Data Cart

Your data extract

0 variables
0 samples
View Cart

REPUBLIC OF LIBERIA

MINISTRY OF PLANNING AND ECONOMIC AFFAIRS

1986 LIBERIA DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD QUESTIONNAIRE

IDENTIFICATION

COUNTY_____

DISTRICT____

TOWN/VILLAGE_____

EA NUMBER____

CLUSTER NUMBER_____

STRUCTURE NUMBER____

HOUSEHOLD NUMBER____

NAME OF HOUSEHOLD HEAD_____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____

RESULT*

COMPLETED 1
NO COMPETENT RESPONDENT AT HOME 2
DEFERRED 3
REFUSED 4
DWELLING VACANT 5
ADDRESS NOT A DWELLING 6
HOUSEHOLD NOT FOUND OR NONEXISTENT 7
OTHER (SPECIFY) 8

NEXT VISIT
DATE___
TIME___

NUMBER OF VISITS____

FIELD EDITED BY:
NAME____
DATE_____

OFFICE EDITED BY:
NAME_____
DATE_____

KEYED BY:
NAME____
DATE_____

HOUSEHOLD QUESTIONNAIRE

I would like some information about the people who usually live in your household or are staying with you now.

1) LINE NUMBER

LINE NO.____

2) NAMES OF USUAL RESIDENTS AND VISITORS: Please give me the names of all the people who usually live in your household and any visitors.

NAME____

3) RESIDENCE: Does (NAME) usually live here?

YES 1
NO 2

4) RESIDENCE: Did (NAME) sleep here last night?

YES 1
NO 2

5) SEX

MALE 1
FEMALE 2

6) AGE: How old is he/she?

AGE___

FOR ALL UNDER AGE 15:

7) Does this child's mother usually live in this household?

YES 1
NO 2

FOR ALL AGED 15 AND OVER:

8) What kind of work does this person do?

KIND OF WORK____

9) EMPLOYMENT STATUS

EMPLOYER 1
EMPLOYEE 2
SELF-EMPLOYED 3
UNEMPLOYED 4
HOUSEWIFE 5
STUDENT 6

10) PUT A CHECK FOR ALL WOMEN 15-49 WHO SLEPT HERE LAST NIGHT

IF CONTINUATION SHEET USED, CHECK HERE:_____

1. Is there anybody else, such as babies or servants or lodgers, that I have not listed?

YES 1 (ADD TO TABLE)
NO 2

2. Do you have any visitors staying with you that I did not list?

YES 1 (ADD TO TABLE)
NO 2