Household schedule
DISTRICT/SEGMENT________
SUB DISTRICT/SEGMENT________
HOUSEHOLD_________
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 2
HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW 3
POSTPONED 4
REFUSED 5
DWELLING VACANT 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _______ 9
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 2
HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW 3
POSTPONED 4
REFUSED 5
DWELLING VACANT 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _______ 9
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 2
HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW 3
POSTPONED 4
REFUSED 5
DWELLING VACANT 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _______ 9
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR 87
INT. NUMBER
HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 2
HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW 3
POSTPONED 4
REFUSED 5
DWELLING VACANT 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _______ 9
FIELD EDITED BY__________
OFFICE EDITED BY____________
KEYED BY___________
KEYED BY_________
Now I would like some information about the people who usually live in your household or who are staying with you now.
001) HOUSEHOLD NUMBER
003) FIRST NAMES AND LAST NAMES OF USUAL RESIDENTS AND VISITORS
MARRIED 2
WIDOW 3
DIVORCED 4
SEPARATED 5
FEMALE 2
ABSENT RESIDENT 2
VISITOR 3
009) NATIONALITY OF HEAD OF HOUSEHOLD
RWANDA 2
ZAIRE 3
TANZANIA 4
OTHER AFRICAN COUNTRY 5
OTHER 6
010) SELECTION OF ELIGIBLE PEOPLE (X)
MEN
CHILDREN
1) Just to make sure that I have a complete listing: are there any other persons such as small children or infants that we have not listed?
NO
2) Are there any other people who many not be members of your family, such as domestic servants or lodgers who usually live here?
NO
3) Are there any guests or temporary visitors staying here, or anyone else who stayed here?
NO