant/lactating women are there in your family? …………………

4. Land title of your household in Dalchoki

Yes / No

5. Land title at other place: …………………………

Area of land: ……………………. (Approximate)

B. EARTHQUAKE HOUSEHOLD SITUATION

1. What is the current living situation of your family and location?

a. At own house ……………………
b. At relatives house ………………….
c. At temporary shelter……………………..
d. At rented house
e. Others …………………….
 IMPROVEMENT OF LIVING CONDITION OF EARTHQUAKE EFFECTED
FAMILIES IN DALCHOKI VDC.

C. EARTH QUAKE RELIEF STATUS

1. What kind of support have youreceived for shelter and livelihoods afterthe earthquake?

 In cash
…………………….
 In kind
……………………

D. SOCIO-ECONOMIC INFORMATION
2. How many skilled labors are there in your family?

a. Mason
b. Carpenter
c. Bar bender
d. Others ……………………

3. How many family members can contribute as labor during construction? …………….

4. Major source of income of your family -

a. Agriculture f. E44ePension
b. Business/Enterprises g. Rent
c. Salaried job h. Bank interest
d. Wage labor i. Others …………..
e. Remittance
Note: this option should have multiple choice

E. WATER, SANITATION AND HYGIENE

1. Main source of drinking water -
a. Piped water (private connection) d. River
b. Public tap stand e. Spring
c. Tube well f. Other (specify)………………
2. Daily Consumption of water in liter ………………………………………………………

3. Type of toilet -
a. Toilet with septic tank c. Toilet without septic tank
b. Pit latrine d. Without toile

F. Capacity Building
1. Are you member of any Saving Groups/Cooperative? ........................
If yes,
2. Saving per month
 0-50
 IMPROVEMENT OF LIVING CONDITION OF EARTHQUAKE EFFECTED
FAMILIES IN DALCHOKI VDC.

 50-100
 100-500
3. Is there schemes available for house loan?

Do you have any recommendation for new construction?

…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………….
Any specific information …………………………………………………………………………………….
…………………………………………………………………………………………………………………

Thank you

Field Surveyor Supervisor

………………………… …………………………………

Date: …………………… Date: …………………………

LOCATION MAP
House photographs
At least 3