Survey Text

Angola 2015 Egypt 2005 Madagascar 2003 Rwanda 2008
Bangladesh 1994 Egypt 2008 Madagascar 2008 Rwanda 2010
Bangladesh 1997 Egypt 2014 Malawi 1992 Rwanda 2014
Bangladesh 2000 Eswatini (Swaziland) 2006 Malawi 2000 Senegal 1992
Bangladesh 2004 Ethiopia 2000 Malawi 2004 Senegal 1997
Bangladesh 2007 Ethiopia 2005 Malawi 2010 Senegal 2005
Bangladesh 2011 Ghana 1993 Malawi 2016 Senegal 2010
Bangladesh 2014 Ghana 1998 Mali 1995 Senegal 2012
Benin 1996 Ghana 2003 Mali 2001 Senegal 2014
Benin 2001 Ghana 2008 Mali 2006 Senegal 2015
Benin 2006 Ghana 2014 Mali 2012 Senegal 2016
Benin 2011 Ghana 2016 Mali 2018 Senegal 2017
Benin 2017 Guinea 1999 Morocco 1992 South Africa 1998
Burkina Faso 1993 Guinea 2005 Morocco 2003 South Africa 2016
Burkina Faso 1998 Guinea 2012 Mozambique 1997 Tanzania 1991
Burkina Faso 2003 Guinea 2018 Mozambique 2003 Tanzania 1996
Burkina Faso 2010 India 1992 Mozambique 2011 Tanzania 1999
Burundi 2010 India 1998 Myanmar 2015 Tanzania 2004
Burundi 2016 India 2005 Namibia 1992 Tanzania 2010
Cameroon 1991 India 2015 Namibia 2000 Tanzania 2015
Cameroon 1998 Jordan 1990 Namibia 2006 Togo 1998
Cameroon 2004 Jordan 1997 Namibia 2013 Togo 2013
Cameroon 2011 Jordan 2002 Niger 1992 Uganda 1995
Cameroon 2018 Jordan 2007 Niger 1998 Uganda 2001
Central African Republic 1995 Jordan 2009 Niger 2006 Uganda 2006
Chad 1996 Jordan 2012 Niger 2012 Uganda 2011
Chad 2004 Jordan 2017 Nigeria 1990 Uganda 2016
Chad 2014 Kenya 1993 Nigeria 1999 Yemen 2013
Congo (Democratic Republic) 2007 Kenya 1998 Nigeria 2003 Zambia 1992
Congo (Democratic Republic) 2013 Kenya 2003 Nigeria 2008 Zambia 1996
Congo Brazzaville 2005 Kenya 2008 Nigeria 2013 Zambia 2001
Congo Brazzaville 2011 Kenya 2014 Nigeria 2018 Zambia 2007
Cote d'Ivoire 1994 Lesotho 2004 Pakistan 1991 Zambia 2013
Cote d'Ivoire 1998 Lesotho 2009 Pakistan 2006 Zambia 2018
Cote d'Ivoire 2011 Lesotho 2014 Pakistan 2012 Zimbabwe 1994
Egypt 1992 Liberia 2007 Pakistan 2017 Zimbabwe 1999
Egypt 1995 Liberia 2013 Rwanda 1992 Zimbabwe 2005
Egypt 2000 Madagascar 1992 Rwanda 2000 Zimbabwe 2010
Egypt 2003 Madagascar 1997 Rwanda 2005 Zimbabwe 2015
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Angola 2015
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE_________
DAY___
MONTH___
INTERVIEWER'S NAME_________
RESULT

COMPLETED 1
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7

NEXT VISIT:
DATE_________
TIME_________

SECOND VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7

NEXT VISIT:
DATE____
TIME____

THIRD VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7

FINAL VISIT
DAY_________
MONTH_________
YEAR_____
INT. NO._________
RESULT

COMPLETED 1
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7

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Bangladesh 1994
Survey form view entire document:  text 
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

DAY
MONTH
YEAR
NAME
RESULT


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Bangladesh 1997
Survey form view entire document:  text 
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

DAY
MONTH
YEAR
NAME
RESULT


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Bangladesh 2000
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE__
INTERVIEWER'S NAME___
RESULT ____

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Bangladesh 2004

No questionnaire text is available for this sample.


