DEMOGRAPHIC AND HEALTH SURVEYS
DEPARTMENT OF STATISTICS
ULTIMATE AREA BLOCK
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME
3 HOUSEHOLD ABSENT
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)_________
TOTAL IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
OFFICE EDITED BY
1) LINE NO.
2) USUAL RESIDENTS AND VISITORS: Please give me the names of the household members (3 NAMES)
3) RELATIONSHIP BETWEEN HH MEMBERS: What is the relationship of (NAME) to the head of the household?
4) RESIDENCE: Does (NAME) usually live here?
5) RESIDENCE: Did (NAME) sleep here last night?
6) SEX: Is (NAME) male or female?
7) AGE: How old is he/she? (IN COMPLETED YEARS)
8) ORPHANHOOD: Is his/her father still alive?
DON'T KNOW 8
9) ORPHANHOOD: Is his/her mother still alive?
DON'T KNOW 8
Just to make sure that I have a complete listing:
1) Are there any other persons such as small children or infants that we have not listed?
2) In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends who usually live here?
3) Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?
10) EDUCATION (FOR PERSONS 5+ YEARS): Has (NAME) ever been to school?
NO LITERATE 2
NO ILLITERATE 3
CURRENTLY IN SCHOOL: What is the highest level of school he/she attended?
What is the highest grade he/she completed at that level?
11) CURRENTLY IN SCHOOL: What is the highest grade he/she completed at that level?
12) CURRENTLY IN SCHOOL: What is the highest level of school he/she attended?
13) CURRENTLY NOT IN SCHOOL: What is the highest grade he/she completed at that level?
14) CURRENTLY NOT IN SCHOOL: What is the highest level of school he/ she attended?
MARTIAL STATUS: FOR PERSON 13 YEARS +
15) What is his/her marital status?
16) WIDOWHOOD (FOR PERSONS EVER MARRIED): Is his/her first spouse still alive?
DON'T KNOW 8
17) POLYGAMY (FOR ALL MARRIED MEN): How many wives does (NAME) have?
18) ECONOMIC ACTIVITY (FOR PERSONS 13 YEARS AND OVER): What did he/she do during the previous week?
19) INSURANCE COVERAGE: RECORD SUM OF CODE(S)
20) CIRCLE LINE NUMBER OF WOMEN ELIGIBLE FOR INDIVIDUAL INTERVIEW
21) NUMBER OF BIRTHS IN THE HOUSEHOLD IN THE PAST 12 MONTHS
22) FAMILY TYPE (CODED IN DOS)
During the last 12 months, have any of the usual members of this household died? IF NO, GO TO 29.
26) MARITAL STATUS PERSONS 13+
28) If the deceased was an ever-married woman aged 15-49, what is the cause of death?
29) SPECIAL INFORMATION: PERSONS 13+:
30) UNEMPLOYED PERSONS: Did you turn down a job offered to you when you were unemployed?
FAR AWAY 2
WORK UNSUITABLE 4
32) EMPLOYED PERSONS: How are you paid?
SELF EMPLOYED 4
33) COUNTRY OF WORK: Was (NAME) employed outside Jordan until this summer?
IF YES: Where? (NAME OF COUNTRY)