This document will be worked as a guideline on assessment of housing conditions, socio economic structure and service facility for low income housing group.

1. 1
Questionnaire on Assessment of Housing Conditions, Socio-economic
Structure and Service Facility in Methor colony of Pabna Municipality
(Academic purpose only)
Questionnaire No. …....
Today’s date: …………
 Personal information
Name: Sex: Male
Age: Female
Marital status: Married Religion:
Unmarried Educational Background:
Current
Profession:
Monthly income :
Address:
Contract number:
 Household Information
Total family members:
No. of children (under 18 years)
No. of aged members (above 50 years)
No. of school going children
Total earning members in family:
Total household income:
 Housing Condition
1. Please answer the following questions.
Housing Type (own, rent or lease)
Housing Type (Kutcha, pucca, semi pucca)
Housing material (roof, fence, veranda etc.)
Number of room
Number of window and door
Have sufficient access of air and light in the room?
Area of house, room space
How much pay for your home?
Pabna University of Science and Technology
Department of Urban and Regional Planning

2. 2
What is your satisfaction rank on your payment?
(Highly satisfied=1, satisfied=2, moderate=3,
dissatisfied=4, highly dissatisfied=5)
Are you face any problems for licensing for your home?
What are the causes of housing problem in this area?
(1=migration from rural area, 2=lake of proper
coordination of responsible authority, 3=poverty,
4=others.
Causes of migration
Tell us about the changes of settlement pattern in this
area.
2. If you have any comments, suggestions about the housing conditions, please write on
it.
 Service Facility
SL.
No
Service Facilities Satisfaction Rank
Highly
Satisfied
Satisfied Moderate Dissatisfied Highly
Dissatisfied
1 Water Supply
2 Electricity Supply
3 Drainage Facility
4 Educational
Facility
5 Solid Waste
Management
6 Transportation
Services
7 Health Facility
8 Market Facility
9 Recreation Facility
10 Gas Supply
11 Emergency
services
12 Security system

3. 3
Here, highly satisfied=1, satisfied=2, moderate=3, dissatisfied=4, highly dissatisfied=5.
1. What is the main source of your drinking water?
 Bore well
 Submersible
 Public tap
 Open well
 Household water supply (piped)
 Others
2. Which of the following sources of water does your household use?
 Tube well
 Submersible
 Public tap
 Open well
 Household water supply (piped)
 Others
3. In a day, what is the total number of hours of water supply?
 12 hrs
 16 hrs
 20 hrs
 24 hrs
4. Please answer to the following questions:
Facilities Comments (if Yes=1,No=2)
Is water available (from your main source) throughout
the year?
Is the quantity of water that you receive (from your main
source of water) adequate?
Do you pay for water?
Generally, does the water have a taste?
Is the water supply subject to any treatment or
disinfection?
Have any metering system to measure the amount of
water?

4. 4
Have you made a complaint related to your drinking
water service in the past one year?
Is your water supply and distribution system
checked/serviced periodically? E.g. are the storage
tanks, pipework and any treatment equipment cleaned
and inspected to ensure they are in good working order?
5. Please answer the following questions.
How is the condition of pedestrian facilities?
How is the condition of transportation network?
Have any street lighting available beside the road?
6. Please fill up the comment box.
Facilities Comments
Is drainage system available in your area? (if Yes=1,No=2)
What kind of drainage system is it? (Kutcha nali=1, Pucca nali=2,
Open=3, underground=4, Covered with steel grill=5, others=6).
7. Please answer to the following questions:
Facilities Comments
(if Yes=1,No=2)
Are the drains blocked by boundary wall?
Are the drains blocked by garbage?
Are the drains cleared regularly?
Is the drainage system sufficient for carrying water of that locality?
Are the water Supply lines passing through the drainage?
8. Does the wastage create any pollution? O Yes O No
If yes, what kind(s)?
 Water pollution
 Soil pollution
 Odor pollution
 Above all
If another source and causes of pollution exists, please specify it.
9. Have any noise pollution in this area? O Yes O No.
If yes, please specify the causes of it.
10. What types of waste are generally collected?
O Solid waste O Liquid waste O Both solid and liquid O Others

5. 5
11. How often do you use Pabna Municipality’s recreation facilities?
O Rarely O At least weekly O At least monthly, not weekly O Several times a
year but not monthly
12. Have enough open spaces or green fields? O Yes O No
13. How will you rate the responsibility showed by the municipal authority?
Not Satisfied 1 2 3 4 5 6 7 8 9 Highly Satisfied
14. If you have any comments, suggestions about the service facility, please write on it.
Thank you for your sincere coordination
Respondent’s signature