ARP502 Planning Studio II M.Tech.

Department of Architecture & Planning,

Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

HOUSEHOLD SURVEY QUESTIONNAIRE

The information filled in this survey form will be used and meant only for academic and study purpose
Name of the Surveyor: ______________________________ Date :_______________Form No.________
Zone No.: ______________Ward No: ___________ Ward Name: ____________________________
Area Name: _________________________________ Landmark:_____________________________
Instruction: √ tick the correct options.
Follow following Codes for numbers
5 4 3 2 1
Good / Sustainable Moderate Good / Neutral Moderate Poor / Poor / Un-Sustainable
Sustainable Un-Sustainable
Strongly Agree Agree Undecided / Neutral Dis-Agree Strongly Dis-Agree
More than sufficient Sufficient Undecided / Neutral In-sufficient Highly Insufficient
Very Safe Safe Neutral Fear High Fear
No Environmental Moderate Environmental Neutral Significant Environmental High Environmental
Degradation Degradation Degradation Degradation

1.0 DEMOGRAPHIC CHARACTERISTICS

1.1 Name of the HoH (Optional)______________________________________Contact no:________________

1.2 Religion Hindu Muslim Buddhist Christian Jain Sikh Others

1.2.1 Caste (if respondent willing to inform)

1.3 Household Composition (Find codes in table below)

No. Relationship to Age Gender Educatio Monthly Employment type/sector/skill type
HoH (in yrs) (M/F) n Income (Choose options from table below)
Type Segment Sector Skill
1.4.1 1.4.2 1.4.3 1.4.4 1.4.5 1.4.6 1.4.7 1.4.8 1.4.9
1 HoH
2
3
4
5
6
7
8
9

Relationships Month Income Education level Employment type Employment Sector

SP(Spouse) 1(<20,000) N (No education) U(Unemployed) P (Primary)
CS/CD(Son/Daughter) 2 (20,000-50,000) P(Primary 4th) G(Govt. employee) S (Secondary)
P(Parents) 3(50,0000-75,000 ) M(Middle 7th) P (Private employee) T (Tertiary)
G(Grandparents) 4(75,0000-1 Lakh) S(Secondary 10th) R(Retired) Employment
A(Aunt/Uncle) O(Other 5(1-2 Lakh) HS(Higher sec. 12th) SE(Self-employed) Segment
family mem) U(Unrelated) 6(>2 Lakh) DP(Diploma) B(Bachelor’s TR(Trader) IF(Informal L (Labour)
Distance in kms degree) MS(Master’s sector) HW(Housewife) W (White collared)
A – 0-0.5 km degree) VT(Vocational) S(Student) O (Other)
B – 0.5-1.0 km O(Others) Employment Skill
O(Others)
C – 1.0 -2.0 km S (Skilled)
D – 2.0-3.0 km SM (Semi Skilled)
E – 3.0-5.0 km US (Unskilled)
F – >5.0 km

2.0 LAND USE AND BUILDING CHARACTERISTICS

2.1 Type of Building: Apartment/Row House/ Individual Multistory Building With Common Wall/Individual Building/
Bungalow /Other
2.1.1 Slope Gradient: 0-30, 30-45, 45 above 2.1.2 Owned/ Rented:……… If rented, Rent Rs…………….
2.1.3 Plot Area: 2.1.4 Land Value:………….. Building Value:……….
Built up area: Total Value:

1
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

2.1.5 Do you have Kitchen garden/ urban agriculture? Yes No

2.1.6 What is the height of the habitable room (in feet)? ………. 2.1.7 How many rooms in the house? ………..

2.2 Settled at place since 0-10 yrs 10-30 yrs 30-50yrs > 51 yrs Native
2.2.1 Do you and your family wish to stay in this same locality in future? Yes/No Reason
2.2.2 Are you willing to stay in the same locality in future Yes/No Reason
2.2.3 Reason for migration: Employment………. Education………. Work transfer……… Other(specify)………..

