HOUSEHOLD SCHEDULE - URDU-ENGLISH
PLACE NAME_______
NAME OF HOUSEHOLD HEAD_____
PROVINCE ___
URBAN/RURAL
RURAL 2
MAJOR CITY/DIVISION/DISTRICT
CLUSTER NUMBER
HOUSEHOLD NUMBER
MAJOR CITY/SMALL CITY, TOWN/VILLAGE
SMALL CITY/TOWN 2
VILLAGE 3
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ____
INTERVIEWER'S NAME ____
RESULT*
COMPLETED 1
HOUSEHOLD PRESENT BUT NO COMPETENT RESPONDENT AT HOME 2
HOUSEHOLD ABSENT 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _____ 9
NEXT VISIT:
DATE ___
TIME ____
FINAL VISIT:
DAY _____
MONTH _____
YEAR _____
NAME _____
RESULT ____
TOTAL IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE HUSBANDS ____
FIELD EDITED BY:
NAME ______
DATE ______
OFFICE EDITED BY
NAME _____
DATE ______
KEYED BY
NAME _____
DATE _____
KEYED BY ____
Now we would like some information about the people who usually live in your household or who are staying with you now.
1. LINE NO.
2. USUAL RESIDENTS AND VISITORS
Please give me the names of the persons who usually live in your household or are staying with you now, starting with the head of the household.
3. RELATIONSHIP TO HEAD OF HOUSEHOLD
What is the relationship of (NAME) to the head of the household?
RECORD '00' IF NATURAL (BIOLOGICAL) PARENT NOT MEMBER OF HOUSEHOLD.
02 WIFE OR HUSBAND
03 SON OR DAUGHTER
04 SON OR DAUGHTER-IN-LAW
05 GRANDCHILD
06 PARENT
07 PARENT-IN-LAW
08 BROTHER OR SISTER
09 OTHER RELATIVE
10 ADOPTED/FOSTER CHILD
11 NOT RELATED
98 DON'T KNOW
4. RESIDENCE
Does (NAME) usually live here?
NO 2
5. Did (NAME) sleep here last night?
NO 2
6. SEX
Is (NAME) male or female?
FEMALE 2
7. AGE
How old is (NAME) in completed years?
MARITAL STATUS FOR ALL AGED 15 AND OVER
8. What is (NAME'S) marital status?
CURRENTLY MARRIED 2
WIDOWED 3
DIVORCED 4
SEPARATED 5
DON'T KNOW 8
9. Has (NAME) ever been to school?
NO 2
10. What is the highest level of school (NAME) attended? What is the highest class (NAME) completed at that level?
MIDDLE 2
SECONDARY 3
HIGHER 4
DON'T KNOW 8
DON'T KNOW 98
11. FOR ALL AGED LESS THAN 25 YEARS:
Is (NAME) still in school?
NO 2
NATURAL PARENTS FOR EVERYONE AGED LESS THAN 15 YEARS
12. Does (NAME'S) natural mother live in this household? IF YES: What is her name?
RECORD MOTHER'S LINE NUMBER.
LINE NUMBER_______
13. Does (NAME'S) natural father live in this household? IF YES: What is his name?
RECORD FATHER'S LINE NUMBER.
LINE NUMBER ____
14. ELIGIBILITY: CIRCLE LINE NUMBER OF ELIGIBLE WOMEN AND PUT SQUARE AROUND LINE NUMBER OF ELIGIBLE HUSBANDS.
H1. What is the source of water your household uses for handwashing and dishwashing?
PIPED ONTO PROPERTY 02 (GO TO H3)
PUBLIC TAP 03
WELL WITH HANDPUMP/TUBE WELL 04
WELL WITHOUT PUMP 05
RIVER, KAREZ, SPRING, CANAL, SURFACE WATER 06
TANKER TRUCK, OTHER VENDER 07
RAINWATER 08
OTHER__________________ 09
H2. How long does it take to go there, get water, and come back?
ON PREMISES 996
H3. Does your household get drinking water from this same source?
NO 2
H4. What is the source of drinking water for members of your household?
PIPED ONTO PROPERTY 02
PUBLIC TAP 03
WELL WITH HANDPUMP/TUBE WELL 04
WELL WITHOUT PUMP 05
RIVER, KAREZ, SPRING, CANAL, SURFACE WATER 06
TANKER TRUCK, OTHER VENDER 07
RAINWATER 08
OTHER__________________ 09
H5. What kind of toilet facility does your household have?
BUCKET 2
PIT 3
OTHER _________________ 4
NO FACILITIES 5
H6. Does your household have the following?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
H7. Does any member of your household own the following?
NO 2
NO 2
NO 2
H8. How many rooms in your household are used for sleeping?
H9. MAIN MATERIAL OF OUTER WALLS
RECORD OBSERVATION.
UNBAKED BRICKS AND MUD 2
WOOD/BAMBOO 3
OTHER_______________ 4
H10. MAIN MATERIAL OF ROOF.
RECORD OBSERVATION.
T-IRON/WOOD/BRICK 2
ASBESTOS/IRON SHEETS 3
WOOD/BAMBOO 4
OTHER_________ 5