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Benfeciary Transport Template 2 -Form Fill
Information
Q01
Name of the LG (GP / Municipality)
Q02
Code
Q03
Name of the Project / asset
Q04
Code
Q05
Year of the Project
Q06
Project / asset UID
Q07
Date of Interview
Q08
Time of interview
Q09
Interviewer
Q10
Respondent’s eligibility Assessment
Q11
What is your age?
Q12
Do you use the services of the asset /project (Specify form the list)?
Yes
No
Q13
Are you a usual resident of this Grama Panchayat / municipality?
Yes
No
Q14
How long you have been staying in this Grama Panchayat?
Q15
How familiar you are with your GP/ municipality activities or initiatives?
Not at all familiar
Somewhat familiar
Moderately familiar
Very familiar
Extremely familiar
Demographic information
A01
Name of the Respondent
A02
UID of the respondent
A03
Gender of the respondent
Male
Female
Other gender
A04
What is your marital status?
Married
Unmarried
Widow / Widower
Divorced
Separated
Deserted
A05
Address of the Respondent
A06
What is your religion?
Hindu
Muslim
Christian
Sikh
Budhist / Neo Budhist
Jains
Jews
Parsi / Zorastrian
No religion
Others (Specify……..)
A07
What is your caste category or community category?
SC
ST
OBC
General
No caste
OEC
Others Specify
A08
What is the highest educational qualification you completed?
Never attended school
Primary(1-5)
Upper Primary (6-8)
Secondary (9-10)
Higher / Senior Secondary (11-12)
DIPLOMA/CERTIFICATE COURSE (BELOW GRADUATE LEVEL)
GRADUATE
POSTGRADUATE AND ABOVE,
A09
What is your profession or key sources of income?
FARMER (CROPS)
AGRICULTURAL DAY LABOR
HERDING ANIMALS
NON-AGRICULTURAL DAY LABOR MAID SERVANT/CLEANING
MAID SERVANT/CLEANING
COOK
CHILD CARE PROVIDER
SERVICE/SALARIED WORKER
SMALL / COTTAGE INDUSTRY
PETTY BUSINESS / SHOP
BUSINESS / TRADER
OTHER SELF-EMPLOYMENT
SKILLED WORKER
NRI
House wife / Home maker
Retired
OTHER (SPECIFY)
A10
Does your family belong to APL or BPL category?
APL
BPL
Don’t Know
A11
Land availability
A11A
Units
Acres
Hectare
Cent
Others (Specify)
A12
Please determine respondent is the key beneficiary of which of the following sectors and skip to related sector
A12_1
Agriculture – (Krishi Bhavan / Farm Mechanization)
Yes
No
A12_2
Anganwadis
Yes
No
A12_3
Animal Husbandry – Veterinary hospital
Yes
No
A12_4
Arts, Culture and sports development, Youth welfare: Playground / Art gallery / Samskarika Nilayam
Yes
No
A12_5
Computerisation – for panchayat office / Transferred institutions /Schools
Yes
No
A12_6
Drinking water
Yes
No
A12_7
Education -School building
Yes
No
A12_8
Electric line, Transformer
Yes
No
A12_9
Energy generation/ Energy protection – Solar street lights
Yes
No
A12_10
Street light, Office electrification: Street lights, High mast lighting, Office electrification
Yes
No
A12_11
Health – Hospitals (PHC, CHC)
Yes
No
A12_12
Housing, House Electrification
Yes
No
A12_13
Irrigation – Minor or micro irrigation projects
Yes
No
A12_14
Other construction works
Yes
No
A12_15
Soil-water conservation, Environment, afforestation
Yes
No
A12_16
Public Buildings which are not included in productive and service sectors - GP/MC office, GP/MC front office, GP/MC community hall / Auditorium,
Yes
No
A12_17
Reading Rooms, Libraries and Grama sabha /ward sabha centres
Yes
No
A12_18
Sanitation, Waste processing: Drainage / Toilets/ bathing places / solid waste management / crematoriums
Yes
No
A12_19
Social welfare, social security
Yes
No
A12_20
Transport (Road /culvert/small bridges/foot paths/side walls/path ways-construction, renovation, maintenance)
Yes
No
A13
Respondent backgrounds
A14
Do you or any of your house hold members use the services of this Road /culvert/small bridge/foot path/side wall/path way/bus stand/parking area?
