SDES Form No. 2 English
Summary Sheets for Village/Enumeration Area (Form No. 2)
Summary Sheets for Village/Enumeration Area (Form No. 2)
10. Potential evacuation sites
SN
Max Occupancy
(person)
Location
(0)
(1)
Distance (km) to nearest Distance (km) to nearest
Hospital/Clinic not local supply (market) not local
(2)
(3)
ISLAMIC REPUBLIC OF AFGHANISTAN
CENTRAL STATISTICS ORGANIZATION
SOCIO-DEMOGRAPHIC AND ECONOMIC SURVEY
Notes
(4)
(5)
Part I - Identification Particulars
1
2
Province Name______________________
Village Name _______________________
District Name _______________________
Aka _______________________
3
4
Village / Nahia Center
5
6
Latitude
N
Longitude
E
City Name__________________________
11. Communication and Media Availability
Media Availability:
Mobile Phone Availability:
1- Yes
2- No
Television
1- Yes
2- No
Radio
Nahia Code
Internet
1- Yes 2- No
Newspaper
Altitude
5. Afghan Telecom
2. MTN
6. Wasil Telecom
3. ROSHAN
7. Other, Specify_______ 2. Local Channel
1. National
1. Daily
1. Mobile
2. AM
2. Weekly
2. Satellite
3. Monthly
3. Line
Remarks:
Name of respondent: ______________ Designation of respondent: _________
Meter
If count = 0, Means of Transportation, Distance & Travel time to the nearest facility
SN
Type
Count
distance (km)
(1)
(2)
(3)
Name of Supervisor:__________________________
Signature of Cartographer: ___________________
Signature of Supervisor: ______________________
Date:
/
Year
/
Day
/
Month
Year
C
Travel Time
(4)
Travel Time by foot
(5)
(6)
Hospital
hr
Min
hr
Min
2
Government Clinic
hr
Min
hr
Min
3
Private Clinic
hr
Min
hr
Min
4
Animal Clinic
hr
Min
hr
Min
5
University
hr
Min
hr
Min
6
Institute
hr
Min
hr
Min
7
High School
hr
Min
hr
Min
8
Secondary School
hr
Min
hr
Min
9
Primary School
hr
Min
hr
Min
10
Mosque
hr
Min
hr
Min
11
Madrasa
hr
Min
hr
Min
12
Gas Station
hr
Min
hr
Min
13
Bank
hr
Min
hr
Min
14
Bazar
hr
Min
hr
Min
15
Post Office
hr
Min
hr
Min
16
Police Station
hr
Min
hr
Min
Signature of respondent: ___________
Name of Cartographer: ______________________
* Common Transportation
1
* Transportation Code
Month
.
ْ
ْ
1. Infrastructure
(0)
Day
.
Provider
1. FM
4. etisalat
/
ْ
ْ
Part II - Facility, Accessibility and others
1. AWCC
Date:
0
ْ
ْ
01 - Bus / Mini Bus / Van
02 - Taxi
03 - Scooter
04 - Car
05 - 4WD
06 - Motorcycle
07 - Bicycle
08 - Wagon
09 - Animal
10 - By foot
Summary Sheets for Village/Enumeration Area (Form No. 2)
Summary Sheets for Village/Enumeration Area (Form No. 2)
2. Means of transportation to or from the district center
6. Community based group functional in last year (for Rural Area)
Type
SN
(0)
(1)
Frequency
Per day
(2)
Per week
(3)
others
Distance in KM
(4)
Travel Time
(5)
SN
Source
Availability
1- Yes, 2- No
Note
(0)
(1)
(2)
(4)
(6)
1
Bus / Mini Bus / Van
hr
Min
2
Taxi
hr
Min
3
Scooter
hr
Min
4
Car
hr
Min
5
4WD
hr
Min
6
Motorcycle
hr
Min
7
Bicycle
hr
Min
8
Wagon
hr
9
Animal
10
By foot
1
Local Shura
2
Health Shura
3
Community Health Workers
4
Community Development Council
5
Other, Specify_______________
7. Aid organization providing development service in last year
SN
Name of Organization
Type of service provided
Note
Min
(0)
(1)
(2)
(3)
hr
Min
1
hr
Min
2
3
3. Electricity
4
SN
Source
Availability
1- Yes, 2- No
Note
(0)
(1)
(2)
(3)
5
6
1
Grid
7
2
Hydro by individual family
8
3
Hydro by Community
9
4
Generator by individual family
10
5
Generator by Community
11
6
Solar by individual family
12
7
Solar by Community
8. Natural disaster latest occurrence and frequency
4. Water for irrigation (for Rural Area)
SN
Source
Availability
1- Yes, 2- No
Note
(0)
(1)
(2)
(3)
1
Rivers
2
Springs
3
Lakes
4
Wells
5. Water for daily activities
SN
Type
Year /Month occurred
(0)
(1)
(2)
1
Flooding
2
Drought
3
Landslide
4
Earthquake
5
Avalanch
6
Others, Specify______________
Disaster Scale description
1- Minor
2- Mild
3- Severe
Times occurred past 10
years
(3)
(4)
No. of Days
Times occurred past 10
years
9. Latest occurrence and frequency of road closure
SN
Source
Availability
1- Yes, 2- No
Note
SN
(0)
(1)
(2)
(3)
(0)
Reason
(1)
1
Piped
1
Snow
2
Rivers
2
Avalanche
3
Springs
3
Flood
4
Lakes
4
Landslide
5
Wells
5
Earthquake
