Baseline survey template
Collect starting-point data for your programme, household by household.
Free. You sign in with Google first, then the template opens in your builder.
Questions in this template
- 1Household head nameShort textRequired
- 2Settlement typeSingle choiceRequired
- 3How many people live in this household?NumberRequired
- 4How well are these needs met in your household?Choice gridRequired
- 5Which services do you use in the community?Multiple choice
- 6What is the biggest challenge your household faces this year?Long text
Preview
This is the form your respondents will see, with the template questions already in place. Switch between desktop and mobile.
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6 · 2 min
Baseline survey
Collect starting-point data for your programme, household by household.
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1of 6
Household head name*
2of 6
Settlement type*
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How many people live in this household?*
Enter a whole number.
4of 6
How well are these needs met in your household?*
| Fully met | Partially met | Not met | |
|---|---|---|---|
| Food | |||
| Water | |||
| Healthcare | |||
| Schooling |
Food
Water
Healthcare
Schooling
0 / 4
5of 6
Which services do you use in the community?
Select all that apply
6of 6
What is the biggest challenge your household faces this year?
0 / 150 words