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Village Town Information -Form Fill
Q1
Name of the Province
Q2
Name of District
Q3
Name of the Hamlet
Q4
Name of the Village/Town
Q5
Total Number of Households in the Village/Town
Q6
Number of Households with Access to Grid Electricity
Q7
Total Population (Male)
Q8
Total Population (Female)
Q9
Total Population
Q10
Transportation and Travel -This section seeks to understand the transport and travel system prevalent in the locality. The type of roads, mode of transport and challenges in transportation will be enquired in this section
Q11
Which of the following transport access types are available to community members?
Paved Road
Unpaved Road
Paths
Lake/River
Others (Specify)
Q12
What is the most popular mode of transport used by individuals for travelling to the nearby town/city center/market
Bus
Van
Truck
Motorbike
Bicycle
Animal Driven Cart
Others (Specify)
Q13
What kind of challenges are faced in reaching the nearest town?
Improper roads
Lack of transport facilities
Expensive
Vehicles are in bad condition
Too crowded
Too Slow
Others
None
Q14
Security and Safety - This section seeks to understand the security condition of town/village
Q15
Have there been any incidents of attack such as (bomb blasts/kidnapping/vandalism) in your locality in the last 6 months?
Yes!No
Q16
If yes, how many such incidents have taken place?
Q17
Have there been any displacements due to extremist attacks?
Yes!No
Q18
How frequently do such incidents take place?
More than Once Week
Once a Week
Once a Month
More than once a Month
Once in a fortnight
More than once in a fortnight
Others
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