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Bangladesh 2007

No questionnaire text is available for this sample.


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Bangladesh 2011

No questionnaire text is available for this sample.


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Bangladesh 2014

No questionnaire text is available for this sample.


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Benin 1996

No questionnaire text is available for this sample.


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Benin 2001

No questionnaire text is available for this sample.


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Benin 2006

No questionnaire text is available for this sample.


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Benin 2011

No questionnaire text is available for this sample.


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Benin 2017
Survey form view entire document:  text 
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:

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __
RESULT* __

TOTAL NUMBER OF VISITS __

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Burkina Faso 1993

No questionnaire text is available for this sample.


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Burkina Faso 1998
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____

COMPLETED 1
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

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Burkina Faso 2003
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME ______

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY _____
MONTH _____
YEAR 2003
INT. NUMBER ______
RESULT __________

COMPLETED 1
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

TOTAL NUMBER OF VISITS _____


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Burkina Faso 2010
Survey form view entire document:  text 
INTERVIEWER VISITS

FIST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2010
INT. NAME _____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

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Burundi 2010
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE_____
INTERVIEWER'S NAME_____
RESULT

NEXT VISIT
DATE____
TIME____

FINAL VISIT
DAY_____
MONTH____
YEAR____
INT. NUMBER____
RESULT____


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Burundi 2016
Survey form view entire document:  text 
INTERVIEWER VISITS
1 2 3
DATE

INTERVIEWER'S NAME
RESULT


COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT


COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7


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Cameroon 1991
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__


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Cameroon 1998
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
INTERVIEWER NAME___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY): ___ 7

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Cameroon 2004
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____


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Cameroon 2011
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
UNABLE 6
OTHER (SPECIFY): ___ 7

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Cameroon 2018
Survey form view entire document:  text 
INTERVIEWER VISITS
DATE______
INTERVIEWER'S NAME_______
RESULT*________

NEXT VISIT
DATE_______
TIME_______

FINAL VISIT
DAY_______
MONTH_______
YEAR __2018__
INT. NO. _______
RESULT*_______

TOTAL NUMBER OF VISITS________

*RESULT CODES:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)_______

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Central African Republic 1995
Survey form view entire document:  text 
INTERVIEWER VISITS
DATE____

INTERVIEWER'S NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7

FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7

NEXT VISIT
DATE
TIME


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Chad 1996

No questionnaire text is available for this sample.


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Chad 2004
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST INTERVIEWER VISIT

DATE______
INTERVIEWER'S NAME__________
RESULT*

SECOND INTERVIEWER VISIT

DATE_____
INTERVIEWER'S NAME________
RESULT*

THIRD INTERVIEWER VISIT

DATE_____
INTERVIEWER'S NAME______
RESULT*

FINAL VISIT

DAY____
MONTH____
YEAR 200__
NAME_______
RESULT___

NEXT VISIT

DATE_____
TIME_____

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Chad 2014
Survey form view entire document:  text 
Check cover of household questionnaire: Household was selected for the men's survey and the HIV test?

YES 1
NO 2

HOUSEHOLD SELECTED FOR MEN'S SURVEY

IF YES (=1) CHECK Q. 403 OF HOUSEHOLD QUESTIONNAIRE: WOMAN SELECTED FOR THE "DOMESTIC VIOLENCE" MODULE? (YES=1, NO=2). IF THE HOUSEHOLD IS NOT SELECTED FOR THE MEN'S SURVEY, LEAVE THE SPACE BLANK.
WOMAN SELECTED FOR THE "DOMESTIC VIOLENCE" SURVEY

INTERVIEWER VISITS
1 2 3
DATE_____

INTERVIEWER'S NAME
RESULT*

FINAL VISIT

DAY__ __
MONTH __ __
YEAR 201__
INT. NUMBER__ __ __
CODE RESULT __

NEXT VISIT

DATE_______
TIME________

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Congo (Democratic Republic) 2007
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
INTERVIEWER VISITS
FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*

NEXT VISIT:
DATE ____
TIME ____

SECOND VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*

NEXT VISIT:
DATE ____
INTERVIEWER'S NAME ____
RESULT*

THIRD VISIT DATE ____
INTERVIEWER'S NAME ____
RESULT*

FINAL VISIT
DAY ____
MONTH ____
YEAR 201_
INTERVIEWER CODE ____
RESULT


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Congo Brazzaville 2005

No questionnaire text is available for this sample.


