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SUDAN DEMOGRAPHIC AND HEALTH SURVEYS
HOUSEHOLD SCHEDULE

IDENTIFICATION
REGION
PROVINCE
URBAN/RURAL

urban=l
rural=2

PLACE NAME
CLUSTER NUMBER
HOUSEHOLD NUMBER

SAME HEAD OF HH
DIFF. HEAD OF HH
ADDITIONAL HH

INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER’S NAME
RESULT**

SECOND VISIT
DATE
INTERVIEWER’S NAME
RESULT**

THIRD VISIT
DATE
INTERVIEWER’S NAME
RESULT**

NEXT VISIT
DATE
TIME

FINAL VISIT
MONTH
YEAR

TOTAL NUMBER OF VISITS

**RESULT CODES:

1 COMPLETED
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME
3 HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW
4 POSTPONED
5 REFUSED TOTAL
6 DWELLING VACANT OR ADDRESS NOT A DWELLING ELIGIBLE
7 DWELLING DESTROYED WOMEN
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ________

FIELD EDITED BY
NAME
DATE

OFFICER EDITED BY
NAME
DATE

CODED BY
NAME
DATE

KEYED BY
NAME
DATE

HOUSEHOLD SCHEDULE

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.

_______________

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

YES 1
NO 2

(4) Did (NAME) stay here last night?

YES 1
NO 2

(5) SEX
Is (NAME) male or female?

M 1
F 2

(6) AGE
How old is he/she in completed years?

IN YEARS _______

EDUCATION
ALL AGE 10 AND ABOVE
(7) What is the highest level and grade of school (NAME) completed?

LEVEL ____
GRADE _____

MARRIAGE
ALL AGE 10 AND ABOVE
(8) Has (NAME) ever been married?

YES 1
NO 2

(9) ELIGIBILITY
CIRCLE LINE NUMBER OF ALL EVER-MARRIED WOMEN AGE 15-49.

TICK HERE IF CONTINUATION SHEET USED
TOTAL NUMBER OF ELIGIBLE WOMEN

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 (ENTER EACH IN TABLE)
NO

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?

YES (ENTER EACH IN TABLE)
NO

3) Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?

YES (ENTER EACH IN TABLE)
NO

NOTE: IN ARABIC QUESTIONNAIRE THE SPACE IS PROVIDED TO RECORD UP TO 39 HOUSEHOLD HEHBERS