6
Rain
Year /Month occurred
(2)
(3)
(4)
Summary Sheets for Village/Enumeration Area (Form No. 2)
10. Potential evacuation sites
SN
Max Occupancy
(person)
Location
(0)
(1)
Distance (km) to nearest Distance (km) to nearest
Hospital/Clinic not local supply (market) not local
(2)
(3)
ISLAMIC REPUBLIC OF AFGHANISTAN
CENTRAL STATISTICS ORGANIZATION
SOCIO-DEMOGRAPHIC AND ECONOMIC SURVEY
Notes
(4)
(5)
Part I - Identification Particulars
1
2
Province Name______________________
Village Name _______________________
District Name _______________________
Aka _______________________
3
4
Village / Nahia Center
5
6
Latitude
N
Longitude
E
City Name__________________________
11. Communication and Media Availability
Media Availability:
Mobile Phone Availability:
1- Yes
2- No
Television
1- Yes
2- No
Radio
Nahia Code
Internet
1- Yes 2- No
Newspaper
Altitude
5. Afghan Telecom
2. MTN
6. Wasil Telecom
3. ROSHAN
7. Other, Specify_______ 2. Local Channel
1. National
1. Daily
1. Mobile
2. AM
2. Weekly
2. Satellite
3. Monthly
3. Line
Remarks:
Name of respondent: ______________ Designation of respondent: _________
Meter
If count = 0, Means of Transportation, Distance & Travel time to the nearest facility
SN
Type
Count
distance (km)
(1)
(2)
(3)
Name of Supervisor:__________________________
Signature of Cartographer: ___________________
Signature of Supervisor: ______________________
Date:
/
Year
/
Day
/
Month
Year
C
Travel Time
(4)
Travel Time by foot
(5)
(6)
Hospital
hr
Min
hr
Min
2
Government Clinic
hr
Min
hr
Min
3
Private Clinic
hr
Min
hr
Min
4
Animal Clinic
hr
Min
hr
Min
5
University
hr
Min
hr
Min
6
Institute
hr
Min
hr
Min
7
High School
hr
Min
hr
Min
8
Secondary School
hr
Min
hr
Min
9
Primary School
hr
Min
hr
Min
10
Mosque
hr
Min
hr
Min
11
Madrasa
hr
Min
hr
Min
12
Gas Station
hr
Min
hr
Min
13
Bank
hr
Min
hr
Min
14
Bazar
hr
Min
hr
Min
15
Post Office
hr
Min
hr
Min
16
Police Station
hr
Min
hr
Min
Signature of respondent: ___________
Name of Cartographer: ______________________
* Common Transportation
1
* Transportation Code
Month
.
ْ
ْ
1. Infrastructure
(0)
Day
.
Provider
1. FM
4. etisalat
/
ْ
ْ
Part II - Facility, Accessibility and others
1. AWCC
Date:
0
ْ
ْ
01 - Bus / Mini Bus / Van
02 - Taxi
03 - Scooter
04 - Car
05 - 4WD
06 - Motorcycle
07 - Bicycle
08 - Wagon
09 - Animal
10 - By foot
Summary Sheets for Village/Enumeration Area (Form No. 2)
Summary Sheets for Village/Enumeration Area (Form No. 2)
2. Means of transportation to or from the district center
6. Community based group functional in last year (for Rural Area)
Type
SN
(0)
(1)
Frequency
Per day
(2)
Per week
(3)
others
Distance in KM
(4)
Travel Time
(5)
SN
Source
Availability
1- Yes, 2- No
Note
(0)
(1)
(2)
(4)
(6)
1
Bus / Mini Bus / Van
hr
Min
2
Taxi
hr
Min
3
Scooter
hr
Min
4
Car
hr
Min
5
4WD
hr
Min
6
Motorcycle
hr
Min
7
Bicycle
hr
Min
8
Wagon
hr
9
Animal
10
By foot
1
Local Shura
2
Health Shura
3
Community Health Workers
4
Community Development Council
5
Other, Specify_______________
7. Aid organization providing development service in last year
SN
Name of Organization
Type of service provided
Note
Min
(0)
(1)
(2)
(3)
hr
Min
1
hr
Min
2
3
3. Electricity
4
SN
Source
Availability
1- Yes, 2- No
Note
(0)
(1)
(2)
(3)
5
6
1
Grid
7
2
Hydro by individual family
8
3
Hydro by Community
9
4
Generator by individual family
10
5
Generator by Community
11
6
Solar by individual family
12
7
Solar by Community
8. Natural disaster latest occurrence and frequency
4. Water for irrigation (for Rural Area)
SN
Source
Availability
1- Yes, 2- No
Note
(0)
(1)
(2)
(3)
1
Rivers
2
Springs
3
Lakes
4
Wells
5. Water for daily activities
SN
Type
Year /Month occurred
(0)
(1)
(2)
1
Flooding
2
Drought
3
Landslide
4
Earthquake
5
Avalanch
6
Others, Specify______________
Disaster Scale description
1- Minor
2- Mild
3- Severe
Times occurred past 10
years
(3)
(4)
No. of Days
Times occurred past 10
years
9. Latest occurrence and frequency of road closure
SN
Source
Availability
1- Yes, 2- No
Note
SN
(0)
(1)
(2)
(3)
(0)
Reason
(1)
1
Piped
1
Snow
2
Rivers
2
Avalanche
3
Springs
3
Flood
4
Lakes
4
Landslide
5
Wells
5
Earthquake
6
Rain
Year /Month occurred
(2)
(3)
(4)