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Congo Brazzaville 2011

No questionnaire text is available for this sample.


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Cote d'Ivoire 1994
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE___
TIME_____

FINAL VISIT
DAY___
MONTH___
YEAR 94
NAME___
RESULT___


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Cote d'Ivoire 1998
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REVIEW FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME __________
RESULT_____

NEXT VISIT
DATE _____
TIME ____

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT ____


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Cote d'Ivoire 2011
Survey form view entire document:  text 
INTERVIEWER VISITS

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____ /201__
INTERVIEWER'S NAME
RESULT____

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 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 (REPEAT FOR INTERVIEWER 2)
DATE____ /201__
TIME______

FINAL VISIT
DAY_______
MONTH_______
YEAR 201___
INTERVIEWER CODE________
RESULT______

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY)________________ 9

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Egypt 1992
Survey form view entire document:  text 
NAME OF HOUSEHOLD HEAD _______________
ADDRESS IN DETAIL ______________
NAME OF WOMAN ______________
LINE NUMBER OF WOMAN ___________

GOVERNORATE ___
PSU/SEGMENT NO.___
HOUSEHOLD NO. ___
URBAN/RURAL ___
LOCALITY ___
LINE NUMBER ___

INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER'S NAME _____
SUPERVISOR 'S NAME_____
RESULT ______
NEXT VISIT: DATE _____ TIME ________

FINAL VISIT: DAY ____ MONTH ____ YEAR ____
TEAM ____
INTERVIEWER _____
SUPERVISOR _____
RESULT _____
TOTAL NUMBER OF VISITS ___


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Egypt 1995
Survey form view entire document:  text 
INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER _____
SUPERVISOR _____
ASSISTANT SUPERVISOR _____
RESULT ______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _______ 7

NEXT VISIT:
DATE _____
TIME ________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____

TEAM ____
INTERVIEWER _____
SUPERVISOR _____
ASSISTANT SUPERVISOR _____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _______ 7

TOTAL NUMBER OF VISITS __


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Egypt 2000
Survey form view entire document:  text 
NAME OF HOUSEHOD HEAD______
ADDRESS IN DETAIL______
NAME OF WOMAN_______
LINE NUMBER OF WOMAN_________

INTERVIEWER VISITS (REPEAT FOR INTERVIEW VISITS 1 AND 2)
DATE_____
TEAM_____
INTERVIEWER_______
SUPERVISOR______
RESULT*______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7

NEXT VISIT
DATE_____
TIME______

TOTALVISITS_______


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Egypt 2003

No questionnaire text is available for this sample.


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Egypt 2005
Survey form view entire document:  text 
FIRST VISIT

DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT

NEXT VISIT

DATE
TIME

SECOND VISIT

DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT

NEXT VISIT

DATE
TIME

THIRD VISIT

DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
FINAL VISIT

DAY __ __
MONTH __ __
YEAR __ __

TEAM __ __
INT. NUMBER __ __
SUP. NUMBER __ __
RESULT __

TOTAL NUMBER OF VISITS __


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Egypt 2008
Survey form view entire document:  text 
NAME OF HOUSEHOLD HEAD _______________
ADDRESS IN DETAIL ______________
NAME OF WOMAN ______________
LINE NUMBER OF WOMAN ___________

GOVERNORATE_____
PSU/SEGMENT NO.____
HOUSEHOLD NO. _____

LINE NUMBER____

INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER _____
SUPERVISOR _____
RESULT ______

