Chars Livelihoods Programme-2
Food Security Survey Questionnaire
DATE: / ______/ ______/ ______ / CLP Phase / 1=CLP12=CLP2
3= Control / ATP Phase: / 1, 2, 3, 4
DD / MM / YYYY
NAME / CODE / NAME / CODE
DISTRICT: / UPAZILA:
UNION: / VILLAGE:
IMO: / HH HEAD:
BENEFICIARY NAME: / GENDER HH HEAD: / 1 = Female,
2 = Male / Religion: / 1=Islam, 2=Hindu, 3=Buddhist, 4=Christian, 5=Others
PLEASE ASK THE PERMISSION OF THE RESPONDENT (CORE PARTICIPANT) 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 is the responsibility of the Enumerator to treat all respondents with respect and to complete this questionnaire faithfully and accurately. Permission should be sought from the respondents to ask the following questions and to enter the household (if appropriate). If deemed necessary, the Enumerator must revisit any household if the data collected is considered incomplete. At no time should the Enumerator accept anything from any household. Non-compliance with these conditions will be considered gross mis-conduct.
It is the responsibility of the Field Supervisor to ensure the quality of the Enumerators work and conduct. This should be achieved by both spot check visits during interviews and by thoroughly checking every questionnaire submitted by the Enumerators they are responsible for. At no time should the Field Supervisor accept anything from any household. Non-compliance with these conditions will be considered gross mis-conduct.
It is the responsibility of the Data Entry Clerk to ensure accurate and high quality data entry.
EnumeratorField Supervision CheckData Entry Check
Name:Name:Name:
Date:Date:Date:
SECTION A: AVAILABILITY
- Food sources
1 / Homestead gardening / A / Do you have a bed crop? / FQ1a / 1 = Yes, 2 = No
B / Do you have a pit crop? / FQ1b / 1 = Yes, 2 = No
2 / Access to land / A / Do you own land? / FQ2a / 1 = Yes, 2 = No
B / Do you mortgage in land? / FQ2b / 1 = Yes, 2 = No
C / Do you share in land? / FQ2c / 1 = Yes, 2 = No
D / Do you lease in land? / FQ2d / 1 = Yes, 2 = No
E / Do you cultivate on khas land? / FQ2e / 1 = Yes, 2 = No
3 / Livestock / A / How many cattle do you own? / FQ3a / Please write a number
B / How many shared cattle do you own? / FQ3b / Please write a number
C / How many goats and/or sheep do you own? / FQ3c / If they own both goats and sheep, add the numbers
D / How many shared goats and/or sheep do you own? / FQ3d / If they own both goats and sheep, add the numbers
E / How many chickens and/or ducks? / FQ3e / If they own both goats and sheep, add the numbers
SECTION B:ACCESS
- Income and food expenditure
4 / During the last thirty days, how much was earned (in cash and in-kind) in wage activities by different household members? How many days did they work to receive this? Were there any associated costs to carry out this work?
If one particular member has earned an income through more than one activity, please list the different activities separately in the table provided.
R’ship with HH Head / Gender / Activity / No. Days Worked / Total CASH Earned in Last Thirty Days (Tk.) / Value of Goods Earned IN KIND (Tk.) / Costs Associated With This Work (Tk.)
Last 30 days / Last 30 days / Last 30 days / Last 30 days
FQ4a / FQ4b / FQ4c / FQ4d / FQ4e / FQ4f / FQ4g
R’ship with HH Head: / 1 = Household Head, 2 = Spouse, 3 = Child, 4 = Parent, 5 = Parent-in-Law, 6 = Sibling, 7 = Niece / Nephew, 8 = Grandchild, 9 = Grandparent,
10 = Son / Daughter-in-Law, 11 = Other (Specify)
Activity / 1= Agricultural Daily Wage Labourer2 = Off-farm Daily Wage Labourer3= Weaver4 = Maid, 5= Rickshaw / Van Puller, 6 = Fisherman, 7 = Other (Specify)
Gender / 1= Female 2 = Male
5 / During the last thirty days, how much did you and other HH members earn in cash and/or in-kind from…..?
Please write down the value in Taka.
INCOME SOURCE / CASH (Tk.) / IN-KIND (Tk.) / INCOME SOURCE / CASH (Tk.) / IN-KIND (Tk.)
