| Type of family | Check Box |
| Nuclear |
|
| Joint |
|
| Number of family members |
|
| Upto 5 |
|
| 5–10 |
|
| >10 |
|
| Type of home |
|
| Pukka |
|
| Kuccha |
|
| Overcrowding |
|
| No |
|
| Yes |
|
| Indoor air pollution |
|
| No |
|
| Yes |
|
| Poor ventilation in living area |
|
| No |
|
| Yes |
|
| Contact with TB |
|
| No |
|
| Yes |
|
| Smoking at home |
|
| No |
|
| Yes |
|
| Drinking water source |
|
| Underground water |
|
| Tap water |
|
| Open defecation |
|
| No |
|
| Yes |
|
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