HUMAN DEVELOPMENT STATUS OF RURAL KERALA: A CASE

STUDY OF PUDUKKAD PANCHAYAT

QUESTIONNAIRE

A: GENERAL

1.Name of Panchayat

2. Ward No.

3. House Name & House No.

4.Name of the Head of Family

5.Religion: Hindu/Muslim/ Christian

6. Caste: Nair/Ezhava/Latin catholic/Scheduled Caste/Scheduled Tribe/………….

B: DEMOGRAPHIC DETAILS

B.1 Details of Family members

Serial No

Name M/F

Age Education & Literacy

Occupation(Mark S for students)

Place of occupation (Tcr, Kerala, India, abroad)

Monthly income (salary/pension/other sources)

1

2

3

4

6

7

8

1

B.2 Details of mortality in the family since 1991

Serial No

Name Relationship with the HOF

Age at death

Reason for death

C: ECONOMIC STATUS OF THE FAMILY

C.1 Land and other assets

1. Area of land

2. Type of land

3. Other assets: Building/ Shopping complex/

4. Financial Assets: shares/debentures/fixed deposits

C.2 House

1.Ownership of house: Owned/ rented

3. Roof: Tiles/Sheet/concrete/concrete +sheet/tiles

4.Wall of house: Mud/stone/brick/ Plastered/not plastered

5.Floor: Mud/ cow dung/ cement/mosaic/ tiles/ marbles/ granite

6.Area of house: …. S.Feet

7.Cooking fuel: Gas/ Kerosene / electricity / firewood

D: LIVING CONDITIONS

1. Source of drinking water: Own well/ Other’s well/ common tap/ pipe connection

2. Latrine facilities: yes/ No

3. House electrified: Yes/ No

2

4. Telephone Connection: Land phone/ Mobile

5. Cable connection: Yes/ No

6. Internet connection: Yes/ No

7. Private vehicles: cycle/Motor cycle/car/jeep/

E: CONSUMER DURABLES

1. TV 2. Radio 3. Video Cassette recorder 4. Washing machine 5.Electric iron

6. Fridge 7. Gas stove 8. Air conditioner 9.Grinder/ Mixie

F: EDUCATION

1. Type of Schools in which children are studying: Govt/ Aided

2. Medium of instruction in the school: English/ Malayalam

3. Are children attending tuition classes: Yes/ No

4. Type of colleges in which children are studying : Government /Aided/ /self financing

G: HEALTH

1. Types of diseases affecting the members of family: cold/ fever/ diabetes/pressure/……….

2. Types of hospitals attending: private/ Govt

3. Types Medical system used: Allopathy/Ayurveda/ Homeopathy

4. Do the family have medical insurance: Yes/No

3