ONSITE OBSERVATIONS

2.3 Land use: Residential /Commercial /Mixed /Other (Specify) Other Observations :

2.3.1 No. of floors: G, G+1, G+2, G+3, G+4,….

2.3.2 Front Road/Street width (in meter):

2.3.3 Condition of structure: (5 Point) 1 2 3 4 5

3. PHYSICAL INFRASTRUCTURE

3.1 Water Supply Services

3.1 Mode of water supply? Piped Supply Tanker Open well/ Bore well Others: Specify
s
3.2. Is your water connection metered? Yes N If Yes Rupees ________ or ______ Units, per bill
o
3.2.1 Frequency (Continuity of water supply) Daily Alternate day Others Supply Duration (Hours)
3.2.2 Water Quality (5 points) 1 2 3 4 5 3.2.3 Storage (approximate in litres)
3.3 Is supplied water sufficient for family 1 2 3 4 5
3.4 Is Rain Water Harvesting practiced in your house? Yes No
3.5 How do you tackle the problem in winter when water solidifies?
3.2.6 Response from Municipal Body regarding your Prompt Delay action No
complains action taken
taken

3.2 Sewage (Sewerage and Sanitation) and Strom Water

3.2.1 Mode of waste water UG Sewer Pit Method Closed drains Open drains Septic No Facility
disposal (kitchen & bathroom) Line Tank
3.2.1 Problems of drains, sewer lines Overflow Clogging Bad Odour No Problem
3.2.2 Overflow of drains during rains Yes No No. of days water overflow
3.2.3 Do you experience water logging or No. of days water logged
flooding during rains?
3.2.4 Water reuse Yes No Gardening Washing/Cleaning Others (Specify)
3.2.5 Family Toilet Yes No If No, Specify details
Facility
3.2.6 Response from Municipal Body Prompt Delay action No
regarding your complains action taken
taken

3.3 Solid Waste Management

3.3.1 Mode of solid waste Door-to-door Dumping in Bins Burning Throwing Other, specify
disposal from house? collection /Designated Spot (self) outside
3.3.2 Frequency of garbage Daily Alternate days Weekly No Door to Door Collection
collection (door to door)
3.3.3 How much garbage 100% 75%(3/4th) 50% 25%(1/4th) 0%
is collected from area ?

2
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

3.3.4 Waste segregation at source Yes No

3.3.5 Satisfaction (5 points) 1 2 3 4 5
3.2.6 Response from Municipal Body Prompt action Delay action taken No
regarding your complains taken

3.4 Electricity
3.4.1 Is electricity available? Yes No
3.4.2 If yes, is the electricity consumption metered? Yes No Electricity consumption in unit _________
3.4.3 Electricity Failure/Shutdown Yes No
3.4.4 Is Solar energy used? Yes No Purpose: Water heater/ Solar light/ Solar cooker/Others
3.4.5 Which of the following appliances do you have in your house? Please specify number
Appliance (√) Numbers Appliance (√) Numbers
Televisions Microwave
Air conditioners Computer/ Laptop
Air coolers Fans
Electric Water Heater Lights
Washing machine Telephone (Landline)
Fridge Mobile phones
Mixer/Grinder Internet (non Mobile ph)

3
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

4. SOCIAL INFRASTRUCTURE

4.1 Health
4.1.1 Do you feel there is environmental degradation in past 10 years? 1 2 3 4 5
4.1.2 What is the frequency of falling ill with water borne diseases last one year? Family Members No of times
4.1.3 What is the frequency of falling ill with air borne diseases last one year? Family Members No of times
4.1.4 Are all children below 10 years in the family vaccinated? Yes No If no, Reason

4.2 Security / Crime

4.2.1 Rate the fear of crime in the locality 1 2 3 4 5
4.2.2 Rate the fear of crime in the city 1 2 3 4 5
4.2.3 Do you feel that your children can go to nearest shop alone, can come back safely Yes No
If no, reason is Traffic Fear of Crime Any other reason, specify
4.2.4 Nature of crime happened in your locality in last 3years Example: 1. Theft; 2. Chain Snatching; 4. Eve Teasing; 5.
Homicide; 7. Kidnapping; 8. Any other (specify)
Nature of Crime No. of Times Nature of Crime No. of Times Nature of Crime No. of Times

5.0 TRANSPORT & URBAN MOBILITY

5.1 Vehicle Ownership Status

No. of vehicles of different types owned by household Parking
2 Wheeler Car Other No Vehicle On Street Off Street Other
             

5.2 Details of Each Trip

Member Trip No. Mode Trip Start Trip End Distance Purpose of Trip time Travel
No. * (Ward) (Ward) trip** Cost
               
               
               
               
               
               
               
