IDENTIFICATION (1)

PLACE NAME __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER __ __ __ __
HOUSEHOLD NUMBER __ __ __ __
NAME AND LINE NUMBER OF MAN __________

(1) This section should be adapted for country-specific survey design.

INTERVIEWER VISITS

FIRST VISIT:
DATE ______
INTERVIEWER'S NAME ________
RESULT* ________

SECOND VISIT:
DATE ______
INTERVIEWER'S NAME ________
RESULT* ________

THIRD VISIT:
DATE ______
INTERVIEWER'S NAME ________
RESULT* ________

NEXT VISIT:
DATE ______
TIME ______

FINAL VISIT:
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __ __
RESULT* __

TOTAL NUMBER OF VISITS: __

*RESULT CODES:

LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW** __ __
NATIVE LANGUAGE OF RESPONDENT** __ __
TRANSLATOR USED (YES = 1, NO = 2)
LANGUAGE OF QUESTIONNAIRE** ENGLISH

**LANGUAGE CODES

SUPERVISOR
NAME ______
NUMBER __ __ __ __

FIELD EDITOR
NAME ______
NUMBER __ __ __ __

OFFICE EDITOR
NUMBER __ __

KEYED BY
NUMBER __ __

FEMALE GENITAL CURRING/MUTILATION FOR MAN'S QUESTIONNAIRE (1)

GCM1. (2) Now I would like to ask you some questions about a practice known as female circumcision. Have you ever heard of female circumcision?

GCM2. In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

GCM3. (2) Do you believe that female circumcision is required by your religion?

GCM4. Do you think that female circumcision should be continued, or should it be stopped?

(1) Female genital cutting/mutilation module can be inserted into the man's questionnaire wherever it is appropriate, and questions should be renumbered appropriately.

(2) Use local term for female circumcision.