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Water Pollution and Drinking Water Crisis Survey
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Welcome to the survey on water pollution and its impact on health and nutrition in India. Please answer the following questions honestly. Your responses will help us understand the situation better. Thank you!
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1. Basic Information:
Age:
Age:
Gender:
Gender:
Location:
Location:
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2. Please select your age group:
Under 18
18-25
26-35
36-45
46-55
56-65
65 and above
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3. What is your gender?
Male
Female
Other
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4. Please specify your location (City/Town/Village):
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5. Do you have access to clean drinking water?
Yes
No
Sometimes
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6. How do you primarily obtain your drinking water?
Tap water
Bottled water
Well water
Rainwater
Others
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7. How often do you use water filters or purifiers?
Always
Often
Sometimes
Rarely
Never
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8. Are you aware of water pollution in your area?
Yes
No
Not sure
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9. What do you think are the main causes of water pollution?
[Checkboxes]
Industrial waste
Agricultural runoff
Household waste
Plastic waste
Others
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10. Have you noticed any changes in water quality over the years?
Yes, it has worsened
Yes, it has improved
No change
Not sure
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11. What health issues do you think are related to water pollution?
[Checkboxes]
Diarrhea
Cholera
Skin diseases
Respiratory issues
Others
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12. Have you or anyone in your family suffered from a waterborne disease?
Yes
No
Not sure
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13. How important do you think hygiene is in preventing waterborne diseases?
Very important
Somewhat important
Not important
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14. Do you believe that water pollution affects nutrition?
Yes
No
Not sure
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15. Have you ever changed your diet due to concerns about water quality?
Yes
No
Not applicable
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16. Please share any personal experiences related to water quality and nutrition:
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17. Are you aware of any government initiatives to address water pollution?
Yes
No
Not sure
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18. What solutions do you think could help improve water quality?
[Checkboxes]
Strict regulations on industries
Public awareness campaigns
Improved waste management
Community water projects
Others
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19. What additional suggestions do you have for improving water quality in your area?
Evaluation object score
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