Water Supply

1. What is the source of water in your area?

2. Is water available for 24x7? If not, what are the timings? Please specify.

3. How is the water quality? How will you rate it?

 Good
 Average
 Poor

4. Is there any water scarcity in your area? What is the overall situation?

5. Have you filed any complaint regarding the same? If yes, do you get any improvement so far?

6. Is there a rain water harvesting system available?

7. Is there a ground water recharge facility available?

8. Is there any OTH nearby? What is its capacity? (capacity can also be written checking OHT)

9. Are there any water charges? If yes, how much you pay monthly?

Electricity

10. What is the source of electricity in your area?

11. Whether there is any electricity cut in your area? If yes, for how many hours? Please specify.

12. Do you have meter in your house?

13. Do you have generator/Invertor? If no, Is there any community generator?

14. Any solar power facility?

15. How much on an average your monthly electricity bill turns up?
Solid waste

16. Is there any solid waste collection van comes up from municipality side? If yes, at what
timings? Please specify.

17. Is this a regular service or weekly service?

18. Do you pay for the service provided? How much?

19. If no van comes to collect garbage, where do you dump your garbage?

20. If open dumping, do you find diseases or unpleasant situation due to the same?

21. What is being done of the dumped waste later on?

22. If dustbins are there, at what distances (on an average) community dustbins are provided in your
area?

Sewerage/Drainage
23. Are drains open or covered in your area? (can also be written on the basis of observation)

24. Is there any blockage of ‘nallas’?

25. If yes, aren’t they getting cleaned by someone? (someone could be community or municipality)

26. Is there any issue like foul smell or diseases around?

Transportation

27. Are all areas in your surrounding properly connected and accessible?

28. What mode you usually choose to visit nearby areas?

29. Is there any public mode (like, autos, rickshaws, bus etc.) facility available to visit to the nearby
areas?

30. Do you own a cycle? Do you use it daily? If not, when and for how many days in a week you use
it?

31. Do you walk to visit areas nearby? If yes, what distance on an average you walk daily?

32. Is there any infrastructure for cyclers and walkers? If not, do you feel safe on road with busy
traffic?

33. Do you have street lights facility in your area? If yes, do they work properly in night?
34. Is the area safe for women and children at night?

35. What is the condition of roads in terms of potholes and obstructions specially during rain? (can
also be written on the basis of observation)

Some questions can also be asked regarding services nearby

36. Is there a daily market or weekly haat in this community? If yes, what is the distance to the nearest
daily market?

37. Is there a post office in this community? If yes, what is the distance to the nearest post office?

38. Is there a bank and ATM facility in this community? If yes, what is the distance to the nearest post
office?

39. How many temples, mosques or churches are there in this community? And at what distance?

40. What is the distance to the nearest government primary school serving this community?

41. What is the distance to the nearest government hospital to this community?

42. Is there any children park in this community? If not, where does children play regularly?

43. Any issues regarding any other thing you face and would like to tell the government? Please
specify.

44. Any sports association or stadium nearby?

45. Any community centers nearby for cultural or social activities?

46. Any active NGOs working in your area? Which sector do they look after? Is it beneficial?
 Happiness Index Questionnaire
Female Male Other

Below 20 years 20-40 years 40-60 years Above 60 years

(Mark your answers on a scale of 1 to 10; 1 being the lowest value and 10 being the highest)

1. How will you rate the 'ease of living' in your area?

1 2 3 4 5 6 7 8 9 10

2. How safe do you feel about your life (health, social security, etc)?

1 2 3 4 5 6 7 8 9 10

3. How satisfied are you with the services provided by government agencies (electricity, water
supply, sanitation system, transportation etc) in your area?

1 2 3 4 5 6 7 8 9 10

4. How satisfied are you with the educational facilities in your area?

1 2 3 4 5 6 7 8 9 10

5. How satisfied are you with the amenities (police station, parks, clubs, parking spaces etc)
provided to you?

1 2 3 4 5 6 7 8 9 10

6. How satisfied are you with the cultural and social framework in of your area?

1 2 3 4 5 6 7 8 9 10

7. How satisfied are you with your economic status?

1 2 3 4 5 6 7 8 9 10
 8. How satisfied are you with your health?

1 2 3 4 5 6 7 8 9 10

9. How satisfied and happy do you feel in your daily life?

1 2 3 4 5 6 7 8 9 10

10. How satisfied do you feel about your life achievements?

1 2 3 4 5 6 7 8 9 10

ENVIROMENT QUESTIONS

Water Bodies
Number of water bodies in the area
Type of water body
Lake River Wetland Canal Other Name
Observation for water quality
Water colour
Water turbidity
Odour
Factors responsible for water deterioration the water quality
Industrial runoff
Agricultural runoff
Domestic runoff
Encroachments within the buffer area Name
Pucca
Semi-Pucca
Kuccha

Air
Pollution levels
No Pollution
Moderate Pollution
Heavy Pollution
Nuisance
Noise Levels Source
No appreciable noise
Some noise
Major problem

Waste Management
Garbage Collection
Segregation at Source
Collection points
Responsible Authority
Dumping sites in the area Name
Yes / No

Measures Taken for Protection

Main Concern
Environmental Hazards Comments
Air Pollution
Water Pollution
Waste Pollution
Damage to scenic beauty
Noise Pollution
Other

Recent environmental hazards / crisis reported in the last five years :