Advertisement
Not a member of Pastebin yet?
Sign Up,
it unlocks many cool features!
- <!DOCTYPE html>
- <html>
- <head>
- <meta charset="UTF-8">
- <style>
- p.ex {
- margin-right: 150px;
- margin-left: 50px;
- }
- </style>
- <body>
- <img src="IIT_BHU.jpg" style="float:left" alt="IIT-BHU Logo"
- width="120" height="120">
- <h5 style="font-family:verdana;">                                                 Travel Demand Modeling for Varanasi: A
- project by Department of Civil Engineering, IIT (BHU), Varanasi. </h5>
- <br> <br> <br>
- <h1 style="font-family:verdana; color:red;text-align:center ;"> HOUSEHOLD TRAVEL SURVEY </h1>
- <br> <br>
- <h4 style="font-family:verdana;text-align:center ;"> Project Name: Travel Demand Modeling for
- Varanasi </h4>
- <h4 style="font-family:verdana;text-align:center ;">(Department of Civil Engineering, IIT (BHU),
- Varanasi) </h4>
- <br>
- <h5 style="font-family:verdana;float:left;"> Objective of Survey: </h5>
- <p style="font-family:arial;color:black;font-size:13px;text-align:center;"> Department of Civil
- Engineering, IIT (BHU), Varanasi has taken up the task of “Integration of Mass
- Transportation System
- through Travel Demand Modeling” and for this purpose, appropriate
- questionnaire has been designed to collect travel data of the commuter to
- understand and model travel behavior. The outcome of the project will finally
- help Transportation Engineers and students to help to improve
- Sustainability of Transportation System of Varanasi City. The information collected
- will be kept confidential and will not be disclosed to others.
- Thank you for your valuable time.
- </p>
- <br> <br>
- <form>
- <fieldset>
- <legend> Personal Information </legend>
- <br>
- <center>
- Name of household: <input type="text" name="house_name"><br> <br>
-                
- Address: <input type="textarea" name="address"><br>
- <br><br>
- <input type="submit" >
- </center>
- </fieldset>
- </form>
- <br> <br> <br>
- <h4 style="font-family:verdana; color:red;text-align:center ;"> HOUSEHOLD INFORMATION </h4>
- <br> <br>
- <p class="ex">
- <b> 1)   How many members are there in your family? </b> </p>
- <p class="ex"> <i> Mark only one box. </i> </p>
- <form action="">
- <p class="ex"><input type="checkbox" name="first_q" value="first_opt">1</p>
- <p class="ex"><input type="checkbox" name="first_q" value="second_opt">2</p>
- <p class="ex"><input type="checkbox" name="first_q" value="third_opt">3</p>
- <p class="ex"><input type="checkbox" name="first_q" value="fourth_opt">4 or more</p>
- </form>
- <br>
- <p class="ex"><b> 2)   How many earning members are there in your household? </b></p>
- <p class="ex"><i> Mark only one box. </i> </p>
- <form action="">
- <p class="ex"><input type="checkbox" name="second_q" value="first_opt">1</p>
- <p class="ex"><input type="checkbox" name="second_q" value="second_opt">2</p>
- <p class="ex"><input type="checkbox" name="second_q" value="third_opt">3</p>
- <p class="ex"><input type="checkbox" name="second_q" value="fourth_opt">4 or more</p>
- </form>
- <br>
- <p class="ex"><b> 3)   How many motorized vehicles are there in your household? </b></p>
- <p class="ex"><b> List all of them. </b> </p>
- <form action="">
- <p class="ex"><input type="checkbox" name="third_q" value="first_opt">None</p>
- <p class="ex"><input type="checkbox" name="third_q" value="second_opt">1</p>
- <p class="ex"><input type="checkbox" name="third_q" value="third_opt">2</p>
- <p class="ex"><input type="checkbox" name="third_q" value="fourth_opt">3</p>
- <p class="ex"><input type="checkbox" name="third_q" value="fifth_opt">4 or more</p>
- </form>
- <br>
- <p class="ex"><b> 4)   What is your monthly family Income? </b></p>
- <p class="ex"><i> Mark only one box. </i> </p>
- <form action="">
- <p class="ex"><input type="checkbox" name="fourth_q" value="first_opt">Below ₹ 10000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="second_opt">₹ 10000 to 20000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="third_opt">₹ 20000-30000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="fourth_opt">₹ 30000-40000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="fifth_opt">₹ 40000-60000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="sixth_opt">₹ 60000-80000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="seven_opt">₹ 80000-100000</p>
- <p class="ex"><input type="checkbox" name="fourth_q" value="eight_opt">Above ₹ 100000</p>
- </form>
- <br>
- <p class="ex"><b> 5)   What is the monthly household travel Expenditure? </b></p>
- <p class="ex"><i> Mark only one box. </i> </p>
- <form action="">
- <p class="ex"><input type="checkbox" name="fifth_q" value="first_opt">Below ₹ 1000</p>
- <p class="ex"><input type="checkbox" name="fifth_q" value="second_opt">₹ 1000-2000</p>
- <p class="ex"><input type="checkbox" name="fifth_q" value="third_opt">₹ 2000-4000</p>
- <p class="ex"><input type="checkbox" name="fifth_q" value="fourth_opt">₹ 4000-6000</p>
- <p class="ex"><input type="checkbox" name="fifth_q" value="fifth_opt">₹ 6000-8000</p>
- <p class="ex"><input type="checkbox" name="fifth_q" value="sixth_opt">₹ 8000 and above</p>
- </form>
- <br>
- </body>
- </html>
Advertisement
Add Comment
Please, Sign In to add comment
Advertisement