Households? WRI/IIASA. Survey Questionnaire for

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1 Households? WRI/IIASA Survey Questionnaire for

2 Identification NAME AND CODE OF DISTRICT NAME AND CODE OF VDC _ WARD NUMBER... NAME OF RESPONDENT_ (Find household member who is at least 18 years or above) SEX OF RESPONDENT (1=Male 2=Female) HOUSEHOLD ID NUMBER... INTERVIEW DETAILS DATE TIME STARTED TIME FINISHED INTERVIEWER SUPERVISOR ENTERED BY STATUS OF THE QUESTIONNAIRE (1=Scrutiny, 2= Back check). _

3 Section I: Details of household head and other household members Q.N. Question Coding Categories Skip -v08! M 3/d"ln / cgo ;b:osf] hfgsf/l _ k =g+= k Zg sf]8 hfg] 1.1 How many persons live in your household? (Number of person)!=! tkfo{+sf] kl/jf/df hddf slt hgf x'g' x'g5 < -hddf kl/jf/ ;+Vof_ 1.2 What is the sex of your household head? Male... 1 FEMALE... 2!=@ 3/d"lnsf] pd]/ slt eof] k'?if ==========================================! dlxnf 1.3 How old is your household head? (Age in completed years)!=# 3/d"lnsf] pd]/ slt -k"/f epsf] jif{_ 1.4 What is the highest completed education level of your household head? Illiterate... 1 Primary Secondary.. 3 Diploma/Grad.... 4!=$ 3/d"lnsf] k9fo{ slt 5 < ;fif/ ==========================================! k fylds dfwolds======================================= # :gfts :gfsf]q/ ========================= $ 1.5 What is the main occupation of your household head? None Self Employed. 1 Salaried 2 Casual wage (Agriculture) 3 Casual wage (non agriculture) 4 Pensioner. 5!=% 3/d"lnsf] d"vo k]zf s] xf] < s]lxklg 5}g ================================= ) :j/f]huf/ ===================================! tnla s[lif Hofnf=================================== # Hofnf -cgo_ k]g;g/===================== $ School Going... 6 ljbfly{ ======================================= % 1.6 In total how many people of different sexes and age groups live in your household? Age Group Sex <18 18 to 60 >60!=^ tkfo{sf] kl/jf/df ljlegg ln / pd]/ ;d"xsf hddf slt hgf ;b:o 5g\ < pd]/ ;d"x ln <!*!* b]lv ^) <^) Male k"?if Female dlxnf Section II Housing Characteristics and Ownership of Assets Q.N. Question Coding Categories Skip M 3/sf] agfj6 / ;DklQsf] ljj/0f _ k =g+= k Zg sf]8 hfg] 2.1 How many rooms do you have in your house? (Including bathroom and kitchen) 2.2 Do you have courtyard in your house? (Number of rooms) Yes... 1 No... tkfo{sf] 3/df hddf slt j6f sf]7f 5 < -afy?d / efg;f ;d]t u/]/ tkfo{sf] 3/df cffug 5 < -hddf sf]7f_ 5 =============================================! 5}g -1- -!-

4 2.3 What is the main material of the walls in your house? (Observe and record) Cement/Brick/tiles. 1 Metal.. 2 Mud/Dung/Thatch.. 3 Mixed. tkfo{sf] 3/sf] elqf d"votof s] n] ag]sf] 5 < -x]g'{xf]; / egg'xf]; _ l;d]g6 O{+ f 6fon =========================! kmnfd df6f] uf]a/ ================================= # ldl>t ===================================== $ 2.4 What is the main material of the roofs in your house? (Observe and record) Cement/Brick/tiles. 1 Metal.. 2 Mud/Dung/Thatch.. 3 Mixed. tkfo{sf] 3/sf] 5fgf d"votof s] n] ag]sf] 5 < -x]g'{xf]; / egg'xf]; _ l;d]g6 O f 6fon ====================! kmnfd df6f] uf]a/ =============================== # ldl>t ======================================== $ 2.5 Do you have a water tap in your house? Yes.. 1 No 2 tkfosf] 3/df vfg] kfglsf] wf/f 5 < 5 =============================================! 2.6 How far is the nearest water source? (Write in ;j} egbf glhs kfglsf] ; f]t slt 6f9f 5 < -ldg]6df_ 2.7 How far is the nearest paved road? (Write in ;a} egbf glhssf] kssl ;8s slt 6f8f 5 < -ldg6df _ 2.8 Do you have toilet in your house? Yes.. 1 No 2 tkfo{sf] 3/df zf}rfno 5 < 5 =============================================! 2.9 How far is the nearest toilet? (Write in glhssf] zf}rfno slt 6f9f 5 < -ldg]6df_ 2.10 How long have you lived in this household? 2.11 Did you move in this house during your lifetime? (Write in years) Yes.. 1 tkfo{ slt aif{ b]lv of] 3/df a:b} cfpg epsf] xf] s] tkfo{ cfkm\gf] lhjgsfndf of] 3/df cfpg' epsf] xf] < -aif{df_ xf] ===============================================! xf]og 2.12 For what reasons did you come here? Write response s] sf/0fn] oxf ;g'{ epsf] xf] < -v'nnf k Zg_ hjfkm oxf n]'vg' xf];\ (Open end question. Write responses as said by the respondent on the left hand side) -2- -@-

