This Questionnaire Is Aiming at Collecting Data at Mouza Level

WASH, EARLY REOVERY AND SHELTER Tropical Cyclone Mahasen Team ID: ______HOUSEHOLD SURVEY

Team Information Shelter ID : ______Date: ____ /_____/ 201_ Team ID : ______Team Leader: Signature: Location ID: ______Enumerator: Signature: Introduction

Hello, my name is ______and I am collecting data for a consortium of local and international NGOs, organizations, UN and the Government. I would like to ask you some questions about how tropical cyclone Mahasen affected your household . he survey is confidential and any answers you provide will remain private. The questionnaire does not have “good” or “bad” answers. You don’t have to answer if you don’t want to. You may decline to answer any questions or stop the interview at any time. It will take around 30 minutes to complete. Do you agree to let me ask you these questions? YES NO

of 10 WASH, EARLY REOVERY AND SHELTER Tropical Cyclone Mahasen Team ID: ______HOUSEHOLD SURVEY

Household details

1. Name: 2. National ID:

3. Fathers/husbands name: 4. Mothers name:

5. How many people live in your house? #Male:____ #Female:____ 6. Are you a single headed Yes No household? If Yes Male or Female 7. What is the age of those Under 1 years: # Male:____# Female:____ 19- 39 years: currently living in the # Male:____# Female:____ household? 1-5 years: # Male:____# Female:____ 40-60 years: # Male:____# Female:____ 6-12 years: # Male:____# Female:____ Over 60 years: # Male:____# Female:____ 13-18 years: # Male:____# Female:____ 8. Is your family part of a No Yes If so which one______minority group 9. How many pregnant or # Pregnant:_____ # Lactating:______lactating women are there in the household? 10. Are there any members No Yes (If no, go to question 3.7) of the family with physical Physical disability # Male:______# or mental disabilities? Female:______Mental disability # Male:______# Female:______Blind # Male:______# Female:______

House before the storm

26. Was your house damaged by the storm Yes No 27. What type of house did you live in before the cyclone Pucca Semi Pucca Traditional/ Mud Temporary/Jhupri 28. What materials was your house made of: Roof: Walls: Frame: Floor: Foundation: Thatch Bamboo Bamboo Earth Clay plinth CGI Sheet matting Timber Timber Brick Other Timber masonry Concrete Concrete planks ______posts Concrete Other ____ CGI posts Brick ______Bricks masonry Other ______Other Other ______

29. What is the size of your house (squared yards)? < 10 10 to 20 20 to 40 40 to 60 60 to 100 More than 100 30. What is the type of property ownership or rights held by the household affected? Private ownership Renting Squatter Other______

31. Do you have legal papers for the 32. Do you still have the legal papers? land? Yes No Yes No

33. Is the household under threat of Yes No eviction? Reason ______

43. What type of sanitation facility are you Sanitary (water-sealed) using before cyclone Mahasen Sanitary (non-water sealed) Non-Sanitary None 44. Was your latrine damaged by Cyclone Yes No Mahasen?

Note: if answer is yes, ask question 1.3 45. What type of sanitation facility are you Sanitary (water-sealed) using now? Sanitary (non-water sealed) Note: Enumerator have to do direct Non-Sanitary observation None

46. Have your household members begun to Yes No rehabilitate sanitation facilities? 47. What are the main problems the Materials/tools for repair are not household faces to repair of rebuild their available latrine? Materials/tools for repair are not accessible (not enough money) Rank up to the top 3; 1st, 2nd, 3rd Skilled/labour for repair not available Skilled/labour for repair not accessible (not enough money) There are potential grievances on land issues Other

48. Do woman and adolescent girls have enough privacy to use latrine? Yes No

49. Do Woman and adolescent girls have enough privacy for bathing? Yes No 50. Where from you collect drinking water? Before Cyclone After Cyclone Tube wells Tube wells Dug wells Dug wells Pond Sand Filter Pond Sand Filter Rain Water Rain Water Harvesting Harvesting Pipe water Pipe water system system

Ponds/River/Canals Ponds/River/Canals If others If others ( Explain) ( Explain) 51. What do you use for hand washing? NOTE: Enumerator have to observe if soap Soap Ash None available anywhere in the house ( nearer to toilet, water point , kitchen etc) 52. Have you notice any particular disease Diarrhoea Skin Disease since recent cyclone? Stomach pain Others

Early Recovery (Livelihood / Income)

53. What are your main BEFORE NOW sources of household Farming Farming income? Livestock Livestock Fishing (boat owner) Fishing (boat owner) Fishing (labour) Fishing (labour) Shrimp Farming Shrimp Farming Small trade Small trade Forest dependent Forest dependent Private service Private service Govt service Govt service Day labourer Day labourer Fully dependent (no Fully dependent (no income) income) Agricultural labour Agricultural labour Van/rickshaw puller Van/rickshaw puller Other (specify) Other (specify) Before storm Projected income after one month 54. What is your average Below 3000 BDT Below 3000 BDT monthly income? 3,000 - 5,000 BDT 3,000 - 5,000 BDT (Only one amount) 5,000 - 10,000 BDT 5,000 - 10,000 BDT The comparison has to be 10,000 above BDT 10,000 above BDT done with projected income after one month of the storm 55. What is your monthly BEFORE NOW expenditure? (this has to Basic HH be translated in % by the necessities (food) team) Health Children education Fire wood/fuel Cloths Transportation Loan repayment Fodder Others (specify) 56. What are the Agricultural crops damaged damages, which impacted fishing boats, nets, etc. damaged on your livelihood? Rickshaw, van damage (select 2 most affected lost poultry livelihood options) livestock loss fisheries damage Agricultural seeds others (specify)