Last 30 days / Last 30 days / Last 30 days / Last 30 days
A / Manure sale / FQ5a1 / FQ5a2 / N / Field Crop Sale / FQ5n1 / FQ5n2
B / Milk sale / FQ5b1 / FQ5b2 / O / Vegetable Crop sale / FQ5o1 / FQ5o2
C / Ploughing sale / FQ5c1 / FQ5c2 / P / NGO (other than CLP) / FQ5p1 / FQ5p2
D / Insemination service sale / FQ5d1 / FQ5d2 / Q / GoB Stipend / Relief / Pension / FQ5q1 / FQ5q2
E / Livestock sale / FQ5e1 / FQ5e2 / R / CLP / FQ5r1 / FQ5r2
F / Poultry Product Sale / FQ5f1 / FQ5f2 / S / Dowry / FQ5s1 / FQ5s2
G / Poultry Sale / FQ5g1 / FQ5g2 / T / Begging / FQ5t1 / FQ5t2
H / Fish sale / FQ5h1 / FQ5h2 / U / Remittance / FQ5u1 / FQ5u2
I / Kantha Sewing / FQ5i1 / FQ5i2 / V / Gleaning sale / FQ5v1 / FQ5v2
J / Shop / Business / FQ5j1 / FQ5j2 / W / Gift / FQ5w1 / FQ5w2
K / Tree (other than fruit) sale / FQ5k1 / FQ5k2 / X / Help / FQ5x1 / FQ5x2
L / Fruit sale / FQ5l1 / FQ5l2 / Y / Income from Service / FQ5y1 / FQ5y2
M / Spices sale / FQ5m1 / FQ5m2 / Z / Other (Specify) / FQ5z1 / FQ5z2
5A / During the last thirty days, have you withdrawn money from savings? / FQ5a1a / 1 = Yes 2 = No
5B / If 5A=1, How much? / FQ5a1b / Please write down the value in Taka
6A / During the last thirty days, have you taken out a loan? / FQ6a / 1 = Yes 2 = No
6B / If 6A=1, how much? / FQ6b / Please write down the value in Taka
227 / During the last thirty days, how much (total in Tk) did your household spend on the following FOOD items…?
# / EXPENDITURE / Taka / # / EXPENDITURE / Taka / # / EXPENDITURE / Taka
Last 30 days / Last 30 days / Last 30 days
A / Rice / FQ7a / G / Eggs / FQ7g / M / Fruits / FQ7m
B / Wheat / Other Cereals / FQ7b / H / Fish & Seafood (Fresh / Dried) / FQ7h / N / Oil / FQ7n
C / Pulses / Beans / Nuts / FQ7c / I / Potato (including Sweet Potato) / FQ7i / O / Spices / FQ7o
D / Milk / Milk Products / FQ7d / J / Dark Green Vegetables – Leafy / FQ7j / P / Biscuits, Cakes, shanachur… / FQ7p
E / Meat / FQ7e / K / Other Vegetables / FQ7k / Q / Beverages / FQ7q
F / Poultry / FQ7f / L / Sugar / Honey / FQ7l / R / Other Food Items / FQ7r
- Food Frequency
8 / How many meals did youeat in the last 7 days? / FQ8
9 / How many meals did your children (5 - 15 years) eat in the last 7 days? / FQ9 / 99 = N/A
- Food Diversity and Food Sources
10 / How many days in the last seven days did your householdeat..….?
What was the source of each food item?
Write 0 if no consumption of that food group.Write up to two food sources for each food item
# / CONSUMPTION / Number of days / Food Sources / # / CONSUMPTION / Number of days / Food Sources / # / CONSUMPTION / Number of days / Food Sources
A / Rice / FQ10a1 / FQ10a2/FQ10a3…. / F / Poultry / FQ10f1 / FQ10f2/FQ10f3…. / K / Other Vegetables / FQ10k1 / FQ10k2/FQ10k3….
B / Wheat / Other Cereals / FQ10b1 / FQ10b2/FQ10b3. / G / Eggs / FQ10g1 / FQ10g2/FQ10g3…. / L / Sugar / Honey / FQ10l1 / FQ10l2/FQ10l3….
C / Pulses / Beans / Nuts / FQ10c1 / FQ10c2/FQ10c3…. / H / Fish & Seafood (Fresh / Dried) / FQ10h1 / FQ10h2/FQ10h3…. / M / Fruits / FQ10m1 / FQ10m2/FQ10m3….
D / Milk / Milk Products / FQ10d1 / FQ10d2/FQ10d3…. / I / Potato (including Sweet Potato) / FQ10i1 / FQ10i2/FQ10i3…. / N / Oil / FQ10n1 / FQ10n2/FQ10n3….
E / Meat / FQ10e1 / FQ10e2/FQ10e3…. / J / Dark Green Vegetables – Leafy / FQ10j1 / FQ10j2/FQ10j3…. / O / Other Food Items / FQ10o1 / FQ10o2/FQ10o3….
Food Sources: / 1 = Own production (crops, animals) 2 = Purchased with own money from market 3 = Purchased by using loaned money 4 = Purchased on credit
5 = Hunting, fishing, gathering 6 = Borrowing food 7 = Receiving food from relatives and neighbours 8 = Food aid (UN, NGOs…)
9 = Receiving food as part of wage
- Coping Strategies
11 / Due to a shortage of food and income, how many days in the last 30 days did any household member ………?