5 2.13 Do you or anyone in your family own land? 2.14 What is the total land that you or anyone in your family owns? Yes.. 1 No 2 KATTHA 1 BIGHAS..2 s] tkfo jf tkfo{sf] kl/jf/sf] ;b:osf] gfp df hldg 5 < tkfo{ jf tkfosf] kl/jf/sf] gfddf hddf slt hldg 5 < 5 =============================================! 5}g hddf hldg s f =======================! lj3f /f]klg 2.15 What is the ownership status of your house? 2.16 How many of these vehicle do you have? Cars Two-Wheelers Bicycles Owned by household member 1 Rented... 2 Cars Two Wheelers of] tkfo{sf] cfkm\g} 3/ xf] sl ef8fsf] xf] tkfo{ ;+u lgdg ;fwg slt j6f 5 < sf/ b'o kfª\u ] ;fosn -olb gepdf æ)æ n]vg'xf];_ cfkm\g}! ;+Vofdf kfªu ] ;fosn (Write 00 of household do not own any) Bicycles 2.17 How many of these cook stoves do you have? Traditional cook stove inside house Traditional cook stove outside house Kerosene stove LPG stove Improved cook stove Electric induction heater (Write 00 of household do not own any) Traditional cook stove inside house Traditional cook stove outside house Kerosene stove LPG stove Improved cook stove tkfo{ ;+u lgdg r"nxf] slt j6f 5 < -olb gepdf æ)æ n]vg'xf];_ k/dk/fut r'nxf] 3/ leq k/dk/fut r'nxf] 3/ aflx/ dl t]n r'nxf] LPG r'nxf] ;'wfl/psf] r'nxf] ljb'lto r'nxf] ;+Vof Electric induction heater 2.18 How many of these lamps do you have? Kerosene lamps LED Bulbs Tube Lights CFLs Solar Lanterns (Write 00 of household do not own any) Kerosene lamps LED Bulbs Tube Lights CFLs Solar Lanterns tkfo{ ;+u lgdg 6"lsx? slt j6f 5 < dl6t]n 6'ls LED lrd l6o"a nfo{6 CFL ;f}o{ 6'ls -olb gepdf æ)æ n]vg'xf];_ dl6t]n 6'ls LED lrd l6o"a nfo{6 CFL ;f}o{ 6'ls ;+Vofdf -3- -#-

