1. A survey of socio-economic conditions of factory workers in Saurashtra:

Instructions:

(1) Please return the duly answered questionnaire in the stamped self-addressed envelope which is enclosed.

(2) Your co-operation will oblige us.

(A) Personal Information :

1. Name:  ___________________________

2. Address: ____________________________

3. Age:  ______Years _____months

4. Educational qualifications:  ________

5. Post or designation:   ___________

6. Experience: Years:   ____________

(B)  About Family Members:

1.

No.       Name                   Relationship         Age            Gender

1.

2.

3.

4.

5.

6.

7.

8.

2. State the number of the earning members in your family.

                 Male: _________     Female: ______

3. Give the number of the unemployed members in your family.

Male: _______       Female: _________

4. (a) How many members of your family are unable to work?    _________

   (b) Why?   _________________________________

(C) About Income :

1. What are the sources of income of your family?

(i)             Salary:  Rs. _________(Monthly)

(ii)           Overtime: Rs. _______ (Monthly)

(i)             Share dividend: Rs. _______ (Yearly)

(ii)           Interest on deposit: Rs. ______ (Yearly)

(iii)         Rent of land or house: Rs. _______ (Monthly)

(iv)          Financial help from any person or social agency: Rs. _______          (Yearly)

(v)           Any other: Rs. _______ (Monthly/Yearly)

2. State the total income of your family. Rs._______ (Monthly)

3. What is the yearly increase in the total income of your family? Rs. _______

(D) About Expenditure:

1. State your monthly expenditure on the following:

(i)             Food                                         :Rs.______

(ii)            Clothes                                       : Rs._______

(iii)         Rent                                         : Rs.______

(iv)         Education : Rs.______

(v)           Transportation                                        : Rs._______

(vi)          Entertainment                                 : Rs._______

(vii)        Gifts or Celebration                         : Rs._______

(viii)  Miscellaneous                                 : Rs._______

Total                                           :Rs._______

2. Does your total expenditure increase every year?          Yes (  ) No (  )

3. If yes, how much? ____________

4. Do you feel that the prices are increasing every year?   Yes (  ) No (  )

(E) About Housing:

1. You live in

         a. Quarters (  )

         b. Your own house/ Apartment (  )

         c. Rented (  )

         d. Slum-area nearby

2. How many rooms does your family occupy?   __

3. Please tick mark before the facilities that you enjoy.

         a. Kitchen (  )

         b. Kitchen Garden (  )

         c. bathroom (  )

d. W. C. (  )

         e. Bedrooms (  )

         e. Study ( )

f. Guest room (  )

4. Do you possess furniture in your bed-room and living room?                                         Yes (  ) No (  )

5. Do you have a television/radio set?   Yes(  ) No (  )

(F) About education:

State the number of children taking education in school and college.

No.   Names (Male)     Standard Names (Female)  Standard

1.

2.

3.

4.

(G) About food:

1. State the food you take normally. Tick mark.

Vegetarian (  )    Non-Vegetarian (  )        Both (  )

2. State the quantity of milk, fruit and eggs you consume.

(i)             Milk:  Litre......................... (daily)

(ii)           Fruit:  Kg............................(daily)

(iii)         Eggs:  ................................(per week)

3. Which of the following do enjoy daily?

(Tick mark against whatever is applicable to you.)

1.  Morning tea (  )

2. Morning tea with breakfast (  )

3. Lunch (   )

4. Evening tea (  )

5. Evening tea with snacks ( )

6. Dinner (  )

7. Milk at night (  )

8. Tea at night (  )

(H) About Health:

1. State your

Height...................... cm                         

Weight...........................Pounds/Kgs

2. Do you use spectacles?   Yes (  ) No (  )

3. Do you take exercise daily?  Yes (  ) No (  )

4. Do you suffer from any seasonal or temporary disease?   Yes(  ) No (  )

(I) About Transportation:

1. Give the distance between your factory and residence ................ kms.

2.  State the mode of transportation you use. Please tick mark.

Bike         ( )

Bicycle        ( )

Rikshaw      ( )

City Bus      ( )

On Foot       ( )

3. How much do you spend per month on transportation? Rs. _______

(J) About Entertainment:

1. How many times do you visit a theatre in a month, with your family? ________

2. How many times do you visit a theatre alone in a month?. _______

3. Do you visit a hotel with your family?      Yes (  ) No (  )

4. Do you go on picnic with your family?  Yes (  ) No (  )

5. Are you satisfied with your standard of living?     Yes (  ) No (  )

6. What would you do to raise your standard of living?

_______________________________________

Thank you for participating in this survey. Your input is valuable in understanding socio-economic landscape for lower strata of Saurashtra.