HOUSEHOLD SCHEDULE
IDENTIFICATION
REGION
PROVINCE
URBAN/RURAL
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:
HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 2
HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW 3
POSTPONED 4
REFUSED TOTAL 5
DWELLING VACANT OR ADDRESS NOT A DWELLING ELIGIBLE 6
DWELLING DESTROYED WOMEN 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ________ 9
OFFICER EDITED BY
NAME
DATE
CODED BY
NAME
DATE
KEYED BY
NAME
DATE
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?
NO 2
(4) Did (NAME) stay here last night?
NO 2
(5) SEX
Is (NAME) male or female?
FEMALE 2
(6) AGE
How old is he/she in completed years?
EDUCATION
ALL AGE 10 AND ABOVE
(7) What is the highest level and grade of school (NAME) completed?
MARRIAGE
ALL AGE 10 AND ABOVE
(8) Has (NAME) ever been married?
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?
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?
NO
3) Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?
NO
NOTE: IN ARABIC QUESTIONNAIRE THE SPACE IS PROVIDED TO RECORD UP TO 39 HOUSEHOLD HEHBERS