6 2.19 How many of these electric appliances do you have? Radio Television Fans Refrigerator Water heater Air conditioner Room heater Washing Machine Mixer/Grinder Computer Iron Water Purifier Kettle Microwave (Write 00 of household do not own any) 2.20 How many of these communication devices do you have? Landline Cell phone Internet (Write 00 of household do not own any. Write 1 if household has internet connection and 0 if they don t have) 2.21 How many of these back up devices do you have? UPS Diesel Generator Battery Solar Home System (Write 00 of household do not own any) Section III: Family Run Activities and Related Assets 3.1 Is anyone in your family involved in some kind of Income Generating Activities? 3.2 What kind of Income Generating Activities (IGA) is that? Radio Television Fans Refrigerator Water heater Air conditioner Room heater Washing Machine Mixer/Grinder Computer Iron Water Purifier Kettle Microwave Landline Cell phone Internet UPS Diesel Generator Battery Solar Home System No No No Q.N. Question Coding Categories Skip Yes.. 1 No 2 Shop... 1 Restaurant. 2 Agro-Processing Poultry... 4 Others. 5 (Specify) tkfo{;+u lgdg law'lto pks/0fx? hddf slt 5 < /]l8of] 6]lnlehg k+vf lk mh kfgl ttfpg] lx6/ sf]7f ttfpg] lx6/ n'uf w'g] d]l;g u fog8/ cfo/g kfgl z'4 ug]{ d]lzg s]tnl dfos f] cf]eg -olb gepdf æ)æ tkfo{ ;+u lgdg ;+rf/ pks/0f slt j6f 5g\ < Landline df]jfon -olb gepdf æ)æ n]vg'xf];_ tkfo{ ;+u lgdg Back Up pks/0f hddf slt j6f 5 < UPS l8h]n h]g]6/ Aof6«L ;f}o{ phf{ k 0fnL -olb gepdf æ)æ n]vg'xf];_ v08 # M Aoj;fo ;DaGwL ljj/0f ;+Vofdf /]l8of] 6]lnlehg k+vf lk mh kfgl ttfpg] lx6/ sf]7f ttfpg] lx6/ n'uf w'g] d]l;g u fog8/ sdko"6/ cfo/g kfgl z'4 ug]{ d]lzg stnl dfos f] cf]eg Landline df]jfon Og6/g]6 UPS l8h]n h]g]6/ Aof6«L ;f}o{ phf{ k 0fnL ;+Vofdf ;+Vofdf k =g+= k Zg sf]8 hfg] #=! s] tkfo{sf] kl/jf/sf] s'g} ;b:on] s]lx cfo cfh{g ;DaGwL sfd ug'{ epsf] 5 < #=@ s:tf] lsl;dsf] cfo cfh{g ;DaGwL sfd ug' { epsf] 5 < -4- -$- 5 =============================================! 5}g k;n ===========================================! vfhf 3/ ldn s'6fgl lk;flg ================ # s'v'/f kfng ================================ $ cgo ========================================== % -v'nfpg' xf];_ #=%

7 3.3 How long have you been involved in such IGA? 3.4 Briefly describe activities and equipment (Open end question) (e.g., refrigerator, flour mill, machines, spending on diesel other equipment) (Write in years) Write response here #=# slxn] b]lv pqm sfo{ ul/ /xg' epsf 5 < #=$ ;+If]kdf pq sfo{ / k of]u epsf pks/0fsf] af/]df egg'xf]; -v'nnf k Zg _ -pbfx/0f M lk mh, ldn,dlzg, pks/0fdf nfug] vr{ h:t} l8hn _ -oxf n]vg' -aif{df _ 3.5 How many hours did adult females spend on these activities in past 30 days? (Write in minutes) Specify the age category of each member (1=18 to 55, 2=>55) M 1 M 2 M 3 Activitities (Write in minutes) #=% klxnf] #) lbgdf tkfo{sf] kl/jf/sf] jozs dlxnfn] lgdg sfo{df slt ;do vr{ ug'{ eof] xf]nf < -ldg]6df _ pd]/ ;d"x!=!* %% ;=! ;=@ ;=# sfo{ ldg]6df Cooking vfgf ksfpg Collecting water/ fuels Household chores Watching TV Reading IGA Community Involvement kfgl phf{ Nofpg 3/ wgwf l6=le=x]g{ k9\g cfo cfh{g ;DaGwL sfo{ ug{ ;d"bfosf] sfd ug{ Other Chores cgo sfo{ Section 4 Household Energy Use Q.N. Question Coding Categories Skip 4.1 Please provide me the details of monthly fuel purchase/collection? Fuelwood Agri Residue Kerosene LPG Fuel Others (Specify) Unit K.G K.G Litres K.G Collection Qty NPR/ Unit Purchase Qty NPR/ Unit -v08 $ M 3/ w"l/df phf{sf] k of]u _ k =g+= k Zg sf]8 hfg] $=! s[kof dnfo{ dlxgfjfl/ phf{ vl/b, hddf af/] atfo lbg' xf]; %- phf{ OsfO bfp/f s]=lh Agri Residue s]=lh dl6t]n ln6/ LPG s]=lh cgo -v'nfpg' xf]; _ hddf vl/b k lt k lt OsfO OsfO{ ;+Vof OsfO{ d"no d"no

