Surveypoint

Q01

Name of the Interviewer

Q02

Team code

Q03

Start time

A01

District code

A02

District name

A03

Village code

A04

Village name

A05

Household number

A06

UID

A07

Name of the respondent

A08

Age of the respondent

A09

Gender of the respondent

A10

Household size

A11

Religion of the respondent

Hindu

Muslim

Christian

Other minority religions (Bathouism and others)

A12

Caste of the respondent

General

Schedule caste

Scheduled tribe

Other backward class

Others (specify)

A13

Sub-social group of the respondent

Bodo

Rabha

Keot (Kaibarta)

Garo

Rajbongshi

Sarania

Others (specify)

A14

What is the primary source of occupation for the household?

Agriculture

Poultry and Livestock

Unskilled wage labour (agricultural labour, MGNREGA labour, construction work, brick kiln labour etc.)

Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)

Contractual or task-based work (ASHAs, CSPs, BC Agents, Tuitions, para-teachers etc.)

Old age/pensioner

Small business (kirana shops, dhabas, mobile shops, ferry shops etc.)

Enterprise in manufacturing sector

Govt. Job

Private Job

Others (specify)

B01

How was your house affected by the floods during June 2022?

Flooded but not damaged

Flooded and partly damaged

Flooded and severely damaged

Not effected by flood

B02

For how many days was your house inundated during floods in June 2022 ?

B03

How many times has your HH suffered severe flooding in the last 3 years (2019-2021)?

B04

Did you or will you repair/rebuilt/renovate your house due to floods in June 2022?

Yes

No

B05

Is your house at risk of severe damage in case there is a flood again?

Yes

No

B06

During the floods of June 2022, did you have to move to a relief shelter?

Yes

No

B07

Did you/your family members have to relocate to a Govt-relief camp during floods of June 2022?

Yes

No

B08

Notes

C01

Do you own livestock?

Yes

No

C02

What is the total number of livestock lost due to floods under each of the following livestock category?

C02A

Cattle (cow, bull, buffalo)

C02B

Goats

C02C

Pigs

C02D

Poultry (duck, chicken)

C02E

Others (specify)

C03

Do you own any farmland?

Yes

No

C04

What extent of your farmland (bighas) was under cultivation before the flood?

C05

What extent of your farmland was inundated by flood water?

C06

How much food grain stock have you lost due to the floods?

C07

Have you lost any Grain Storage Facility such as granaries?

Yes

No

C08

Have you lost any Agricultural Equipment?

Yes

No

C09

How many Agricultural Equipment have you lost?

C09A

Power tiller

C09B

Seed drill

C09C

Harrows

C09D

Winnowing machine

C09E

Thresher

C09F

Tractors

C09G

Hand hoe

C09H

Plough

C09I

Irrigation pump

C09J

Irrigation pipes

C09K

Others (specify)

C10

Did you/any household member face loss of wage employment (for non-agricultural/non-land-owning HHs) due to floods?

Yes

No

C11

What were the sources of your livelihood before June 2022 flood?

Farming

Livestock rearing

Daily wage labour

Skilled labour

Self-employed/business

Do not know

C11A

Can you please briefly explain the nature of livelihood sources (including migration), that you used to pursue before June 2022?

C12

Have you chosen alternative livelihood options due to floods?

Yes

No

C13

What alternative livelihood options have you chosen due to floods?

Farming

Livestock rearing

Daily wage labour

Skilled labour

Self-employed/business

Do not know

C14

Have you lost any non-farm livelihood assets?

Yes

No

C15

If yes, What non-farm livelihood assets have you lost?

C16

Notes

D01

Are there any existing medical emergencies in the family (any household member suffering from health/medical issues)?

Drowning

Physical injuries

Hypothermia

Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis A and E

Vector-borne diseases, such as malaria, dengue

Pregnant woman about to deliver

Mentally/physically challenged member

No medical emergency

Others (specify)

D02

In case of any emergency health issues, are health facilities (health centres, govt. hospital and doctors) available within a 5 km. radius of the village?

Yes

No

Do not have any such member

D03

Have you or any other household member been exposed to filthy water, pesticides, hazardous chemicals fumes, toxic gases, particulates, dead matter

Yes

No

D04

Have you/your family experienced flood-induced insect or reptile-related accidents such as snake bites?

Yes

No

D05

Have you or any other household member suffered from any rodent-infestation & outbreak such as due to rats and mice?

Yes

No

D06

Have you or any other household member suffered from any physical injuries during flood such as fractures, illness, or bleeding?

Yes

No

D07

Notes

E01

What toilet facilities were available for use during the flood?

Household toilet

Government/public facility

Open area

Others (specify)

E02

Were the household toilets damaged during the flood?

Yes

No

E03

What sources of drinking water were available during the flood?

Household water source

Government/public facility

Government relief

Others (specify)

E04

Were the household drinking water sources damaged during the flood?

Yes

No

E05

If Yes, what are the current source of drinking water?

Household water source

Government/public facility

Government relief

Others (specify)

E06

Did you have access to Soaps, Handwash, Detergents, Chlorine tablets?

