Road Accident in Trivandrum City Survey

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Dear sir/madam
Name:Gender:malefemaleAge:No: of dependent:Date of accident: ………………………………. Today’s date……………………….. | I am a student of Allama iqbal institute of management studies peringammala. And presenting doing project on road accident rate in young generation in Trivandrum district. i request you to kindly fill the questionnaire below and assure you that data generated shall be kept confidentially. 1. Education qualification

10 or below 10+2 below
Graduate post graduate other (specified)…………………………… 2. Do you have vehicle.
No yes . if yes 4 wheeler 2wheeler other 3. Who owns the vehicle you were in?_____________________________ Relationship________________________ 4. Your occupation

Salaried self employed retired daily wage
House wife students NRIother 5. The Following question pertain to you and vehicle you where in
Vehicle type vehicle size
Carpickup mini lightother
Vantruck heavy
Busother……………………………………..
6. Your position in vehicle
Driver passenger other
Location: Left right middle
Other:front passenger rear passenger

7. Speed of vehicle why vehicle was slowed or stopped
Stopped vehicle moving moderatelytraffic signal parking
Parked moving fastpedestriantraffic
Slowed...
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