Surveypoint

Q01

Village

Q02

District

Q03

Block

Q04

Project/Comparison area

Project

Comparison

Q05

Structure Type

Residential

Non-residential

Q06

Structure No.

Q07

Household No.

Q08

Unique Reference ID

Q09

Name of Household Head

Q10

Religion

Hindu

Muslim

Christian

Sikh

Buddhist/Neo-Buddhist

Jain

Jewish

Parsi/Zoroastrian

Sarna

No Religion

Others

Q11

Caste

Schedule Caste

Schedule Tribe

Other Backward Caste(OBC)

General

others

Q12

Result of visit

Complete

Refused

HH Migrated

HH temporarily away

No female respondent of age present to respond

Q13

Investigator’s code

Q14

Date

Q15

Are there any women/girls in this household between the ages of 15 and 49 years?

Yes

No

Q16

Name of the household member

Q17

Age (in completed years)

Q18

Sex

Male

Female

Transgender

Q19

Whether ever married?

Yes

No

Q20

In the past three years, did woman give birth to any child?

Yes

No

Q21

What is/was the name of the child?

Q22

What is/was the DOB of the child?

Q23

What is/was the gender of the child?