Yes

No

E07

Did you have access to Sanitary napkins during floods?

Yes

No

E08

Notes

F01

Did you have to skip meals during the flood?

Yes

No

F02

If Yes, how many times per day did you skip your melas?

F03

Did you have access to adequate quantities of food from your own sources?

Yes

No

F04

What food aid did you receive during the flood?

No aid received

Rice

Pulses

Vegetable

Cooking Oil

Others (specify)

F05

Was your food supply adequate after receiving the aforementioned aid?

Yes

No

Don't know

F06

Has your intake of vegetables changed after the flood?

Increased

Remained same

Decreased

F07

Has your intake of protein-based food (animal source foods, pulses, soy etc) changed after the flood?

Increased

Remained same

Decreased

F08

Has your intake of rice changed after the flood?

Increased

Remained same

Decreased

F09

Were there any specific food requirements for family members (Pregnant mothers/Lactating mothers/Newborn children/Family members suffering from any ailments or old age)

Yes

No

Do not have any such member

F10

Did you have access to such food requirements?

Yes

No

F11

Notes

G01

Is there any school going child in the household?

Yes

No

G02

For how many days have you or the children not been able to attend the school?

G03

Was the school flooded during the heavy rainfall/floods in June 2022?

Yes

No

Don't know

G04

What is the extent of damage to the school property?

Flooded but not damaged

Flooded and partly damaged

Flooded and severely damaged

Others (specify)

G05

Did the child alternate access to education (local tuitions, group study, online teaching etc.)during the flood?

Yes

No

Don't know

G06

Has the damage to school caused by the flood reduced the access to education?

Yes

No

G07

Have you lost school stationeries, books, etc due to floods?

Yes

No

G08

Do you feel hopeful to continue education after the floods?

G09

Notes

G10

GPS coordinate of the household

G11

Rapid Assessment -Form Fill

Name of the Interviewer

Team code

Start time

District code

District name

Village code

Village name

Household number

UID

Name of the respondent

Age of the respondent

Gender of the respondent

Household size

Religion of the respondent

Caste of the respondent

Sub-social group of the respondent

What is the primary source of occupation for the household?

How was your house affected by the floods during June 2022?

For how many days was your house inundated during floods in June 2022 ?

How many times has your HH suffered severe flooding in the last 3 years (2019-2021)?

Did you or will you repair/rebuilt/renovate your house due to floods in June 2022?

Is your house at risk of severe damage in case there is a flood again?

During the floods of June 2022, did you have to move to a relief shelter?

Did you/your family members have to relocate to a Govt-relief camp during floods of June 2022?

Notes

Do you own livestock?

What is the total number of livestock lost due to floods under each of the following livestock category?

Cattle (cow, bull, buffalo)

Goats

Pigs

Poultry (duck, chicken)

Others (specify)

Do you own any farmland?

What extent of your farmland (bighas) was under cultivation before the flood?

What extent of your farmland was inundated by flood water?

How much food grain stock have you lost due to the floods?

Have you lost any Grain Storage Facility such as granaries?

Have you lost any Agricultural Equipment?

How many Agricultural Equipment have you lost?

Power tiller

Seed drill

Harrows

Winnowing machine

Thresher

Tractors

Hand hoe

Plough

Irrigation pump

Irrigation pipes

Others (specify)

Did you/any household member face loss of wage employment (for non-agricultural/non-land-owning HHs) due to floods?

What were the sources of your livelihood before June 2022 flood?

Can you please briefly explain the nature of livelihood sources (including migration), that you used to pursue before June 2022?

Have you chosen alternative livelihood options due to floods?

What alternative livelihood options have you chosen due to floods?

Have you lost any non-farm livelihood assets?

If yes, What non-farm livelihood assets have you lost?

Notes

Are there any existing medical emergencies in the family (any household member suffering from health/medical issues)?

In case of any emergency health issues, are health facilities (health centres, govt. hospital and doctors) available within a 5 km. radius of the village?

Have you or any other household member been exposed to filthy water, pesticides, hazardous chemicals fumes, toxic gases, particulates, dead matter

Have you/your family experienced flood-induced insect or reptile-related accidents such as snake bites?

Have you or any other household member suffered from any rodent-infestation & outbreak such as due to rats and mice?

Have you or any other household member suffered from any physical injuries during flood such as fractures, illness, or bleeding?

Notes

What toilet facilities were available for use during the flood?

Were the household toilets damaged during the flood?

What sources of drinking water were available during the flood?

Were the household drinking water sources damaged during the flood?

If Yes, what are the current source of drinking water?

Did you have access to Soaps, Handwash, Detergents, Chlorine tablets?

Did you have access to Sanitary napkins during floods?

Notes

Did you have to skip meals during the flood?

If Yes, how many times per day did you skip your melas?

Did you have access to adequate quantities of food from your own sources?

What food aid did you receive during the flood?

Was your food supply adequate after receiving the aforementioned aid?

Has your intake of vegetables changed after the flood?