               

* 1- Walk, 2-Two Wheeler, 3-Car, 4-Intermediate Public Transport(Taxi, Rickshaw), 5-Bicycle, 6-Bus
** 1-Going to Work, 2-Going to Education, 3- Going to Shopping, 4- Going to Leisure, 5-Other
6-Returning from Work, 7- Returning from Education, 8- Returning from Shopping, 9- Returning from Leisure, 10-Other
5.3 Any suggestion regarding the transport facility within the city? (5 points)
5.3.1 Condition or road (Kuccha/ Pucca) (internal access road) 1 2 3 4 5
5.3.2 Maintenance of road (Good/ Bad/ worse/ Not any) 1 2 3 4 5
5.3.3 Safety (street lights on roads, potholes, side drains, etc.) 1 2 3 4 5
5.3.4 Condition of public transport (Good/ Bad/ worse/ Not any) 1 2 3 4 5
5.3.5 Willingness to use improved public transport YES NO

4
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

5.4 Distance to nearest amenities you use, provided they are affordable and compatible (Find codes in table in between)
Facility Mode/Dist. Mode Facility Mode/Dist.
Nursery School BI, CR, AR Grocery store / Daily Needs Shop
W, 2W, 4W
Primary school Main Market
BU, O
Secondary/ Higher Secondary Sch Distances Community Hall/Club
College / Training Institute A(<0.5 km) Police Station / Chowky
Clinic B(0.5-1km) Post office
Hospital C(1-2 km) Banks
Pharmacy/ Medical store D(2-3km) Fire station
E(>3km)
Indoor sports complex Others (Library, etc.)

5.5 Social spaces Parks/Open Religious/ Streets Commercial Squares/ Community Natural
(A) Cultural (B) (C) Areas (D) Junctions(E) /Civic (F) Open (G)
Distance
Visit Frequency
Visit Time
Travel Mode
Overall (5 points)
5.5.1 In order of priority, list down five of your most visited social spaces.

6.0 GOVERNANCE
6.1 Governance issues: Rate your overall satisfaction for listed facility in your area:
Services 1 2 3 4 5 Services 1 2 3 4 5
Water Supply Electricity supply
Solid waste mgt. Tax collection
Sewerage system Accessibility
Drainage system Road condition
6.2.1 Is the local body efficient in infrastructure maintenance? 1 2 3 4 5
6.2.2 Is local body take suggestions from you about development works? Yes No
6.2.3 Are able to meet the corporate or elected representative easily? Yes No
6.2.4 How much time does it take for addressing complaints related to infrastructure?
Within a day or two days, immediately Week 4 Weeks More than months

7.0 TOURISM
7.1.1 Do you work in tourism? Yes No
7.1.2 If yes, do you work all year? Yes No 7.1.2.1 % of income from tourism
7.1.3 Tourism has increased protection of heritage & natural areas 1 2 3 4 5
7.1.4 More tourist activities like nature walks, etc. should be promoted 1 2 3 4 5
7.1.5 Tourism helps promote your culture and traditions 1 2 3 4 5
7.1.6 Do you prefer to have more international tourist arrivals? 1 2 3 4 5
7.1.7 Jobs have increased because of increased tourism 1 2 3 4 5
7.1.8 Infrastructure in the area has improved because of tourism 1 2 3 4 5
7.1.9 Tourism has brought increased crime/bad practices to the area 1 2 3 4 5
7.1.10 The current rules to manage tourist activity are adequate 1 2 3 4 5
7.1.11 Residents should decide how much and kind of tourism acceptable 1 2 3 4 5
7.1.12 More people from the community should be involved in tourism 1 2 3 4 5
7.1.13 Tourist activity should be restricted in certain areas Yes No
7.1.14 If yes, please specify
7.1.15 Has tourism damaged the attractiveness of the city Yes No
7.1.16 According to you which are the four most important tourist spots
7.1.17 Which destinations contributes to local area the most
7.1.18 Have you been involved in any events,activities & programs of this Yes No
destinations

5
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

8.0 Disaster Mitigation and Management

8.1 Are you Aware of the Disasters that Occur in your City? Yes No
8.2 Tick any 3 Disasters that frequently occur in your city.
Earthquake Floods Droughts Tsunami Cyclones Fire hazards
Rise in sea
Industrial Hazards Terrorist attack/war Coastline alteration
levels
8.3 Have you prepared yourself for any disasters that might occur? Yes No
I have collected the information    
I have spoken to disaster management representatives in my area    
I have prepared a family/ neighbourhood emergency plan    
I have prepared disaster survival kits    
I have taken special training    
I have trained other members in the community    
I have signed up with entities that provide emergency news or alert systems    
8.4 Have you arranged for the following, in case of an emergency or a disaster? Yes No
A minimum of 72 hours of water supply and food supply    
A mode of communication which is not dependent on electricity    
Enough First aid kits    
An alert system for family and community    
Necessary hygiene and sanitation products, Disaster kits and Necessary medications    
Supplies for children, aged, or people with special needs    
Evacuation plan    
Emergency operational plan    
8.5 In your opinion, how should the community receive information about a disaster or an emergency situation?
Internet/
Newspaper Television Family or friend cell phones Other
social media
8.6 As per your knowledge, what are the health-related issues that have occurred when a disaster struck?
Disease Water contamination Damage to
Severe injuries Food shortage Other
outbreaks or shortage the hospitals
8.7 Has you or your family ever been affected by a disaster? Yes No

9 Environment and biodiversity

9.1.1 How is the air quality in your neighbourhood ? 1 2 3 4 5

9.1.2 How is the water quality in your neighbourhood ? 1 2 3 4 5
9.1.3 Have you faced any health problems due to Air ? 1 2 3 4 5
9.1.4 Have you faced any health problem due to water? 1 2 3 4 5
9.1.5 Proximity to any Natural feature (km) 0-5 5-10 10-15 15-20 >20
9.1.6 Rate the Green Cover changes in the neighborhood in the last 10 1 2 3 4 5
year.?
9.1.7 Are you satisfied with existing natural features.? 1 2 3 4 5
9.1.8 How often you locate birds in your neighborhood in a month.? 1 2 3 4 >5

10 Slums
1.Name of Slum:................................... 2.Slum Code:.................................. 5.Is the Slum Notified/Declared? Yes / No
3. Age of Slum in Years:........................4.Type of Area surrounding Slum: Residential / Industrial / Commercial/ Institutional / Other
1. SOCIAL

• Land tenure status:Patta / Possession Certificate or Occupancy Right / Private Land Encroached / Public Land Encroached / Rented
/ Other- .

• Type/structure of the house: Pucca / Semi-Pucca / Katcha..

6
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

Source of drinking water:

a) Within premises- Tap / Tube well / hand pump /Open well OR

b) Outside premises- Public tap / Tube well / Bore well / Hand pump / Open well / Tank / pond / River / Canal / Lake / Spring
/ Water tanker / Other-

c)If piped water supply then duration: Less than 1 hour daily / 1-2 hrs daily / more than 2 hrs daily / once a week / twice a week /
not regular / no supply

d)If outside premises: then distance from drinking water source [ Less than 0.5 kms / 0.5 to 1.0 km. / 1.0 km to 2.0 km / 2.0 km to
5.0 km / more than 5.0 km

• Existence of toilet facility: Own septic tank / flush latrine / Own dry latrine / Shared septic tank / flush latrine / Shared dry
latrine / Community septic tank / flush latrine / Community dry latrine / Open defecation

• Bathroom facility : Within premises / Outside premises / Community bath / No bathroom.

• Road in front of house: Motor able Pucca / Motor able Katcha / Non- motor able Pucca / Non - motor able Katcha

• Type of Education facility available : Municipal / Government / Private

• Type of health facility access : Primary Health Centre / Government Hospital / Maternity Centre / Private Clinic / RMP /
Ayurvedic Doctor / Vaidya

• Nearby Recreational/Social/ Open Space : Less than 0.5 kms / 0.5 to 1.0 km. / 1.0 km to 2.0 km. / 2.0 km to 5.0 km. / more
than 5.0 km.

2. ENVIRONMENTAL :

• Is Land Stable? (Yes / No)

• Is Air quality good ? (Rate: 1- Very bad,2-Bad, 3- Okay, 4- good, 5- Very good

• Is There any disaster history?..................................................................

• Frequency of Disaster: ………………………. (How many times in 10 year)

3. ECONOMIC

• Employment status : Self-employed / Salaried / Regular wage / Casual labour / Unemployed.

• Place of work :Within the slum area / Outside the slum area : within distance Less than 0.5 kms , / 0.5 to 1.0 km. / 1.0
km to 2.0 km / 2.0 km to 5.0 km. / more than 5.0 km .

• Time of work : Whole day / Half day / Part time / 3 Months in a year / 6 Months in a year / Whole year.

• Monthly earning: Less than Rs. 500 / 500 to 1000 / 1000 to 1500 / 1500 to 2000 / 2000 to 3000/ More than 3000.

• Main Reason for Unemployment of Unemployed Member of the Household : Illiterate / Lack of vocation skill / Lack of job
opportunity / Disability / Low wage / Lack of capital to invest / Loss of earlier job / Closure of unit / Lack of work in the
enterprise / Lack of work in the area / Lay-off without pay / Employer harsh / Health hazard / Other…………….

7
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

9.0 General comments on the locality/ area

_________________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________ Thank You for sparing your valuable time

8
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

INDUSTRIAL QUESTIONNAIRE
The information filled in this survey form will be used and meant only for academic and study purpose
Name of the Surveyor: ______________________________ Date: ________________Form No.__________
Zone No.: _________________Ward No: _______________ Ward Name: ____________________________
Area Name: _______________________________________ Landmark: ______________________________

1.0 DETAILS OF THE INDUSTRY

1.1 Name of the industry: ____________________________________ 1.2 Year of establishment: _______________
1.3 Location: ______________________________________________ 1.4 Plot area :__________________( Sft./sq.m./ha)
1.6 Surrounding land-use: 1.5 Built-up area: ______________ ( Sft./sq.m./ha)
1.6.1 East
1.6.2 West
1.6.3 North
1.6.4 South
1.7 Type of Industry: 1. Small 2. Medium 3. Large
1.8 License: Required- Yes/No Taken- Yes/No
1.9 Environmental clearance: Required- Yes/No Taken- Yes/No
1.10Approval agencies: ___________________________________
2.0 COMPONENTS OF INDUSTRY:
Sl.No. Components Available others
2.1.1 Raw materials un-loading
2.1.2 Storage units
2.1.3 Manufacturing area
2.1.4 Processing area
2.1.5 Finished product storage
2.1.6 Loading
2.2 Manufacturing process:
1.____________________________
2.____________________________
3.____________________________
4.____________________________
5.____________________________
6.____________________________
3.0 PHYSICAL INFRASTRUCTURE
Resource / Water Power Other fuels Solid waste Sewage Other observations
units (lts/day) (KW/day) ( ) (MLD) (MGD)
3.0.1 Consumption
3.0.2 Source
3.0.3 Alternate options
3.0.4 Recycle/reuse
3.0.4 Charges/tariff
4.0 RAW MATERIALS:
4.1 Source: 4.1.1 Dehradun city 4.1.2 East district

5.0 Road/Parking
5.1 Access road condition 1 2 3 4 5
5.2 Parking space Required Available
5.2.1 2 wheelers
5.2.2 Cars
5.2.3 Tempo
5.2.4 Trucks
5.2.5 Lorries
5.2.6 Others
4.1.3 Uttarakhand state 4.1.4 within country 4.1.5 Abroad
Sl.No. 4.2.1 Raw materials 4.2.2 Source 4.2.3 Distance(km)
1

9
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

2
3
4
5
6
6.0 Workforce:
Type of workers Male Female Monthly wages Wage range
1. Main (Rs.)
2. Marginal 1. < 5000
3. Helpers 2. 5000-10000
4. Skilled 3. 10000-20000
5. Unskilled 4. >20000
Native place/ No. of workers
Type of work Skilled Unskill
ed
Dehradun city
East district
Intra state
Outside state
7.0 PRODUCTION AND DISTRIBUTION:
7 7.1 Products 7.2 By-products 7.3 Waste products 7.4 Production Distribution Mode of
1 (unit-________) (unit-_______) distribution
2 7.4.1 Daily Local markets
3 7.4.2 Monthly Within India
4 7.4.3 Annual Outside India
5 7.5 Any seasonal change in products/ process:
6

8.0 ECONOMY
8.1 Investment: Rs. monthly/ annually 8.2Profit: (Rs. monthly/ annually) ______________________
Raw materials
Production
Distribution
9.0 OTHERS
9.0.1 Are there any policies to promote the industry? Yes / No
9.0.2 If yes, mention_________________________________________________

