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Questions marked with a * are required Exit Survey
 
 
* Date of Survey
   
 
 
 
* Name of BLF (Village) / Estate (Division)
 
 
 
* Name of the respondent
   
 
 
 
* Age
   
 
 
 
* Gender
 
 
 
* Literacy level
 
Nil
 
10th and below
 
12th & 11th
 
Graduates
 
 
 
* No. of household dependents
   
 
 
 
* Occupation
 
Farmer
 
Farm Worker
 
Worker
 
 
 
* % dependance of agriculture
 
Nil
 
less than 50%
 
Above 50%
 
100%
 
 
 
* Remembrance of total food group numbers?
 
Yes
 
No