Rural Electrification Project Survey Form
Share information about your community’s current electricity access, needs, and priorities to help plan a rural electrification project.
Respondent and Location Details
Respondent Name
*
First Name
Last Name
Role or Relationship to the Project
Please Select
Household Head
Community Leader
School Representative
Business Owner
Local Official
Other
Phone Number or Alternative Contact Method
Village or Community Name
*
District or Region
*
Is this location currently electrified?
*
Yes
No
Partially
Electricity Access and Current Situation
Current household or site power source
*
Grid
Solar home system
Generator
Lanterns/None
Other
Average hours of electricity available per day
*
Please Select
0 hours
1–3 hours
4–6 hours
7–12 hours
More than 12 hours
Reliability of current electricity supply
*
Very unreliable
1
2
3
4
5
6
7
8
9
Very reliable
10
1 is Very unreliable, 10 is Very reliable
Main problems experienced with current electricity access
*
No electricity at all
Frequent outages
Low voltage
High cost of fuel or service
Limited hours of supply
Equipment breakdowns
Safety concerns
Cannot power needed appliances
Other
Project Needs and Priorities
Electrification need level
*
Low need
1
2
3
4
Very high need
5
1 is Low need, 5 is Very high need
Priority uses for electricity
*
Lighting
Phone charging
Refrigeration
Irrigation
School use
Clinic use
Small business
Other
Would you connect if service becomes available?
*
Yes
No
Not sure
Preferred connection type
Grid extension
Mini-grid
Solar
Other
Additional comments or community needs
Submit
Should be Empty: