Area Amenities Questionnaire
Respondent Information
1. Name: __________________________
2. Age: ____________
3. Gender: ☐ Male ☐ Female ☐ Other
4. Occupation: __________________________
5. How long have you been staying here? _______ years
6. How many members of your family stay with you? _______
Section 1: Water Supply
1. How frequently is water supplied to your location? ☐ Every day ☐ Alternate days ☐
Irregular
2. What is the primary source of drinking water? ☐ Tap ☐ Tanker ☐ Borewell ☐ Other:
____________
3. Do you experience water scarcity during summer? ☐ Yes ☐ No
4. Is the drinking water safe? ☐ Yes ☐ No
5. If yes (to Q3), how do you cope with water scarcity?
6. Describe any serious problem you have with water supply:
7. Likert Scale (1=Strongly Disagree to 5=Strongly Agree):
- The water supply is timely and regular
- The drinking water provided is clean and safe
- Authorities respond to water-related complaints effectively
Section 2: Electricity Supply
1. How many hours of electricity do you get per day? ☐ <8 ☐ 8–16 ☐ 16–24 ☐ More than
24
2. Do you experience frequent power cuts? ☐ Yes ☐ No
3. Is your house connected to official electricity supply? ☐ Yes ☐ No
4. Do you use alternative sources (solar, generator)? ☐ Yes ☐ No
5. If yes (to Q2), how do power cuts affect your daily life?
6. What improvements would you suggest for electricity in your area?
7. Likert Scale (1=Strongly Disagree to 5=Strongly Agree):
- Electricity supply is consistent
- Power cuts are managed well
- Electricity charges are affordable
Section 3: Roadways Condition
1. How would you rate the quality of roads in your area? ☐ Good ☐ Average ☐ Poor
2. Are the roads garbage-free and clean? ☐ Yes ☐ No
3. Do you face waterlogging or damaged roads during rains? ☐ Yes ☐ No
4. Is the road suitable for children and elderly to walk? ☐ Yes ☐ No
5. What improvements are needed in road infrastructure?
6. Likert Scale (1=Strongly Disagree to 5=Strongly Agree):
- Roads are maintained regularly
- Road conditions hinder daily commuting
- The area has proper drainage to avoid road damage
Section 4: Sanitation
1. Do you have a private toilet at home? ☐ Private ☐ Public Toilet ☐ No Access
2. Are public toilets clean and maintained? ☐ Yes ☐ No ☐ Not Applicable
3. Is there a wastewater drainage system? ☐ Yes ☐ No
4. How often is the drainage cleaned? ☐ Weekly ☐ Monthly ☐ Rarely ☐ Never
5. What are the major sanitation issues you face?
6. Likert Scale (1=Strongly Disagree to 5=Strongly Agree):
- Public sanitation services are satisfactory
- Drainage is cleaned often enough to prevent waterlogging
- Toilets (private/public) are usable and hygienic
Section 5: Education Facilities
1. Is there a nearby school? ☐ Yes ☐ No
2. Do children in your home attend school regularly? ☐ Yes ☐ No
3. Are school facilities (toilets, classrooms, etc.) adequate? ☐ Yes ☐ No ☐ Not Sure
4. How far is the nearest school (in km)? ___________ km
5. If children do not attend regularly, why?
6. What more can be done to improve education?
7. Likert Scale (1=Strongly Disagree to 5=Strongly Agree):
- Schools are accessible and within walking distance
- Educational quality is satisfactory
- Teachers and school staff are supportive
Section 6: Sanitary Disposal of Garbage
1. How is waste typically disposed of in your area? ☐ Municipal collection ☐ Open dumping
☐ Burning ☐ Other: __________
2. Is garbage collected regularly? ☐ Yes ☐ No
3. Are public garbage bins available? ☐ Yes ☐ No
4. Is uncollected waste a health issue in your area? ☐ Yes ☐ No ☐ Not Sure
5. How can waste best be disposed of?
6. Likert Scale (1=Strongly Disagree to 5=Strongly Agree):
- Waste is disposed of in a sanitary manner
- The area has enough dustbins for public use
- Waste collection is timely and prevents health issues
