A question of questions: what do we include in the survey that we have to conduct in our target villages of Garhi Harsaru and Dhankot? In a bid to get as many inputs as possible (and at the risk of too many cooks…), I’m putting up what we’ve worked out so far. Please feel free to suggest additions, deletions, changes, and especially re-wording.

Draft Survey Questionnaire for Community Radio

Section – Media access and ownership


Do you read newspapers? ? Yes ? No

If yes, how do you access newspapers

Own copy at home ?

Neighbour’s/Friend’s copy ?

School/Library copy ?

Other (Please specify) ?


Do you read magazines? ? Yes ? No

If yes, which magazine?

How do you access magazines?

Own copy at home ?

Neighbour’s/Friend’s copy ?

School/Library copy ?

Other (Please specify) ?


Do you watch television? ? Yes ? No

If yes, where do you watch television?

Own TV at home ?

Neighbour’s/Friend’s TV ?

Community TV ?

Other (Please specify) ?

Do you watch cable TV ? Yes ? No

Which two channels do you like to watch. Specify.

Which television programs do you like to watch regularly.


Do you listen to the radio? ? Yes ? No

If yes, what channels do you listen to?

AIR (Specify Channels)

Private FM (Specify channels)

What language radio do you listen to? ? English ? Hindi ? Other (Specify)

How do you listen to radio?

Own radio ?

Radio on mobile phone ?

Radio outside the home (shop, office etc) ?

School ?

Which radio programs do you hear regularly?

According to you, what is the most important piece of news this week? (“week” refers to the week before the day the survey is being taken).


What is your favourite form of entertainment? For example, singing, dancing, playing games, watching movies, watching television, listening to the radio, going to the market (specify which market), talking to friends, etc.

Section – Demographic Profile

Name (first name only)

Village: District: State:

Gender: ? Male ? Female



Hindu ?

Muslim ?

Christian ?

Sikh ?

Jain ?

Buddhist ?

Other (Please specify)

Languages spoken: ? Hindi ? Haryanvi ? English ? Other

Languages written: ? Hindi ? Haryanvi ? English ? Other

Marital Status: ? Single ? Married ? Other

Education: Currently studying in Class ___________

Are you a migrant? ? Yes ? No

If yes, specify: Village District State

Family Profile

How many members (including you) live in your home?




Children below 5 yrs

Children 5-12 yrs

Adoloscents 13-17 yrs

Adults above 18 years


Where does the male head of the house live?

In this village.

Outside the village (specify)

Outside the country (specify)

No male head of the household.

What is the livelihood of the head of the household?

Where do you get your drinking water?

Tap inside the house ?

Common tap outside the house ?

Hand-pump or bore well ?

Well ?

Tank or Pond ?

Others (Specify) ?

Don’t know ?

Does the house have an electricity connection?

? Yes ? No

How many hours do you get electricity in the house?

Less than 10 hours a day ?

11 to 18 hours a day ?

19 – 22 hours a day ?

24 hours a day ?

What type of a house do you live in? Tick one. ? Own ? Tenant

Hut ?

Semi-Pucca ?

Pucca ?

Apartment ?

Independent house/bungalow ?

What type of toilet facilities do you use?

Private (In your own house) ?

Common (Outside your house) ?

Open fields ?

Others (Please specify) ?

What type of cooking fuel do you use?

Kerosene ?

LPG/ Gas ?

Firewood ?

Gobar Gas/Bio fuels (Upla) ?

Others (Please specify)

Don’t know ?

Are there any persons with disabilties in your house? ? Yes ? No

Nature of disability (Select one)

Visual ?

Hearing/Speech ?

Orthopedic ?

Mental ?

Other (Please specify)

Don’t know ?

What is your monthly household income?

Upto Rs 1,500/- ?

1,501 to 3,000 ?

3,001 to 5,000 ?

5,001 to 7,500 ?

7,501 to 10,000 ?

10,000 to 15,000 ?

15,000 to 20,000 ?

Above 20,000 ?

Don’t know ?

Which of these does your household own? (Tick whatever is there in your household)

Tape Recorder ?

CD Player ?

Radio ?

Telephone ?

Mobile Phone ?

Television ? Colour ? Black and White

Mixer-Grinder ?

Air cooler ?

Refrigerator ?

Washing Machine ?

Does your household have any vehicle Yes No

If yes, which one? Select whichever is applicable.

Cycle ?

Moped ?

Scooter ?

Motorcycle ?

Rickshaw ?

Auto-rickshaw ?

Car ?

Jeep ?

Tractor ?

Van ?

Tempo ?

Truck ?

Other ? (specify)

Who is the head of your household?

Father ?

Mother ?

Grandparent ?

Uncle/Aunt ?

Other (Specify) ?

Health facilities

When you or someone in your family is sick, where is the nearest doctor?

In the village ?

Nearby village (specify village) ?

Nearby town (specify) ?

Don’t know ?

Where is the nearest hospital?

In the village ?

Nearby village (specify village) ?

Nearby town (specify) ?
Don’t know ?


List the subjects you are studying in school.











Which are your favourite subjects?

Which subjects are you struggling with in school? Which subjects are you having difficulty understanding?

What career would you like to take up when you grow up?

How far have you travelled?

Within Haryana ?

Nearby states (Specify) ?

Other parts of India (specify) ?

Outside India (specify) ?

What is the furthest you have travelled Place State Country

Never travelled ?

Open ended question

Describe a typical day in your life. Give the time you get up in the morning, what you do from then up to the time you go to sleep.