57. When do you expect to Already restarted restart your main previous Within one month livelihood activity? Within three months In more than three months I don’t know Agricultural land still under water Plan for alternative livelihood option (specify) 58. What are your main Agricultural land under debris constraints to restart your Too much pressure on daily labor market main livelihood activity? Shrimp farm damaged by storm Fish pond damaged by storm Livelihood assets damaged by storm Livelihood assets has been sold to buy food Other (specify) 59. What plans you have Selling of household assets or fix assets to cope with current loss Will migrate outside for work of livelihood? Alternative livelihood borrow loan with high interest other (specify) 60. What are the main Firewood sources of energy you use Cattle dung for household? (cooking, Kerosene lighting, etc.) Others 61. Do you own land for Yes No agriculture? 62. If yes, how much land Less than 10 decimal do you own? 11 - 30 decimal 31 - 100 decimal 100 - 300 decimal More than 300 decimal

Assistance already received

63. Has there already Yes No been support provided? 64. What kind of support Food, eg GR rice Shelter NFIs was provided? Temporary shelter Shelter Material Cash (GR) Cash for work Water Access Sanitation Seed, tools Health Psycho-Social Child

protection Hygiene Kits Other:______

Local authorities Own funds Private individuals Local charity associations 65. Who provided such Local NGOs International NGOs / UN / Donors support? Other:______Name organisation : Food, eg GR rice Shelter NFIs Temporary shelter Shelter Material Cash (GR) Cash for 66. What shelter work assistance has been Water Access Sanitation Seed, committed but not yet tools received? Health Psycho-Social Child protection Hygiene Kits Other:______

Question on Communication Needs and Access

67.1: What are your main sources of information you used before any disaster happened? 67.2: What are your main sources of information you used during any disaster happened? 67.3: What are your main sources of information you used after any disaster happened? 67.4: In your opinion what are your most favorable sources of information to get information regarding disaster responses (TICK ONLY THREE)? DO NOT READ OUT. MULTIPLE CODES 1.1 1.2 1.3 1.4 Most ALLOWED. Before During After Favorable 1 Word of Mouth 2 Notice Board 3 Loudspeaker/mic 4 Volunteers 5 Television 6 Radio 7 Newspaper/magazine 8 Internet (e.g. social media sites 9 Mobile phone (e.g. news service) 10 I don’t get any information on these issues

88 Don’t know 99 Refused Those who ticked in 5 in Q 1.1 ASK Q 2.1 Those who ticked in 5 in Q 1.2 ASK Q 2.2 Those who ticked in 5 in Q 1.3 ASK Q 2.3 68.1 Now, I’m going to read you a list of some television channels available in your area, can you tell me which of these channels you watch to get the information before any disaster happened? 68.2 Now, I’m going to read you a list of some television channels available in your area, can you tell me which of these channels you watch to get the information during any disaster happened? 68.3 Now, I’m going to read you a list of some television channels available in your area, can you tell me which of these channels you watch to get the information after any disaster happened 2.1 Before 2.2 2.3 TV Channel During After 01 ATN Bangla 02 ATN News 03 Bangla Vision 04 Boishakhi tv 05 BTV 06 Channel 24 07 Channel 9 08 Channel I 09 Desh tv 10 Diganta tv 11 ETV 12 Gazi tv 13 Indepenent TV 14 Islamic TV 15 Maasranga 16 Mohona TV 17 My TV 18 NTV 19 RTV 20 Somoy TV 21 71 TV 22 Channel 16 23 Don’t watch Bangladeshi Channels 88 DK 99 REF Question 3 Those who ticked in 6 in Q 1.1 ASK Q 3.1 Those who ticked in 6 in Q 1.2 ASK Q 3.2 Those who ticked in 6 in Q 1.3 ASK Q 3.3

69.1 Now, I’m going to read you a list of some Radio channels available in your area, can you tell me which of these channels you listen to get the information before any disaster happened? 69.2 Now, I’m going to read you a list of some Radio channels available in your area, can you tell me which of these channels you listen to get the information during any disaster happened? 69.3 Now, I’m going to read you a list of some Radio channels available in your area, can you tell me which of these channels you listen to get the information after any disaster happened? Radio Channels 3.1 Before 3.2 3.3 After During 01 Bangladesh Betar 02 BBC Bangla 03 BBC World 04 Radio ABC (89.2) 05 Radio Amar (88.4) 06 Radio Foorti (88.0) 07 Radio Today (89.6) 08 Voice of America (VOA) 09 Peoples Radio (91.6) 10 Dhaka FM (90.4) Community Radio 11 Radio Sundarban - Koyra, Khulna Lokobetar - West Sadar Road, 12 Barguna Krishi Radio - Amtoli, 13 Barguna 88 Don’t know 99 Refused 70. Do you agree or disagree that the following are the reason you do not/might not get any information about disaster responses READ OUT EACH STATEMENT. SINGLE CODE ONLYON PROVIDING AN AGREE OR DISAGREE RESPONSE, FOLLOW UP WITH: Would you say you [agree/disagree] a lot, or just a normal amount? y l e g e n w r e o o d g r e e e n t a r

e s k S g

r y u l e t a f g ’ e g s e A i n r n R o g D o a r D t s i S D 4 3 2 1 88 99 A I do not have enough time to collect the information B I have other priorities than getting information about Page 9 of 10 WASH, EARLY REOVERY AND SHELTER Tropical Cyclone Mahasen Team ID: ______HOUSEHOLD SURVEY

disaster responses c I do not feel the information that was provided is useful d I do not feel the information that was provided is correct / accurate. e I do not have access (either TV or Radio or Newspaper) to the information. f It is very hard to get information about disaster responses from my area.