NEXT VISIT :
DATE _____
TIME ________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
TEAM ____
INT. NUMBER _____
SUP. NUMBER _____
RESULT _____


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Egypt 2014
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS):
DATE__________
TEAM__________
INTERVIEWER_________
SUPERVISOR__________
RESULT____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2):
DATE__________
TIME__________

FINAL VISIT:
DAY__ __
MONTH __ __
YEAR__ __
TEAM __ __
INT. NUMBER__ __
SUP. NUMBER__ __
RESULT__


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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
LANGUAGE OF QUESTIONNAIRE 2

LANGUAGE OF INTERVIEW:_____

LANGUAGE:

SISWATI 1
ENGLISH 2
OTHER 3

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Ethiopia 2000
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____


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Ethiopia 2005
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Ghana 1993
Survey form view entire document:  text 
INTERVIEWER VISITS

INTERVIEW 1
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____

NEXT VISIT:
DATE ____
TIME ____

INTERVIEW 2
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____

NEXT VISIT:
DATE ____
TIME ____

INTERVIEW 3
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ___


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Ghana 1998
Survey form view entire document:  text 
INTERVIEW 1
DATE ___
INTERVIEWER'S NAME ___
RESULT ___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ___
RESULT ___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ___
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6

FINAL VISIT
DAY___
MONTH ___
YEAR _19__
NAME ___

RESULT ___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6

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Ghana 2003
Survey form view entire document:  text 
INTERVIEWER VISITS

VISIT 1
DATE _________
NTERVIEWER'S NAME __________
RESULT* __________

NEXT VISIT:
DATE _______
TIME ________

VISIT 2
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________

NEXT VISIT:
DATE _______
TIME ________

INTERVIEWER VISIT 3
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________

FINAL VISIT
DAY __
MONTH __
YEAR 2003
NAME ___
RESULT __


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Ghana 2008
Survey form view entire document:  text 
INTERVIEW 1
DATE ____
INTERVIEWER'S NAME ____
RESULT*____

NEXT VISIT:
DATE ___
TIME____

INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ____
RESULT*____

NEXT VISIT:
DATE ___
TIME____

INTERVIEW 2 DATE ____
INTERVIEWER'S NAME ____
RESULT*____

FINAL VISIT
DAY___
MONTH ___
YEAR 2008
INT. NUMBER ____
RESULT____


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Ghana 2014
Survey form view entire document:  text 
INTERVIEW VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____7

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2014
INT. NUMBER _____
RESULT ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____7

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Ghana 2016
Survey form view entire document:  text 
INTERVIEWER VISITS

VISITS 1, 2, AND 3

DATE _________
INTERVIEWER'S NAME ______________
RESULT
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ____________(SPECIFY) 7

NEXT VISIT:

DATE: ______________
TIME: ______________

FINAL VISIT

DAY ________
MONTH _________
YEAR 2016

INTERVIEWER NUMBER __________
RESULT
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ____________(SPECIFY) 7

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Guinea 1999
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 1999
NAME _____


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Guinea 2005
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2005
NAME _____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7

top
Guinea 2012
Survey form view entire document:  text 
INTERVIEWER VISITS

DATE______________
INTERVIEWER'S NAME___________
RESULT_____________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

FINAL VISIT_____________
DAY___________
MONTH___________
YEAR 2012
INT. NUMBER_____________
RESULT___________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT____________
DATE___________
TIME__________


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Guinea 2018
Survey form view entire document:  text 
INTERVIEWER VISITS
FIRST VISIT
DATE

INTERVIEWER'S NAME
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7

FINAL VISIT
DAY
MONTH
YEAR 2018
INT. NUMBER
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS


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India 1992
Survey form view entire document:  text 
INTERVIEW VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ______
INTERVIEWER'S NAME ______
RESULT ______


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India 1998
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ______
INTERVIEWER'S NAME ________
RESULT _______


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India 2005
Survey form view entire document:  text 
FINAL VISIT
DATE ______
MONTH ______
YEAR ______
INT. NO. ______
RESULT CODE _____

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India 2015
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7