10
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

10.0 INDUSTRIAL WORKERS

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
10.5 Any issues faced:

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
10.5 Any issues faced:

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
10.5 Any issues faced:

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
10.5 Any issues faced:

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
10.5 Any issues faced:

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
10.5 Any issues faced:

Worker no:
10.1 Age: Sex: M /F Job title: Education:
10.2 Type of work: skilled/ unskilled Duration of work: Monthly wages:
10.3 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other state
10.4 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:

11
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

10.5 Any issues faced:

12
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

HOUSEHOLD INDUTRIAL QUESTIONNAIRE

The information filled in this survey form will be used and meant only for academic and study purpose
Name of the Surveyor: ______________________________ Date: ________________Form No.__________
Zone No.: _________________Ward No: _______________ Ward Name: ____________________________
Area Name: _______________________________________ Landmark: _____________________________
1.0 GENERAL DETAILS
1.1 Name of the industry: Owner: Age: Sex: M/ F
1.2.1 Job title: Type of employment: 1. Self-employed 2. State corporation 3. Public 4. Private
1.2.2 Duration of work: 1.4 Type of products made:
1.2.3 Payment/Income: 1. 4.
1.5.1 Any other job: Yes/No Type of job: skilled/unskilled 2. 5.
1.5.2 Location: Distance to work: 3. 6.
2.0 INFRASTRUCTURE / FACILITIES USED
Resource Raw materials Water(lts/day) Power(KW/day) Other fuels( )
Supply
Source
Charges/tariff
3.0 WORKER DETAILS:
1.2.1 Number of workers/ employees: Type of work: skilled/ unskilled
1.2.2 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other
state
4.0 PRODUCTION AND DISTRIBUTION:
4 4.1 Products 4.2 By-products 4.3 Waste products 4.4 Production Distribution Mode of
1 (unit-________) (unit-_______) distribution
2 4.4.1 Daily Local markets
3 4.4.2 Monthly Within India
4 4.4.3 Annual Outside India
5 4.5 Any seasonal change in products/ process:
6
4.6 Investment: Rs. monthly/ annually 4.7 Profit: (Rs. monthly/ annually) ______________________
Raw materials
Production
Distribution
5.0 OTHERS
5.1 Are there any policies by govt. to promote the industry? Yes / No
5.2 If yes, mention_________________________________________________

1.0 GENERAL DETAILS

1.1 Name of the industry: Owner: Age: Sex: M/ F
1.2.1 Job title: Type of employment: 1. Self-employed 2. State corporation 3. Public 4. Private
1.2.2 Duration of work: 1.4 Type of products made:
1.2.3 Payment/Income: 1. 4.
1.5.1 Any other job: Yes/No Type of job: skilled/unskilled 2. 5.
1.5.2 Location: Distance to work: 3. 6.
2.0 INFRASTRUCTURE / FACILITIES USED
Resource Raw materials Water(lts/day) Power(KW/day) Other fuels( )
Supply
Source
Charges/tariff
3.0 WORKER DETAILS:
1.2.1 Number of workers/ employees: Type of work: skilled/ unskilled
1.2.2 Native place: 1. dehradun city 2. East district 3. Other district 4. Other
state
4.0 PRODUCTION AND DISTRIBUTION:
4 4.1 Products 4.2 By-products 4.3 Waste products 4.4 Production Distribution Mode of
1 (unit-________) (unit-_______) distribution
2 4.4.1 Daily Local markets

13
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

3 4.4.2 Monthly Within India

4 4.4.3 Annual Outside India
5 4.5 Any seasonal change in products/ process:
6
4.6 Investment: Rs. monthly/ annually 4.7 Profit: (Rs. monthly/ annually) ______________________
Raw materials
Production
Distribution
5.0 OTHERS
5.1 Are there any policies by govt. to promote the industry? Yes / No
5.2 If yes, mention_________________________________________________