8 4.2 What type of electricity connection do you have? No electricity connection. 1 Single Phase Multiple Phase $=@ tkfosf] 3/df s'g lsl;dsf] ljw'lto k 0ffln hl8t 5. 5}g ===========================================! Single Phase Multiple Phase ======================= # 4.3 What is the main source of electricity in your household? National Grid.. 1 Mini Grid Hook up Solar Grid 4 $=# tkfo{sf] 3/df law'tsf] d'vo ; f]t s] xf] < g]zgn u L8==================================! ldlg u L8 x's ck ======================================= # ;f]nf/ ======================================== $ 4.4 How long have you been using electricity from the above mentioned source? (Write in years) $=$ pq ; f]t af6 slxn] lab'lto ;]jf k of]u ub} { cfpg' epsf] xf]. -aif{df_ 4.5 What was the connection Fee? (Including any equipment purchase costs, or fees) (Amount in NPR) $=% lab't ;]jf h8fg ug{ slt vr{ nfuof] -hddf /sd _ 4.6 What is the tariff system? Tariff in NPR $=^ lab't ;]jfsf] z'ns s;/l / slt ltg'{ x'g5 < z'ns Per kwh basis...1 Monthly fixed basis 2 kwh df ===========! dlxgfdf Ps ;d"x ==@ 4.7 Do you know the total kwh used last month and amount paid for it? (Write 999 or 9999 if don t know) KWh used Amount paid NPR $=& tkfo{ klxnnf] dlxgf hddf slt lah"ln k of]u eof] yfxf 5 < / pq lah"lnsf] slt /sd ltg' { eof] < -yfxf 5}g eg] æ(((æ æ((((æ n]vg' xf];. KWh k of]u hddf lt/]sf] /sd If Household is un-electrified (Response to Q 4.1 is 1) then skip to Q 4.9 olb 3/df lah'ln 5}g -k =$=! df!_ eg] k Zg $=( df hfg] 4.8 On an average, how many hours per day do you get supply, and at what times of the day? (Specify for the last 30 days, and for summer and winter months, if different) Summer Winter (Average electricity supply hrs/day ) $=* cf};t lbgdf hddf slt 306f lah'ln cfk"lt{ x'g5 < -kl5nnf] #) lbgsf] n]vg'xf]; / uld{ / hf8f]sf] nflu km/s æs / sæ n]vg' xf]; _ uld{ hf8f] cf};t lah"ln k of]u æ306fæ -lbg_ 4.9 Indicate which lighting source you use with no power? (Multiple Response) Candles... 1 Kerosene Lamps Torches Battery Solar Home System 5 $=( lah'nl gepsf] ;dodf s'g phf{ k of]u ug'p{ x'g5. -ax' pq/_ -6- -^- d}g alq ===================================! dl6 t]n 6r{ nfo6 =================================== # Aofl6«======================================== $ ;f}o{ phf{ k 0ffnL ========================== %

9 4.10 Please describe how electricity service affects your life and home activities. (Open End Question) Write responses here $=!) s[kof lah'lnn] tkfo{sf] lhjg / 3 ofl; sfdnfo{ c;/ u5{ atfolbg" xf];. -v'nnf k Zg_ -hjfkm oxf n]vg'xf]; # 4 $ 5 % 6 ^ If household has no child below 18 years skip to Q 4.15 olb 3/df!* aif{ d"lgsf arrf 5}gg\ eg] k =g+ $=!% df hfg'xf]; On an average how many days per week do your children attend school? (Days per week) $=!! ;fdfgotof tkfo{sf] arrfx? xktfdf slt lbg labfno hfg5g\ < -Ps xktfdf hddf lbg_ 4.12 How do you children study in the evenings/night when there is no electricity? (Multiple Response) With Candles.. 1 With a kerosene lamp. 2 With a torch (including solar) 3 Go to elsewhere.. 4 $=!@ a]n'sf lah'ln gepsf] ;dodf tkfosf] arrfx? s;/l k9\5g\ < -ax'pq/_ d}g alq ====================================! dl6t]n 6'ls 6r{ nfo{6 -;f]nf/ ;d]t_ ============== # cgo 7fpdf up/========================== $ (Specify place) Don t study because no electricity. 5 Children never study at home 6 Always have electricity.. 7 -v'nfpg' xf];_ lah'ln gep/ gk9\g]===================== % arrfx? 3/df k9\b}gg\ ================== ^ ;w} lah'ln ;]jf pknjw x'g5 ======= & 4.13 Rate how much you agree with the following statements? (1=Disagree; 2=Agree) Statements Rate Children study more with electric lighting than with candles $=!# tkfo{ lgdg egfo ;+u ;xdt x'g' x'g5 < -! = = c;xdt _ egfo /]6 arrfx? dogalq egbf lah'ln alqdf w]/} k9\5g] Children attend school more often when schools have electricity arrfx? labfnodf lah'ln epdf ljbfno hfg al9?lr u5{g\ Please describe how electricity service affects your children s life? (Open End Question) Write responses here 1 2 $=!$ lah'lnn] tkfo{sf] arrfsf] lhagnfo{ s;/l c;/ u/]sf] 5 < s[kof atfo lbg'xf];. -v'nnf k Zg_ hjfkm oxf n]vg' -7- -&-

