REPUBLIC OF LIBERIA
MINISTRY OF PLANNING AND ECONOMIC AFFAIRS
NAME OF HOUSEHOLD HEAD_____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
NO COMPETENT RESPONDENT AT HOME 2
DWELLING VACANT 5
ADDRESS NOT A DWELLING 6
HOUSEHOLD NOT FOUND OR NONEXISTENT 7
OTHER (SPECIFY) 8
FIELD EDITED BY:
OFFICE EDITED BY:
I would like some information about the people who usually live in your household or are staying with you now.
1) LINE NUMBER
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.
3) RESIDENCE: Does (NAME) usually live here?
4) RESIDENCE: Did (NAME) sleep here last night?
7) Does this child's mother usually live in this household?
8) What kind of work does this person do?
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?
2. Do you have any visitors staying with you that I did not list?