Water pollution control & solid waste

management in the ………………………..

Part of …………………………………………..zone :
A perception based study

WATER POLLUTION & WASTE MANAGEMENT

 Details of Respondent:-
 General knowledge:-

1. Respondent's Name: - ...................................................................................

2. Age:-

A. ☐ < 25 B.☐ 26-35 C. ☐ 36-45 D. ☐ 46 -55 E. ☐ 56 –65 F. ☐ >65

3: Gender:-

A. ☐ Men B. ☐ Women C.☐ others

4. Education:-

A. ☐Illirate B. ☐Upto 8th class C. ☐ 8th -12th class D. ☐ Graduate E. ☐ Postgraduate

F. ☐Others
 5. Occupation:-

A. ☐ Employed B. ☐ Unemployed C. ☐ Farmer D. ☐ Other

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6. Religion:-

A. ☐ Hindu B. ☐ Muslim C. ☐ Christian D. ☐ Other

7. Race:-

A. ☐ GENERAL B. ☐ SC C. ☐ ST D. ☐ OBC

8. Martial Status:-

A. ☐ Married B. ☐ Unmarried C. ☐ Widow D. ☐ Divorced

 Family information:-
1. Total family member: - .............................................................................

2. Total Male: - Total Female: -

Serial Age Education Occupation Serial Age Education Occupation

No. No.
1. 1.
2. 2.
3. 3.
5. 4.
6. 5.

3. Total family income:-

A. ☐ <5000 B. ☐ 5000 – 14999 C. ☐ 15000 – 24999 D. ☐ 25000 – 34999

E. ☐ 35000 – 44999 F. ☐ >45000

4. Total land:-....................................................................................................

5. Total agricultural land: - ..............................................................................

6. Total houses present: -.....................................................................................

7. Types of house: -
A. ☐Kacha house B.☐ Semi-pacca house C.☐Pacca house

8. Type of House:-.............................................................................................

9. Total number of rooms:-...............................................................................

10. Migration: ☐ Yes ☐ No

If yes, the number of years:-………………………………………………...........

11. Household Benefits:-

A. ☐ Air Conditioner B. ☐ Refrigerator C. ☐ Bicycle D. ☐ Bike E. ☐ LPG F.

☐ Smart Phone G. ☐ Laptop/Desktop H. ☐ Chair I. ☐ Table
J. ☐ Electricity

12. Source of drinking water: -.......................................................................

13. Dissociation of drinking water:-

A.☐ Boiling B.☐ Sedimentation C.☐ Filtration D.☐ Disinfection

14. Kitchen ventilation: ☐ Yes ☐ no

15. Drainage System: ☐ Yes ☐ No

16. Latrine Facility: ☐ Yes ☐ No

If yes, how many ............................................................................................

17. Use of dustbins: ☐ Yes ☐ no

If yes, how many............................................................................................

 WATER POLLUTION

1. Are you satisfy your drinking water quality?

Yes☐ No☐

2. Is there any water logging in your surroundings?

Yes☐ No☐

3. To what extant do you believe that you are informed about water pollution?

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4. To what extant do you believe that local environmental issue related to water pollution?

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5. To what extant do you believe that you are aware ecological knowledge?

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6. To what extant do you feel personally can influence the solution to the water pollution?

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7. To what extant do you feel that local governing body or any other agencies are working to control
the water pollution?

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8. What is the health related issue in your family currently facing.

A. Diarrhoea☐ B. Gastric Issue☐ C. Skin Problem☐ D. Viral Fever ☐ E .Blood Pressure☐

F. Diabetes ☐ G. Asthma ☐ H. Other☐

9. Last two year in your family any member effected chronic disease?

Yes☐ No☐

10. What is your monthly/Annual expenditure related to chronic disease in last two year?

A. B

elow 5000☐ B. 5000-10000☐ C.10000-15000☐ D. Above15000☐

11. Last two year any death cases in your locality for this problem?

Yes☐ No☐
12. During rainy season are you facing like-

A. Dengue☐ B. Malaria☐ C. Typhoid☐ D. Other☐

13. Last two year in your family any member are affected?

Yes☐ No ☐

14. Your neighbour are aware the water pollution?

Yes☐ No☐

15. Do you have any water body?

Yes☐ No☐

If yes then water quality of it?

A. Very good☐ B. Good☐ C. Bad☐ D. Worst ☐

Do you use its water at home?

Yes☐ No☐

WASTE MANAGEMENT

1. Do you know about Waste Management?

Yes☐ No☐

 If yes then explain

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2. How often waste management team visit your locality for waste collection or disposable.

A. Every day☐ B. Once in week☐ C .Once in two week☐ D .Once in month☐ E. Never ☐

3. How do you dispose in your household waste?

A .Burning☐ B. Open Dispose☐ C. Bury under ground☐

4. What category waste is dominant in your daily household waste-

A. Food Waste☐ B. Paper Waste☐ C. Plastic Waste☐ D. Textile Waste☐ E. Other☐

5. Waste management control change in last 10 year-

A. Yes changes☐ B. As it is☐ C. Nothing is change☐

6. What effort by the waste management to control the offencing-

A. Recycling☐ B. Provide Waste Disposal☐ C. Biological Treatment☐ D. None☐

7. Do you have any knowledge on the effect on Municipal Solid Waste (MSW) on public health in
the environment?

Yes☐ No☐

8. What significant has the present MSW caused in your locality?

A .Flood☐ B. Air Pollution☐ C. Dengue☐ D .None☐

9. How can you rate the waste management in your locality?

A. Good ☐ B .Better☐ C. Bad☐ D. Worst☐

 Explain it
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10. How many waste management point in your locality?

A. 1-2☐ B. 2-3☐ C. 3-4☐ D. None☐

11. You and your neighbour are contributed in waste management?

Yes☐ No ☐

If yes then tell something

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12. How your local Govt. or NGO are participating to control solid waste
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13. Give your suggestion regarding pollution control and waste management process
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