Resident Condition Survey

Resident Condition Survey

v1
by
N
Nurika@21
Resident Condition Survey
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CITIZEN REGISTRATION

Citizen Condition Survey

Owner access

FIELD FORM

Family condition data collection

Fill in all questions with the latest data. Grouping results can only be seen by the owner.

Private data
Surveyor identity

Record the officer who conducted the visit.

Surveyor nameSurveyor title
Family identity

This information is used for recording and field verification.

Head of household nameFamily card numberContact number
Full address Number of family members Family condition

Select the answer that matches the situation during data collection.

Are there any elderly family members?
YesNone
Are there any family members with disabilities?
YesNone
Female head of household?
YesNo
Are there any children currently in school?
YesNo
Are there any other family members working besides the head of the family?
YesNo
Main occupation of the head of the family Access to services and housing conditions

Select the condition that best matches the family's situation during data collection.

Health insurance accessHousing ownership statusFloor typeFloor conditionWall typeWall conditionToilet facilityElectricity power capacityDrinking water sourceCooking fuelSocial assistance received
Income, assets, expenses

Enter the monthly rupiah value for income and expenses. Assets are calculated as the total estimated value.

Total monthly income (Rp)Estimated total asset value (Rp)Total monthly expenses (Rp)Total installments / debt (Rp)
Do you own any vehicle assets?
Own other land / buildings besides the one occupied?
YesNo
Notes and imagesField notes
Front view of houseUpload 1 image of the front of the house.BathroomUpload 1 bathroom image.

All questions are mandatory.

Save survey results

FILLED RECAP

Names already surveyed

    OWNER AREA

    Open result summary

    Log in to view categories, priorities, images, and download all data.

    UsernamePasswordLog in to summary

    OWNER AREA

    Socio-economic summary of residents

    Categories and priorities are only visible in the owner space.

    Download CSVDownload JSONLog out

    Distribution of 10 categories

    Decile 1 is the lowest to decile 10 is the most capable.

    Family details

    Open images or download summary as needed.

    Data collection for citizens' socio-economic needs.Access to recap is restricted to the owner.