SECOND VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7

THIRD VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7

NEXT VISIT
DATE_______
TIME_______

FINAL VISIT
DAY ______
MONTH ______
YEAR _____
INT. NO ______
RESULT CODE ______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7

TOTAL NUMBER OF VISITS _______

SUPERVISOR'S NAME_______

SUPERVISOR NUMBER ________


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Jordan 1990
Survey form view entire document:  text 
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
DAY
MONTH
YEAR
NAME
RESULT


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Jordan 1997
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR 1997
NAME
RESULT

TOTAL NUMBER OF VISITS


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Jordan 2002
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR 2002
NAME
RESULT

TOTAL NUMBER OF VISITS


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Jordan 2007
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

NEXT VISIT:
DATE__
TIME__

SECOND VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

NEXT VISIT:
DATE__
TIME__

THIRD VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

FINAL VISIT
DAY__
MONTH__
YEAR 2007
INT. NUMBER__
RESULT:

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

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Jordan 2009
Survey form view entire document:  text 
INTERVIEWER VISITS:

FIRST VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* ________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7

NEXT VISIT:
DATE ________
TIME ________

SECOND VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7

NEXT VISIT:
DATE _______
TIME _______

THIRD VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7

FINAL VISIT
DAY _______
MONTH _______
YEAR 2009
INT. NUMBER _______
RESULT* _______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7

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Jordan 2012
Survey form view entire document:  text 
INTERVIEWER VISITS (REPEAT FOR SECOND AND THIRD VISITS)

DATE __________
INTERVIEWER'S NAME __________
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY ____
MONTH _____
YEAR _____
INTERVIEW NUMBER _____
RESULT____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7

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Jordan 2017
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIWER'S NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________________ 7

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________________ 7

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________________ 7

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Kenya 1993
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REVIEW FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME __________
RESULT_____

NEXT VISIT
DATE _____
TIME ____

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT ____


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Kenya 1998
Survey form view entire document:  text 
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

DAY
MONTH
YEAR
NAME
RESULT


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Kenya 2003
Survey form view entire document:  text 
INTERVIEWER VISIT

INTERVIEW VISIT 1 (REPEAT FOR INTERVIEW VISIT 2 AND VISIT 3)
DATE ______
INTERVIEWER'S NAME __________
RESULT** ____________

NEXT VISIT:
DATE _____________
TIME ______________

FINAL VISIT
DAY ____________
MONTH ____________
YEAR 2003 __________
INT. CODE __________
RESULT ___________


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Kenya 2008
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Kenya 2014
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6

SECOND VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6

THIRD VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY ____
MONTH _____
YEAR _____
INTERVIEW NUMBER _____
RESULT* ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6

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Lesotho 2004
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME __________
RESULT* ________

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE _______
TIME _______

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER ______
RESULT _____


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Lesotho 2009
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____
RESULT___

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE____
TIME____

FINAL VISIT
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
INT. NUMBER ___ ___ ___


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Lesotho 2014
Survey form view entire document:  text 
INTERVIEWER VISITS:

FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT CODE**

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT:
DATE ____
TIME ____

SECOND VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT CODE**

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT:
DATE ____
TIME ____

THIRD VISIT
DATE ____
INTERVIEWER'S NAME____
RESULT CODE**

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

FINAL VISIT
DAY ____
MONTH ____
YEAR 2014
INT. NUMBER ____
RESULT CODE**

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

TOTAL NUMBER OF VISITS ____


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Liberia 2007

No questionnaire text is available for this sample.


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Liberia 2013

No questionnaire text is available for this sample.


