Data Cart

Your data extract

0 variables
0 samples
View Cart

NATIONAL POPULATION AND HEALTH SURVEY (ENPS II)
HOUSEHOLD SCHEDULE

IDENTIFICATION

PROVINCE OR PREFECTURE

CIRCLE

MUNICIPALITY:

AUTONOMOUS CENTER
RURAL COMMUNE

CENTER

PRIMARY UNIT NUMBER

SECONDARY UNIT NUMBER

LEVEL

1 RABAT-CASA
2 LARGE CITY
3 CITY
4 COUNTRYSIDE

HOUSEHOLD NUMBER ____

HOUSEHOLD ADDRESS _____

INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME _____
RESULT*

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)_________

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR

KEYED BY

HOUSEHOLD SCHEDULE

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

1) LINE NUMBER _____

2) FIRST AND LAST NAME ____

Please give me the name of the people who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

3) RELATIONSHIP TO THE HEAD OF HOUSEHOLD*
What is the relationship of (NAME) to the head of household?

1 HEAD
2 WIFE OR HUSBAND
3 SON OR DAUGHTER
4 SON-IN-LAW OR DAUGHTER-IN-LAW
5 GRANDCHILD
6 PARENT
7 PARENT-IN-LAW
8 BROTHER OR SISTER
9 OTHER RELATIVE
10 ADOPTED CHILD/FOSTER CHILD/
11 NOT RELATED
98 DON'T KNOW

RESIDENCE

4) Does (NAME) usually live here?

YES 1
NO 2

5) Did (NAME) sleep here last night?

YES 1
NO 2

6) SEX
Is (NAME) male or female?

MALE 1
FEMALE 2

7) AGE
How old is (NAME)?

AGE IN YEARS____

EDUCATION IF AGE 7 YEARS OR OLDER

8) Has (NAME) ever been to school?

YES 1
NO 2

IF ATTENDED SCHOOL

9) What is the highest level of school (NAME) has attended?
What is the highest grade (NAME) completed at that level?**

EDUCATION LEVEL

1 PRIMARY
2 SECONDARY
3 HIGHER
8 DON'T KNOW

GRADE

00 LESS THAN ONE YEAR ACHIEVED
98 DON'T KNOW

IF AGE 25 OR LESS

10) Is (NAME) still in school?

YES 1
NO 2

PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD

11) Is (NAME)'s natural mother alive?

YES 1
NO 2
DON'T KNOW 8

12) IF ALIVE: Does (NAME)'s natural mother usually live in this household?
IF YES: What is her name?
RECORD MOTHER'S LINE NUMBER.

MOTHER'S LINE NUMBER____

13) Is (NAME)'s natural father alive?

YES 1
NO 2
DON'T KNOW 8

14) IF ALIVE: Does (NAME)'s natural father live in this household?
If yes, what is his name?
RECORD FATHER'S LINE NUMBER.

FATHER'S LINE NUMBER____

ELIGIBILITY
15) CIRCLE LINE NUMBER OF WOMEN ELIGIBLE FOR INDIVIDUAL INTERVIEW

TICK HERE IF CONTINUATION SHEET USED:

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?

YES (ADD TO TABLE)
NO

2) In addition, are there any other people who many not be members of your family, such as domestic servants, lodgers or friends who usually live here?

YES (ADD TO TABLE)
NO

3) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?

YES (ADD TO TABLE)
NO

16) What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 18
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 18
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 18
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 18
OTHER (SPECIFY) 71

17) How long does it take to go there, get water, and come back?

MINUTES____
ON PREMISES 996

18) Does your household get drinking water from this same source?

YES 1 (GO TO 20)
NO 2

19) What is the main source of drinking water for your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
BOTTLED WATER 61
OTHER (SPECIFY) 71

20) What kind of toilet facility does your household have?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) 41

21) Does your household have:

ELECTRICITY?
YES 1
NO 2
A RADIO?
YES 1
NO 2
A TELEVISION?
YES 1
NO 2
A TELEPHONE?
YES 1
NO 2
A REFRIGERATOR?
YES 1
NO 2

22) How many rooms in your household are used for sleeping?

ROOMS____

23) MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALMS/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT 32
TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) 41

24) Does any member of your household own:

A BICYCLE?
YES 1
NO 2
A MOTORCYCLE OR MOTOR SCOOTER?
YES 1
NO 2
A CAR?
YES 1
NO 2

25) What is the roof of your dwelling made of?

FLAGSTONE 01
PLANKS/REEDS/BRANCHES WITH EARTH 02
PLANKS/REEDS/BRANCHES WITH NO EARTH 03
SHEET METAL/TIN 04
PLANKS/TILES 05
OTHER (SPECIFY) 06

26) What is the occupation status of the dwelling?

OWNER 1
RENTER 2
FREE USAGE 3
OTHER (SPECIFY) 4