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


Do you read magazines? ? Yes ? No

If yes, which magazine?

How do you access magazines?


Do you watch television? ? Yes ? No

If yes, where do you watch television?

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?

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

How do you listen to radio?

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



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?








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Children below 5 yrs




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Children 5-12 yrs




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Adoloscents 13-17 yrs




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Adults above 18 years




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Where does the male head of the house live?

What is the livelihood of the head of the household?

Where do you get your drinking water?

Does the house have an electricity connection?

? Yes ? No

How many hours do you get electricity in the house?

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

What type of toilet facilities do you use?

What type of cooking fuel do you use?

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

Nature of disability (Select one)

What is your monthly household income?

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

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?

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.

First published on September 3, 2008