Kuesioner Survei Banjir

Nama Narasumber :
Alamat :

1. Apakah didaerah ini pernah atau sering terjadi banjir?

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2. Berapa kira – kira tinggi genangan banjirnya?
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3. Berapa kira – kira luas genangan banjirnya?
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4. Berapa frekwensi terjadinya banjir disini? (dalam skala tahun)
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5. Apa kira – kira peyebab terjadinya banjir disini?
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6. Daerah mana saja kira – kira yang terkena dampak banjir?
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7. Berapa KK kira – kira yang terkena dampak banjir?
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8. Apa kerugian akibat efek banjir di daerah ini?
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9. Kepadatan penduduk (jiwa/km2) <500 500-1000 >1000
10. Rasio jenis kelamin (%) <20 20-40 >40
11. Rasio Kemiskinan (%) <20 20-40 >40
12. Kelas Rumah (juta) <400 400-800 >800
13. Fasilitas Umum (juta) <500 400-1 M >1 Milyar
14. Luas Hutan (Ha) <20 20-50 >50
15. Luas Semak Belukar (Ha) <10 10-30 >30
16. Luas Rawa (Ha) <5 5-20 >20
17. Alat Peringatan dini banjir tidak ada rendah sedang tinggi
18. Pendidikan kebencanaan banjir tidak ada rendah sedang tinggi
19. Pembangunan mitigasi bencana banjir tidak ada rendah sedang tinggi

Nb:
Tolong dokumentasikan warga/ narasumber dan kondisi daerah sekitar