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SCHEDULE ON DEMOGRAPHIC PROFILE

DEMOGRAPHIC QUESTIONS

Demographic questions collect data about the characteristics of your sample population (gender,
age, ethnicity, income, residence, social status, presence of children, education level, and language
spoken, etc.)

For Classification purpose only.

1. Name:
2. Age:
3. Sex/Gender:
o Female
o Male
o Transgender
o Prefer not to respond
4. Religion:
o Hinduism
o Islamic
o Christianity
o Sikhism
o Buddhism
o Jainism
o Zoroastrianism
5. Education
o Post-Graduation
o Graduation
o Intermediate
o Matric
o Primary
o Other:
6. Occupation
o Business
o Salaried
o Labour
o Agriculture & Allied
o Student
o Unemployed
o Others:
7. Marriage
o Married
o Unmarried
o Divorce
o Widow
7.1. Age of 1st Marriage:
7.2. Age of wife, when got married:
7.3. Age at which you got married:
8. How many Children do you have? (Living or Dead)
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o 0
o 0-2
o 2-4
o 4+
8.1. Age of Mother at which 1st Child was born :
8.2. Age of Mother at which 1st Child was born:
8.3. Age of Father at which 2nd Child was born:
8.4. Age of Father at which 2nd Child was born:
9. In last one year, did you have any infant death?
9.1. Sex of Infant:
9.2. Reason of death:
10. Have you migrated here from anywhere?
10.1. Original habitant of this area:
10.2. Place from where you have migrated:
10.3. Frequency of visit to native place:
11. Employment status in present?
o Employed:
o Unemployed:
12. Do you have any house?
o Kutcha
o Pukka
o Rent
13. Annual Income of family
o Less than 1 lac
o 1 lac- 2 lac
o 2 lac- 5 lac
o 5 lac +
14. Composition of family
o Joint :
(a) No. of Male Personal
(b) Age structure of Male Personal
(c) No. of Female Personal
(d) Age structure of Female Personal
o Nuclear:
(a) No. of Male Personal
(b) Age structure of Male Personal
(c) No. of female personal
(d) Age structure of female personal
15. Whether you have any subsidy occupation?
o Yes
o No
16. Income through Subsidy occupation?
17. Do you possess any land at your native place?
o Yes
o No
18. Availability of Toilets at house
o Yes
o No
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19. Source of Drinking water

o Treated Tap Water
o Untreated Tap Water
o Covered Well
o Uncovered Well
o Hand Pump
o Tube well/Bore well
o Others. (River, Canal, Pond, Lake Etc.)
20. Any livestock or Cattle owned.
o Yes
o No
21. Modern gadgets at your home
o Refrigerator
o Television
o Air Conditioner
o DTH
o Mobile/Smartphone
o Car/Four Wheelers
o Motorcycle/Two Wheelers
o Washing machine
o Etc.

22. Health status of the family.

o Ancient medical beliefs
o Modern medical beliefs
23. The frequency of visit to local hospitals or clinic for routine check-ups.
o Fortnight
o Monthly
o Quarterly
o Half- yearly
o Yearly

Interviewed by:

Date: