Social Problems and Living Conditions in Urban Slums: A Study on
Poverty, Crime, and Access to Amenities
Section A: Respondent Information
1. Name of Respondent (optional): _____________________
2. Age: __________
3. Gender: Male / Female / Other
4. Marital Status: Single / Married / Widowed / Separated
5. Religion: Hindu / Muslim / Christian / Other: __________
6. Caste/Community: SC / ST / OBC / General / Minority
7. Highest Level of Education: Illiterate / Primary / Secondary / Higher Secondary /
Graduate and above
8. Occupation: Daily wage labor / Factory worker / Vendor / Hawker / Domestic work /
Small business / Other: __________
9. Monthly Household Income: Below ₹5,000 / ₹5,000 - ₹10,000 / ₹10,000 - ₹20,000 /
Above ₹20,000
10. Number of family members: __________
11. How long have you been living in this slum area? Less than 1 year / 1–5 years / More
than 5 years
Section B: Access to Basic Amenities
12. Type of House: Kuccha / Semi-pucca / Pucca
13. Ownership of House: Owned / Rented / Occupied without ownership
14. Drinking Water Source: Tap water (treated/untreated) / Borewell / Community hand
pump / Public tap / Other: __________
15. Availability of Toilet: Private / Shared community toilet / Open defecation
16. Availability of Electricity: Yes (metered) / Yes (illegal connection) / No
17. Cooking Fuel Used: LPG / Kerosene / Firewood / Cow dung
18. Garbage Disposal: Municipal collection / Dumping in open areas / Burning waste
19. Access to Public Services: (Please specify Yes/No and Near/Far for each service:
Primary school, Healthcare, Public transport, Market, Police station)
20. How often do you face power cuts? Never / Rarely / Sometimes / Often / Very often
21. What problems do you face while accessing water or sanitation facilities?
_________________________________
22. Rate your satisfaction with the amenities in your area: Water Supply, Toilet Facilities,
Electricity Supply, Drainage System, Public Transport (Very Unsatisfied to Very Satisfied).
Section C: Economic Challenges (Poverty)
23. Is your income sufficient for basic needs? Yes / No
24. Has anyone in your family faced unemployment in the last 6 months? Yes / No
25. Do you receive any government support (ration card, pension, scholarship)? Yes / No
26. Which of the following issues have you faced in the last year? (Tick all that apply: Food
shortage, Medical expenses unmet, Child drop-out from school, Debt burden, Eviction
threats)
27. What do you think would improve your economic condition?
_________________________________
Section D: Crime and Safety
28. How safe do you feel in your locality during the day? Safe / Unsafe
29. How safe do you feel at night? Safe / Unsafe
30. What crimes are common in your area? (Tick all that apply: Theft, Robbery, Drug abuse,
Domestic violence, Assault, Child abuse, Others: __________)
31. Have you or your family been a victim of a crime in the last year? Yes / No
32. Have you reported a crime to the police? Yes / No
33. Do you feel the police provide enough protection? Yes / No
34. Do children and women feel safe in your community? Yes / No / Not sure
35. How often do the following crimes occur in your area? Theft, Drug abuse, Domestic
violence, Gang fights, Street robbery (Never to Very Often).
36. What actions do you think can reduce crime in your locality?
_________________________________
Section E: Community Life and Suggestions
37. Are there any community groups for safety, cleanliness, or youth activities? Yes / No
38. What improvements do you want most in your locality? (Tick all that apply: More job
opportunities, Better education, Waste management, Street lighting, Police patrolling, Public
toilets, Water supply, Health services, Others: __________)
39. How satisfied are you with your quality of life in this locality? Very Dissatisfied /
Dissatisfied / Neutral / Satisfied / Very Satisfied
40. What message would you give to the government or NGOs to improve your area?
_________________________________
