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ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY 1988

HOUSEHOLD SCHEDULE COVER SHEET
CENTRAL STATISTICAL OFFICE

IDENTIFICATION

PLACE NAME __________
PROVINCE __________
STRATA ___
DHS SEGMENT NUMBER _____
HOUSEHOLD NUMBER ___

INTERVIEWER VISITS

FIRST VISIT

DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

NEXT VISIT:

DATE _____
TIME _____

SECOND VISIT

DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

NEXT VISIT:

DATE
TIME

THIRD VISIT

DATE _____
INTERVIEWER'S NAME __________
RESULT * __________

FINAL VISIT

MONTH __________
YEAR _____
INTERVIEWER'S NAME __________
RESULT * __________

TOTAL NUMBER OF VISITS ___

RESULT__
*RESULT CODES:

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

TOTAL IN HOUSEHOLD ___

TOTAL ELIGIBLE WOMEN ___

LANGUAGE

SHONA 1
NDEBELE 2
ENGLISH 3
OTHER 4 __________

FIELD EDITOR

NAME __________
DATE _____

OFFICE EDITOR

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.

NUMBER

1) ___

USUAL RESIDENTS AND VISITORS

2) Please give me the names of the persons who usually live in your household and visitors who stayed with you last night starting with the head of household.

____________

RESIDENCE

3) Does (NAME) usually live here?

YES 1
NO 2

4) Did (NAME) sleep here last night?

YES 1
NO 2

SEX

5) Is (NAME) male or female?

Male 1
Female 2

AGE

6) How old was (NAME) at his/her last birthday?

IN YEARS ___

ELIGIBILITY

7) CIRCLE LINE NUMBER OF WOMEN ELIGIBLE FOR INDIVIDUAL INTERVIEW:
SLEPT HERE LAST NIGHT, FEMALE 15 - 49

TICK HERE IF CONTINUATION SHEET USED ___

TOTAL NUMBER OF ELIGIBLE WOMEN ON THIS SHEET __

Just to make sure I have a complete listing:

1. Are there any other persons such as small children or infants that we have not listed?

YES (ENTER IN TABLE) ___
NO ___

2. In addition, are there any other people such as domestic servants, lodgers or friends who usually live here and cook with your household?

YES (ENTER IN TABLE) ___
NO ___

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

YES (ENTER IN TABLE) ___
NO ___

TOTAL NUMBER OF ELIGIBLE WOMEN ON THIS SHEET ___
TOTAL NUMBER OF ELIGIBLE WOMEN ON BOTH SHEETS ___

AGE DETERMINATION TABLE

To find the person's age, locate the decade of their year of birth on the left hand column, and the last number of their year of birth in the row which goes across the top. If that person has had a birthday already this year before the date of the interview, their age is the number in the left corner of the box. If they have not yet had a birthday in the year of the interview, their age is the lower of the two numbers in the box.

FIRST THREE DIGITS OF THE YEAR OF BIRTH (193- to 198- ) _____
LAST DIGIT OF THE YEAR OF BIRTH (0-9) ___