# / Food Strategy / Number of Days in Last 30 Days / # / Food Strategy / Number of Days in Last 30 Days
A / Reduced quantity of food eaten / FQ11a / G / Sold hens and/or ducks / FQ11g
B / Collected wild vegetables (shak) / FQ11b / H / Took money from savings / FQ11h
C / Took a food loan / FQ11c / I / Eating twice a day / FQ11i
D / Mother skipped a meal/ate less for child / FQ11d / J / Reduced quality of food eaten / FQ11j
E / Eating once a day / FQ11e / K / Sold goats and/or sheep / FQ11k
F / Only ate rice with salt and chillies / FQ11f / L / Took money loan with interest to buy food / FQ11l
SECTION C: UTILISATION
- WASH
Please ensure you view the area around the actual tube-well and latrine used by the household. Then ask the following questions
- WATER
12 / What is your HH’s main source of drinking water? / FQ12 / 1 = HH own TW 2 = TW – shared ownership 3 = TW – Owned by others 4 = Pond 5 = River 6 = Other (specify)
13 / If 12=1,2,3, then ask these specific questions….
A / Is the TW on a raised plinth above the flood line? / FQ13a / 1 = Yes 2 = No 3 = N/A
B / Is the TW 40 ft deep? / FQ13b / 1 = Yes 2 = No 3 = N/A
C / Is the TW over 10 metres from a latrine? / FQ13c / 1 = Yes 2 = No 3 = N/A
D / Does the TW have an intact concrete platform(CLP standard? / FQ13d / 1 = Yes 2 = No 3 = N/A
E / How far is the TW from your homestead / FQ13e / Please write the full return journey time in minutes in the box provided
- SANITATION
14 / Where do HH adults males usually defecate? / FQ14 & FQ14_others / CODES:
1 = Own latrine
2 = Other HH’s latrine
3 = Homestead, River/Pond, Open space
4 = Other (specify)
5 = N/A (ie: no child)
15 / Where do HH adult females usually defecate? / FQ15 & FQ15_others
16 / Where do HH children usually defecate? / FQ16 & FQ16_others
17 / If 14/15/16 = 1, 2 then ask these specific questions….
A / Is the pit covered with a concrete slab fitted with a pan and water seal? / FQ17a / 1 = Yes 2 = No 3 = N/A
B / If17A=1, is the water seal broken? / FQ17b / 1 = Yes 2 = No 3 = N/A
C / Is the pit supported internally to prevent collapse? / FQ17c / 1 = Yes 2 = No 3 = N/A
D / Is the latrine above flood level (raised on a plinth)? / FQ17d / 1 = Yes 2 = No 3 = N/A
E / Does the latrine have a superstructure to provide privacy? / FQ17e / 1 = Yes 2 = No 3 = N/A
OBSERVATION ONLY
Please ensure you view the area around the actual tube-well and latrine used by the household. Also observe the area around the house.
Then answer the following questions:
1 = Yes, soap, 2 = Yes, ash, 3 = No, 99 = N/A
19 / Are soap or ash close to the latrine used by the household? / FQ19
- HYGIENE PRACTICES
20 / Please ensure you direct this question to the direct female beneficiary.
When do you wash your hands? For each hand washing event ask: How do you wash your hands?
DO NOT prompt respondents into using the list below. First ask them when they wash their hands, record the information and then ask them how?
ACTIVITY / CODE / ACTIVITY / CODE / CODES:
1 = Yes with soap
2 = Yes with ash
3 = Yes only with water
77 = Did not mention this hand washing event
99 = N/A (i.e. no child)
A / Before Preparing Food / FQ20a / E / After Cleaning a Child’s Anus / FQ20e
B / Before Eating / FQ20b / F / After Defecating / FQ20f
C / Before Feeding a Child / FQ20c / G / After cleaning cow dung / FQ20g
D / Before Serving Food / FQ20d / H / Other-2 (Please Specify) / FQ20h
- Food Security indicators
21 / In the last 7 days, has your household…
A / Eatenfish and/or meat / FQ21a / 1 = Yes 2 = No
B / Eaten vegetables / FQ21b / 1 = Yes 2 = No
C / Eaten less than three times a day / FQ21c / 1 = Yes 2 = No
D / Collected wild vegetables / FQ21d / 1 = Yes 2 = No
22 / In the last 30 days, has your household taken a loan (in cash or in food) for food / FQ22 / 1 = Yes 2 = No
23 / Did you cultivate any crops during the last or current harvesting season? / FQ23 / 1 = Yes 2 = No
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