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APPENDIX - IV
QUESTIONNAIRE
SAMPLE SURVEY OF HOUSEHOLDS USING DAY-CARE SERVICE
IN MANGALORE URBAN AGGLOMERATION
Religion: H/M/C/O
Caste :
1. Family particulars of the Household:
SI. Members of Sex Age Marital Education Occupation Monthly
No. the family status Income
(Rs.)
1. Husband
2. Wife
3. Child - 1
4. Child - 2
5. Child - 3
6. Child - 4
7. Father/Mother
8. Brother/Sister
9. Parents/Inlaws
Total Monthly Family Income Rs
2. Type of family structure:
Nuclear / extended / joint
3. Type of the Dwelling:
RCC Flat Tiled Thatched
Own
Rented
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4. Particulars of the child going to the Day-Care Centre:
SI. Child Age Sex
NO.
1. First
2. Second
3. Third
4. Fourth
5. Reasons for sending the child to the Day-Care Centre:
a...........
b
c.....................................
d.....................................
6. From where did you get the information about the
availability of Day-Care Service ?
Source of Information:
a. Family members / relatives
b. Neighbours
c. Colleagues
d. Friends
7. Please mention your major considerations while choosing
a particular Day-Care Centre:
a.....................................
b.....................................
c.....................................
d.....................................
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8. Are you happy with the service provided by the Day-Care
Centre ?
a. Happy
b. Neutral
c. Unhappy
9. In case you are dissatisfied with the Day-Care Service,
please specify the dissatisfying aspects of the Day-Care
Service:
a..................................
b..................................
c..................................
d..................................
10. What actions you have taken to reduce your
dissatisfaction ?
Action taken:
a..................................
b..................................
c................................. .
d..................................
11. To whom have you recommended the day-Care Centre so
far ?
a. Family members
b. Relatives
c. Neighbours
d. Colleagues
e. Friends
f. None
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12. What suggestions do you offer to improve the quality of
Day-Care Services in Mangalore Urban Agglomeration ?
Suggestions:
a..................................
b..................................
c..................................
d..................................
13. Payment made to the Day-Care Centre:
a. Fees paid per month : Rs..........
b. Any other charges paid per month: Rs..........
14. Do you find the fees charged by the centre reasonable ?
Yes / No
15. Do you find any difficulty in leaving and picking up the
child at and from the centre ?
Yes / No
16. Are you happy with the timings of the Day-Care Centre ?
a. Happy
b. Neutral
c. Unhappy
17. Does the child like going to the Day-Care Centre ?
Yes / No
18. Did you make any assessment of the facilities provided
by the other Day-Care Centres before sending your child
to this centre ?
Yes / No
Ill
19. Do you supply food to the child while sending it to the
Day-Care Centre ?
Yes / No
20. Any other points observed/gathered;