Yes
No
A15
How far this Road /culvert/small bridge/foot path/side wall/path way/bus stand/parking area is from your house hold?
A16
What is the most common mode of road transport you or your house hold is using?
Personal vehicle (2 wheeler)
Personal vehicle (4 wheeler)
Public transport (Auto / taxi)
Public transport (Bus / Tempo)
Others (Specify……………….)
A17
Project / Asset Planning
A18
Do you think constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area was very much needed?
Yes
No
A19
If so, please why it is much needed or not needed? Please elaborate
A20
Did GP /Municipality officials consult residents of this ward or in this area before constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes
No
A21
Do you know whether the Grama /wards Sambha has discussed the need / requirement of this project in any of its meeting before constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes
No
A22
What kind of suggestions residents or grama /ward sabha members has given?
A23
What is the compliance to the suggestions given?
Suggestion accepted but, not implemented
Suggestion accepted and implemented
Suggestion not accepted
Don’t know
A24
Project / Asset Implementation
A25
Approximately how long ago construction /maintenance / renovation of this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area was completed and this was ready for public use?
A26
Did the Engineers or Officials from GP/Municipality has supervised the construction /maintenance / renovation of this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area ?
Yes
No
A27
Did the local elected representative involved themselves during the construction /maintenance / renovation of this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area ?
Yes
No
A28
Any forest land or sensitive areas were invaded or modified during the constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes
No
A29
If yes, please elaborate
A30
Any natural resource depleted during the constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes
No
A31
If yes, please elaborate
A32
Any unreasonable interference caused to the environmental values (air pollution, smoke, sound pollution, water logging, erosions, mud or material stocking) during the constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes
No
A33
What kind of remedies were taken to reduce or stop the unreasonable interference to the environment?
A34
Project / Asset Maintenance
A35
How frequently this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area is maintained or repaired by GP/ Municipality?
Less than once six months
Once a year
Once in two year
Other (specify…………..)
Don’t know
A36
When was this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area was maintained or repaired by GP/ Municipality last time?
A37
Did the GP / Municipality has repaired or conducted maintenance work of this (focal project) road /culvert / small bridges/foot paths/side walls/path ways/bus stands/parking area before the last rainy season?
Yes
No
A38
Use and Utility
A39
How often do you utilize the services from this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Every day
Alternative days
Weekly twice
Weekly
Once in 15 days
Once in a month
Others (Specify ………………………………………)
A40
When was the last time you utilized the services from this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Today
Yesterday
In present week
In last week
Others (Specify ………………………………………)
A41
What kind of services do you or your house hold receive from this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Daily transportation
Emergency transportation
Goods transportation
Animal transportation
Markets/Street vendors/Shops
Others (Specify ………………………………………)
A42
What are the benefits or advantages of this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Using personal vehicle
Accessing public transport near to house (Auto / Bus/Taxi)
Time saving
Land values improved
Area has become commercial
Improvments in business
Day and night transportation
Others (Specify ………………………………………)
A43
What are the dis advantages or drawback of this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Noise pollution
Increased traffic
Area has become congested
Area has become commercial from residential
Reduction in agricultural land
Security issues
Road accidents
Others (Specify ………………………………………)
A44
How beneficial do you think this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area has been for you?
Very Beneficial
Beneficial
Average
A little beneficial
Not at all beneficial
A45
How satisfied you are with the benefits or services you have received from this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Very satisfied
Satisfied
Neither satisfied nor unsatisfied
Partially satisfied
Not at all satisfied
A46
Provide details on your satisfaction level.
