Qlarr AI
Community needs assessment for NGO field teams interviewing households.
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CRDI Community Needs AssessmentPreview
Page 1 of 14 · Before you begin
Q1. Has the respondent given consent to take part? *YesNoNo ends the interview
Q2. Enumerator ID *EN-Format EN-0000
Q3. Community *Select…
Q4. Household ID *HH-Format HH-0000
Q5. Interview date *DD / MM / YYYYNot in the future
Page 2 of 14 · Household profile
Q6. Who is answering today? *Head of householdSpouseOther relative
Q7. Respondent’s ageYearsShown when Q6 is not Head of household18 to 110
Q8. People in household *01 to 30
Q9. Children under 50Must be ≤ Q8
Page 3 of 14 · Water and food
Q12. Main drinking water source *Select…
Q13. Minutes to collect water, round tripMinutesShown when Q12 is outside the home1 to 600
Q14. In the last 7 days, how often did the household… *Never1–2 days3+ daysSkipped mealsReduced portionsBorrowed foodOne answer per row
Page 4 of 14 · Priority needs
Q20. Rank the household’s top 3 needs *FoodClean waterShelterHealthcareEducationRank exactly 3
Q21. If “Other”, please describeShort textShown when Q20 includes Other
Q22. Anything else the household would like to share?Long textMax 500 characters
Page 5 of 14 · Housing and shelter
Page 6 of 14 · Sanitation
Page 7 of 14 · Health
Page 8 of 14 · Children under 5
Page 9 of 14 · Education
Page 10 of 14 · Livelihoods
Page 11 of 14 · Income and expenses
Page 12 of 14 · Displacement history
Page 13 of 14 · Safety and protection
Thank you page (final page)
Thank you!
Thank you for your time. Your answers help CRDI plan support for communities in Kenya and Uganda.
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