Survey Text

Senegal 2015
Senegal 2016
top
Senegal 2015
Survey form view entire document:  text 

IDENTIFICATION

PLACE NAME _______
NAME OF HEAD OF HOUSEHOLD
HOUSEHOLD NUMBER ______
PLOT NUMBER _____
CLUSTER NUMBER ______
REGION ______

URBAN/RURAL

URBAN 1
RURAL 2

LOCATION


DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

LOCATION (DETAIL) ______

WOMAN'S NAME AND LINE NUMBER _____


top
Senegal 2016
Survey form view entire document:  text 

IDENTIFICATION

PLACE NAME _____

NAME OF HEAD OF HOUSEHOLD ______

HOUSEHOLD NUMBER ____

PLOT NUMBER ____

CLUSTER NUMBER _____

REGION ____

DEPARTMENT ____

SANITATION DISTRICT ____

URBAN/RURAL

URBAN 1
RURAL 2

MILIEU ____

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

WOMAN'S NAME AND LINE NUMBER _____

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE

HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2

IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2