A47
How beneficial do you think this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area has been for the residents of this ward or in this area?
Very Beneficial
Beneficial
Average
A little beneficial
Not at all beneficial
A48
Do you think there are changes in the life of the residents of this ward or in this area due to this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes, there is considerable changes
Yes, but minor improvements
No changes, it is same
A49
Please elaborate the changes in life of residents of this ward or in this area due to this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
A50
Quality of the asset or Infrastructure
A51
How would you rate the aesthetic view of this (focal project) roads /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Very Good
Good
Average
Below Average
Poor
A52
How would you rate the infrastructure quality of this (focal project) roads /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Very Good
Good
Average
Below Average
Poor
A53
Does the road has followings?
A53_1
Drainage
Yes
No
A53_2
Tarring / Concrete
Yes
No
A53_3
Potholes / Cracks
Yes
No
A53_4
Signage’s
Yes
No
A53_5
Water logging
Yes
No
A53_6
Railings
Yes
No
A53_7
Blockages
Yes
No
A53_8
Sharp Curves
Yes
No
A53A
Does the bridge has followings?
A53A_1
Railings
Yes
No
A53A_2
Cracks
Yes
No
A53A_3
Lose fittings
Yes
No
A53B
Does the culvert has followings?
A53B_1
Blockages
Yes
No
A53B_2
Breakages / Cracks
Yes
No
A53C
Does the Pathways and Footpaths has followings?
A53C_1
Interlocks / Tiles/ Concreting / Tarring
Yes
No
A53C_2
Lose fitting
Yes
No
A53C_3
Breakages / Cracks
Yes
No
A53D
Does the Side walls / Protection walls followings?
A53D_1
Land sliding
Yes
No
A53D_2
Lose fittings
Yes
No
A53E
Does the bus stand has followings?
A53E_1
Roof
Yes
No
A53E_2
Seating
Yes
No
A53E_3
Seating differently abled
Yes
No
A53E_4
Cement / Tile floor
Yes
No
A53E_5
Signage’s
Yes
No
A53F
Does the parking areas has followings?
A53F_1
Adequate parking space
Yes
No
A53F_2
Adequate staff for security or management
Yes
No
A53F_3
Signage’s / boards
Yes
No
A53F_4
Security /Digital security measures
Yes
No
A53F_5
Fencing
Yes
No
A54
GP / Municipality service delivery (Improvements in quality)
A55
What are the different services / facilities provided by GP / municipality to improve the transport related services in the GP / Municipality locality?
A56
Do you think there are improvements in the quality of Transport facilities provided by GP / municipality to improve the transport related services in the GP / Municipality locality?
Yes
No
A57
How would you rate the quality of Transport facilities provided by GP / municipality to improve the transport related services in the GP / Municipality locality?
Very Good
Good
Average
Below Average
Poor
A58
How satisfied you are with the quality of service of GP / Municipality in construction and maintenance transport related infrastructure (Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area) within a village panchayat / Municipality?
Very satisfied
Satisfied
Neither satisfied nor unsatisfied
Partially satisfied
Not at all satisfied
A59
Have you utilized the Transport related services of GP/Municipality before constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Yes
No
A60
How would you rate the quality of Transport related services of GP/Municipality before constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Very Good
Good
Average
Below Average
Poor
A61
How often did you utilize the Transport related services of GP/Municipality before constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
Every day
Weekly Once
Once in 15 days 15
Once in a month
Others (specify……………..)
A62
Do you think GP /Municipality has provided adequate infrastructure facilities for maintaining and setting up transport related assets such as road, culverts, bridges, pathways, footpaths etc. as per the needs of the locality?
Yes, adequate facilities are given (Please elaborate….)
Yes, but need improvements (Please elaborate….)
No, adequate facilities are not provided (Please elaborate…….)
A63
Would you like to say anything about this road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area which we haven’t discussed so far?
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