10 If household is not a kerosene user skip to Q No Have you had injuries in the house from kerosene stoves or lanterns? Yes.. 1 No olb 3/df dl6t]n k of]u x'fb}g eg] k =g+=%=! df hfg] $=!% tkfosf] 3/df dl6t]n r'nf] jf 6'lsn] s'g} b'3{6gf epsf] lyof] < # $ % ^ lyof] ===============================================! lypg 4.16 Were any of these injuries permanent or cause death? Yes.. 1 No 2 $=!^ pqm b3{6gfn] :yfol rf]6k6s jf d[to" epsf] lyof] < lyof] ===============================================! lypg %=! 4.17 How much have you spent to treat such injuries in the last 365 days (Rs)? (Amount in NPR) $=!& pqm rf]6 k6s pkrf/ ug{ kl5nnf] Ps aif{df slt vr{ eof] < -hddf /sd _ 4.18 Please provide any other information on the impacts or causes of these injuries (Open End Question) Write responses here 1 2 $=!* pqm b'3{6gfsf] sf/0f / k efj af/] s[kof la:t[tdf atfo lbg' xf];. -v'nnf k Zg_ hjfkm oxf n]vg' 3 # 4 $ 5 % 6 ^ Section 5: Household Expenses/Income Q.N. Question Coding Categories Skip 5.1 What was your last month expenditure on following items? Items Phones (landline and cellphone Medicines, doctors visits Children school fees Amount in NPR v08 % M 3/ w'l/sf] cfo vr{ ;DaGwL laj/0f k =g+= k Zg sf]8 hfg] %=! kl5nn] Ps dlxgfdf lgdg a:t'df slt vr{ ug'{ eof] < a:t' kmf]g -tf/ kmf]g / df]afon cf}ifwl / 8fS6/sf] lkm arrfsf] labfno z'ns hddf /sd -8- -*-

11 Groceries (food, house wares, petrol etc vfbfgg, d;nf, ef8f s'f8f OTofbL Transport Cost (Including fuel maintenance etc oftfoft vr{ House monthly cost (EMI or Rent) OPd cfo ef8f 5.2 How much did you spent on following items in past one year? Items Appliances Amount in NPR tkfon] ut Ps aif{df lgdg a:t'df slt vr{ ug'{ eof] < pks/0f a:t' hddf /sd Furniture kmlg{r/ Business equipment Aoj;fosf] pks/0f Vehicle Afxfg Miscellaneous cgo 5.3 Total household income (including foreign remittances) %=# hddf cfdbfgl -lab];l /]ld6]g; ;d]t _ Remarks... This is all what I had to ask. I would like to thank you for your time. Finally, should I need to get more information from you can you please give me your contact number. gf]6 ======================================================================================================================================================================= ======================================================================================================================================================================= k Zgsf] lznlznf ;dfkt eof]. tkfon] lbg' epsf] ;dosf] nflu wgojfb 5. olb d}n] tkfo{ ;+u cgo s'/f ;f]wg rfx] eg] tkfo{sf] ;Dks{ gda/ kfpg ;S5' xf]nf < (note the contact number of the respondent) -kmf]g g+ n]vg' xf];_ -9- -(-

12 Notes l6kf]6

Harmonized survey questions for monitoring household energy use and SDG indicators and 7.1.2

Harmonized survey questions for monitoring household energy use and SDG indicators 7.1.1 and 7.1.2 List format This document contains a set of questions essential to monitor SDG indicator 7.1.2 on primary