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Benfeciary Transport Template 1 -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

Code 
Q11

Verbal Consent from the respondent
Respondent’s eligibility Assessment 
A01

What is your age?
A02

Do you use the services of the asset /project (Specify form the list)?
A03

Are you a usual resident of this Grama Panchayat / municipality?
A04

How long you have been staying in this Grama Panchayat?
A05

How familiar you are with your GP/ municipality activities or initiatives?

Demographic information
B01

Name of the Respondent

B02

UID of the respondent
B03

Gender of the respondent
B04

What is your marital status?
B05

Address of the Respondent
B06

What is your religion?
B07

What is your caste category or community category?
B08

What is the highest educational qualification you completed?
B09

What is your profession or key sources of income?
B10

Does your family belong to APL or BPL category?
B11

Land availability
B11A

Units

B12

Please determine respondent is the key beneficiary of which of the following sectors and skip to related sector

B12_1

Agriculture – (Krishi Bhavan / Farm Mechanization)
B12_2

Anganwadis

B12_3

Animal Husbandry – Veterinary hospital
B12_4

Arts, Culture and sports development, Youth welfare: Playground / Art gallery / Samskarika Nilayam
B12_5

Computerisation – for panchayat office / Transferred institutions /Schools
B12_6

Drinking water
B12_7

Education -School building
B12_8

Electric line, Transformer
B12_9

Energy generation/ Energy protection – Solar street lights
B12_10

Street light, Office electrification: Street lights, High mast lighting, Office electrification
B12_11

Health – Hospitals (PHC, CHC)
B12_12

Housing, House Electrification
B12_13

Irrigation – Minor or micro irrigation projects
B12_14

Other construction works
B12_15

Soil-water conservation, Environment, afforestation
B12_16

Public Buildings which are not included in productive and service sectors - GP/MC office, GP/MC front office, GP/MC community hall / Auditorium,
B12_17

Reading Rooms, Libraries and Grama sabha /ward sabha centres
B12_18

Sanitation, Waste processing: Drainage / Toilets/ bathing places / solid waste management / crematoriums
B12_19

Social welfare, social security
B12_20

Transport (Road /culvert/small bridges/foot paths/side walls/path ways-construction, renovation, maintenance)
B13

Respondent backgrounds

B14

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?
B15

How far this Road /culvert/small bridge/foot path/side wall/path way/bus stand/parking area is from your house hold?
B16

What is the most common mode of road transport you or your house hold is using?
B17

Project / Asset Planning

B18

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?
B19

If so, please why it is much needed or not needed? Please elaborate
B20

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?
B21

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?
B22

What kind of suggestions residents or grama /ward sabha members has given?
B23

What is the compliance to the suggestions given?
B24

Project / Asset Implementation

B25

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?
B26

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 ?
B27

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 ?
B28

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?
B29

If yes, please elaborate
B30

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?
B31

If yes, please elaborate
B32

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?
B33

What kind of remedies were taken to reduce or stop the unreasonable interference to the environment?
B34

Project / Asset Maintenance

B35

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?
B36

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?
B37

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?
B38

Use and Utility

B39

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?
B40

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 ?
B41

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? 
B42

What are the benefits or advantages of this (focal project) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area ?
B43

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?
B44

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?

B45

How satisfied you are with the benefits or services you have received from this (focal project1) Road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area?
B46

Provide details on your satisfaction level.
B47

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?
B48

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?
B49

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?
B50

Quality of the asset or Infrastructure

B51

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?
B52

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?
B53

Does the road has followings?

B53_1

Drainage
B53_2

Tarring / Concrete
B53_3

Potholes / Cracks
B53_4

Signage’s
B53_5

Water logging
B53_6

Railings
B53_7

Blockages
B53_8

Sharp Curves
B53A

Does the bridge has followings?

B53A_1

Railings
B53A_2

Cracks
B53A_3

Lose fittings
B53B

Does the culvert has followings?

B53B_1

Blockages
B53B_2

Breakages / Cracks
B53C

Does the Pathways and Footpaths has followings?

B53C_1

Interlocks / Tiles/ Concreting / Tarring
B53C_2

Lose fitting
B53C_3

Breakages / Cracks
B53D

Does the Side walls / Protection walls followings?

B53D_1

Land sliding
B53D_2

Lose fittings
B53E

Does the bus stand has followings?

B53E_1

Roof
B53E_2

Seating
B53E_3

Seating differently abled
B53E_4

Cement / Tile floor
B53E_5

Signage’s
B53F

Does the parking areas has followings?

B53F_1

Adequate parking space
B53F_2

Adequate staff for security or management
B53F_3

Signage’s / boards
B53F_4

Security /Digital security measures
B53F_5

Fencing
B54

GP / Municipality service delivery (Improvements in quality)

B55

What are the different services / facilities provided by GP / municipality to improve the transport related services in the GP / Municipality locality?
B56

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?
B57

How would you rate the quality of Transport facilities provided by GP / municipality to improve the transport related services in the GP / Municipality locality?
B58

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?
B59

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?
B60

If yes or no, please elaborate 
B61

What was the situation before constructing /maintaining / renovating this (focal project) road /culvert/small bridges/foot paths/side walls/path ways/bus stands/parking area
B62

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?
B63

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?
B64

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?
B65

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?