Womn s Empowrmnt Survy Upat on: 27-06-2012 Cars Lvloos Proramm-2 Womn s Empowrmnt Survy DATE: / / DD MM YYYY CLP Pas 1=CLP1 2=CLP2 3= Control ATP Pas: 1, 2, 3, 4 DISTRICT: UNION: IMO: NAME CODE NAME CODE UPAZILA: VILLAGE: HH HEAD: BENEFICIARY NAME: HH a nr (1 = Mal 2 = Fmal Rlon: 1=Islam, 2=Hnu, 3=Bust, 4=Crstan, 5=Otrs PLEASE ASK THE PERMISSION OF THE RESPONDENT TO ASK A SERIES OF QUESTIONS RELATED TO THEIR HOUSEHOLD. INFORM THAT AT ANY TIME THEY CAN REFUSE TO ANSWER A QUESTION IF THEY WISH. It s t rsponslty o t Enumrator to trat all rsponnts wt rspt an to omplt ts qustonnar atully an auratly. Prmsson soul sout rom t rsponnts to ask t ollown qustons an to ntr t ousol ( approprat). I m nssary, t Enumrator must rvst any ousol t ata ollt s onsr nomplt. At no tm soul t Enumrator apt anytn rom any ousol. Non-omplan wt ts ontons wll onsr ross ms-onut. It s t rsponslty o t Fl Suprvsor to nsur t qualty o t Enumrators work an onut. Ts soul av y ot spot k vsts urn ntrvws an y torouly kn vry qustonnar sumtt y t Enumrators ty ar rsponsl or. At no tm soul t Fl Suprvsor apt anytn rom any ousol. Non-omplan wt ts ontons wll onsr ross ms-onut. It s t rsponslty o t Data Entry Clrk to nsur aurat an qualty ata ntry. Enumrator Fl Suprvson Ck Data Entry Ck Nam: Nam: Nam: Dat: Dat: Dat: Womn s Empowrmnt Survy 2012 Pa 1 o 5
Womn s Empowrmnt Survy Upat on: 27-06-2012 Qustons 1, 2 an 3 to onut on CORE PARTICIPANTS wo ar mmrs o a MALE HEADED HOUSEHOLD ONLY. Qustons 4, 5 an 6 to onut on CORE PARTICIPANTS wo ar mmrs o a FEMALE HEADED HOUSEHOLD ONLY Qustons 7 13 to onut on ALL CORE PARTICIPANTS 1. Wo most otn maks sons n t ollown aras? Ts quston applal only or mal a partpants a T puras o small tms or t ousol or xampl ookn utnsls, soap t Wtr to tak a loan Wtr to v a loan Purasn an usn mal tratmnt an mal av or ousol mmrs Puras o t amly s lotn Manan usts, or xampl, or wat typs o oo to prov, wtr to prov ts T puras o oo or t ousol Wtr to sll a lar asst, an wat pr to sll t or ( attl, lan) Wtr or sll a small asst, an wat pr to sll t or ( oats, poultry) : 1 = Mal Housol Mmr Only, 2 = You Only, 3 = Dson s ma ontly. Total Numr o Rsponss n You an Dson s ma ontly mal HH mmr alon olumns: Mal Housol Mmr Only You Only, Dson s ma ontly. Womn s Empowrmnt Survy 2012 Pa 2 o 5
Womn s Empowrmnt Survy Upat on: 27-06-2012 Ts quston applal only or mal a partpants 2 At prsnt, o you pysally kp your ousol s as? 3 Ar you usually al to nlun nvstmnt sons? : 1 = Ys, 4. Wo most otn maks sons n t ollown aras? Ts quston applal only or mal a partpants a T puras o small tms or t ousol or xampl ookn utnsls, soap, osmts t Wtr to tak a loan Wtr to v a loan Purasn an usn mal tratmnt an mal av or ousol mmrs Puras o t amly s lotn Manan usts, or xampl, or wat typs o oo to prov, wtr to prov ts T puras o oo or t ousol Wtr to sll a lar asst, an wat pr to sll t or ( attl, lan) Wtr or sll a small asst, an wat pr to sll t or ( oats, poultry) : 1 = Alon, 2 = Dson s ma y anotr ousol mmr, 3 = Dson s ma y a rlatv, 4 = Otrs. Total Numr o Rsponss n You an Dson s ma ontly mal HH mmr alon olumns: Alon Dson s ma y anotr ousol mmr Dson s ma y a rlatv Otrs Ts quston applal only or mal a partpants 5 Do your rlatvs rspt you? For xampl, provn oo, takn ar o you wl you ar sk, lpn you n a rss, askn aout your alt, wtr you av atn t. 1 = Mum, 2 = Goo,3 = Vry Goo, 4 = Not rspt Womn s Empowrmnt Survy 2012 Pa 3 o 5
Womn s Empowrmnt Survy Upat on: 27-06-2012 Ts quston applal only or mal a partpants 6. O t ollown assts, wat s t approxmat urrnt valu o t assts you own? : 1=Ys, 2=N0 a Goats Sp Trs Crops (on las lan or sar rops) Cattl Lan Total : Otrs asst (Plas spy) Valu o Asst Ts quston applal or all or partpants 7 In t last sx monts, av you arn any mony rom atvts w you av unrtakn npnntly (w you oul arn wtout lp rom a mal ousol mmr)? For xampl slln mlk, ar wavn, slln laour. 8 Do you av your own prsonal savns (not savns own y t wol ousol)? :1 = Ys, 9 Hav otr mmrs o your ommunty ask you or av n t last sx monts? 10 In t last twlv monts, av you lp to stop onlt an / or quarrlln n anotr ousol, or twn otr ousols? Womn s Empowrmnt Survy 2012 Pa 4 o 5
Womn s Empowrmnt Survy Upat on: 27-06-2012 11. Exlun nvtatons rom loo rlatvs (atr, motr, sstr, rotr, loo unl, loo aunt), av you n nvt to attn t ollown soal oasons n t last twlv monts? A B C D E F Marra Crumson Dat rmony Rlous Oason (or xampl, mla) Otr Soal Oason (plas spy) Total Numr o Ys Rsponss : 1 = Ys 1= On or ratr, 2 = Non 12. Hav you attn any o t ollown mtns or trann n t last sx monts? a RDRS Fraton Mtn / Clu k Sool Mtn NGO Group Mtn (xlun CLP Groups) CLP Group Mtn Unon Parsa Mtn CLP Vlla Dvlopmnt Mtn Non-CLP Vlla Dvlopmnt Mtn Dsastr Manamnt Mtn Sals Sm Implmntaton Commtt Mtn Any otr mtn or trann (Plas spy) : 1 = Ys l Total Numr o Ys Rsponss 1= On or ratr n 13. Ar you urrntly a mmr o any o t ollown ommtts? a CLP SD roup ommtt Dsastr Manamnt Group Commtt : NGO Group Commtt (Exlun 1 = Ys RDRS Fraton Mtn / Clu CLP Groups) Sool Commtt Sm Implmntaton Commtt CLP Vlla Dvlopmnt Commtt Non-CLP Vlla Dvlopmnt Commtt VSL Group Commtt Any Otr Commtt (Plas spy) : 1 = Ys k Total Numr o Ys Rsponss 1= On or ratr, n Womn s Empowrmnt Survy 2012 Pa 5 o 5