14
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

STAKEHOLDER QUESTIONNAIRE
The information filled in this survey form will be used and meant only for academic and study purpose
Name of the Surveyor: ______________________________ Date: ________________Form No.__________
Zone No.: _________________Ward No: _______________ Ward Name: ____________________________
Area Name: _______________________________________ Landmark: _____________________________
1.0 SHOPS/ OUTLETS
1.0 Name of the shop: Location: Area :(Sft/sq.m) Established year:
1.1 No. of workers: Nature: 1. Self-employed 2. State corporation 3. Public 4. Private
1.2 Native place: 1. Dehradun city 2. East district 3. Other district 4. Other Duration of work:
state
1.3 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
1.4 Type of products sold: Source 1.5 No. of customers per day: 1. Local
1. 2. Indian tourist 3. Foreign tourists
2. 1.6 Investment: 1. Shop 2. Products
3. Daily income: Profits:
4. 1.7 Is there any provision made by the government to support the
5. industry? Yes/ No
6. Mention

1.0 SHOPS/ OUTLETS

1.0 Name of the shop: Location: Area :(Sft/sq.m) Established year:
1.1 No. of workers: Nature: 1. Self-employed 2. State corporation 3. Public 4. Private
1.2 Native place: 1. Gangtok city 2. East district 3. Other district 4. Other state Duration of work:
1.3 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
1.4 Type of products sold: Source 1.5 No. of customers per day: 1. Local
1. 2. Indian tourist 3. Foreign tourists
2. 1.6 Investment: 1. Shop 2. Products
3. Daily income: Profits:
4. 1.7 Is there any provision made by the government to support the
5. industry? Yes/ No
6. Mention

1.0 SHOPS/ OUTLETS

1.0 Name of the shop: Location: Area :(Sft/sq.m) Established year:
1.1 No. of workers: Nature: 1. Self-employed 2. State corporation 3. Public 4. Private
1.2 Native place: 1. Gangtok city 2. East district 3. Other district 4. Other state Duration of work:
1.3 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
1.4 Type of products sold: Source 1.5 No. of customers per day: 1. Local
1. 2. Indian tourist 3. Foreign tourists
2. 1.6 Investment: 1. Shop 2. Products
3. Daily income: Profits:
4. 1.7 Is there any provision made by the government to support the
5. industry? Yes/ No
6. Mention

1.0 SHOPS/ OUTLETS

1.0 Name of the shop: Location: Area :(Sft/sq.m) Established year:
1.1 No. of workers: Nature: 1. Self-employed 2. State corporation 3. Public 4. Private
1.2 Native place: 1. Gangtok city 2. East district 3. Other district 4. Other state Duration of work:
1.3 Location of residence: Ward no.: Distance to work:
Mode of transportation: Cost: Time:
1.4 Type of products sold: Source 1.5 No. of customers per day: 1. Local
1. 2. Indian tourist 3. Foreign tourists
2. 1.6 Investment: 1. Shop 2. Products

15
ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

3. Daily income: Profits:

4. 1.7 Is there any provision made by the government to support the
5. industry? Yes/ No
6. Mention

16
 ARP502 Planning Studio II M.Tech. Department of Architecture & Planning,
Urban Planning Visvesvaraya National Institute of Technology, Nagpur 440 010

WARD LEVEL OBSERVATIONS

1. Major Land use: Residential /Commercial /Mixed / Industrial/ Other (Specify)
2. Majority no. of floors: G, G+1, G+2, G+3, 3. Density of Ward: Highly dense, Medium Dense, Not dense….
G+4,….
4. Road widths of major roads:(in meter)…. 5. Type of Public Transport used: Bus/ Auto/ Cycle-Rickshaw/
Taxi/ Others…...
6. Condition of structures: (5 Point) 1 2 3 4 5
7 a. ward condition on the basis of: Is locality at higher level than river? (Yes/No)
b. Slums: Present/ Not present….
c. Locality away from the industrial area? (Yes/No)

8. Type of Public Transport used: Bus/ Auto/ Cycle-Rickshaw/ Taxi/ Others…...

9. Vehicles of different types used in the ward 10. Parking
2-Wheeler Car Public Other On Street Off Street Other
Transport
             

11. Maintenance of roads (Good/ Bad/ worse/ Not any) 1 2 3 4 5

12. Safety (street lights on roads, potholes, side drains, etc.) 1 2 3 4 5
13. Condition of public transport (Good/ Bad/ worse/ Not any) 1 2 3 4 5
14. Tourist Sites present 1 2 3 4 5
15. Names of Tourist spots:

16. Social spaces present (Gardens, Hospitals, Community centres, 1 2 3 4 5

markets)

17. Major Landmarks

17