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Madagascar 1992
Survey form view entire document:  text 
INTERVIEWER VISITS:

DATE ____
INTERVIEWER'S NAME _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH ____
YEAR ____
NAME ____
RESULT ____

COMPLETED 1
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

top
Madagascar 1997
Survey form view entire document:  text 
INTERVIEWER VISITS

INTERVIEW ONE (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____

NEXT VISIT
DATE ____
TIME ____

FINAL VISIT
DAY ____
MONTH ____
YEAR 1997
INT. NUMBER ____
RESULT ____

COMPLETED 1
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

top
Madagascar 2003
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME ______
RESULT _____

1 COMPLETED
2 NOT AT HOME
3 DEFERRED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY _____
MONTH _____
YEAR 2003
INT. NUMBER _______
RESULT ______


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Madagascar 2008
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Malawi 1992
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ____
INTERVIEWER'S NAME ___
RESULT* ___

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Malawi 2000
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE__
INTERVIEWER'S NAME___
RESULT ____

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Malawi 2004
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE__
INTERVIEWER'S NAME___
RESULT ____

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Malawi 2010
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Malawi 2016
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NUMBER
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

TOTAL NUMBER OF VISITS:


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Mali 1995
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR 1996
INTERVIEWER NAME____
RESULT ____


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Mali 2001
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____


top
Mali 2006
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Mali 2012
Survey form view entire document:  text 
INTERVIEWER VISITS

(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE________
INTERVIEWER'S NAME____________
RESULT*______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____________ 7

NEXT VISIT
DATE________
TIME__________

FINAL VISIT
DAY____
MONTH____
YEAR 2012
INTERVIEWER______
RESULT*____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____________ 7

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Mali 2018
Survey form view entire document:  text 
INTERVIEWER VISITS
1 2 3
DATE

INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

FINAL VISIT
DAY
MONTH
YEAR 2018
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT
DATE
TIME


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Morocco 1992
Survey form view entire document:  text 
INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 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: (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY)_________ 9

TOTAL NUMBER OF VISITS


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Morocco 2003
Survey form view entire document:  text 
INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER NAME___
RESULTS

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) __________

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Mozambique 1997
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME_____

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR_____
NAME______
RESULT_____

COMPLETED 1
ABSENT 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED/INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

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Mozambique 2003
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER'S NAME______

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR 2003
CODE_____
RESULT______


top
Mozambique 2011
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME_________
RESULT____

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE_________
TIME_________

FINAL VISIT
DAY_________
MONTH_________
YEAR 2011
CODE_________
RESULT_________


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Myanmar 2015
Survey form view entire document:  text 

INTERVIEWER VISITS

FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER___(SPECIFY) 7

NEXT VISIT:
DATE___
TIME___

SECOND VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER___(SPECIFY) 7

NEXT VISIT:
DATE___
TIME___

THIRD VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER___(SPECIFY) 7

FINAL VISIT
DAY___
MONTH___
YEAR___
INT. NO.____
RESULT____


top
Namibia 1992
Survey form view entire document:  text 
INTERVIEWER VISIT 1 (REPEAT FOR INTERVIEWER VISITS 2 AND 2)
DATE_____
INTERVIEWER'S NAME_____
RESULT_____

NEXT VISIT:
DATE____
TIME_____

FINAL VISIT
DAY____
MONTH_____
YEAR_____
NAME_____
RESULT_____


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Namibia 2000
Survey form view entire document:  text 
INTERVIEWER VISITS:

INTERVIEWER 1(REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
RESULT ___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7

NEXT VISIT:
DATE ___
TIME ___

FINAL VISIT
DAY ___
MONTH ___
YEAR 20___
INT. COD ___
RESULT ___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7

top
Namibia 2006
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Namibia 2013
Survey form view entire document:  text 
INTERVIEW VISITS:

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
NAME_____
RESULT____


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Niger 1992
Survey form view entire document:  text 
INTERVIEWER:
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__

FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__


top
Niger 1998
Survey form view entire document:  text 
INTERVIEWER 1:
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPABLE 6
OTHER (SPECIFY): ___ 7

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__

FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPABLE 6
OTHER (SPECIFY): ___ 7

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Niger 2006
Survey form view entire document:  text 
INTERVIEWER 1
DATE _____
DAY _____
MONTH _____
YEAR 2006
INTERVIEWER NAME __________
RESULT * __________

COMPLETED 1
NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 7

INTERVIEWER 2
DATE _____
DAY _____
MONTH _____
YEAR 1998
INTERVIEWER NAME __________
RESULT * __________

COMPLETED 1
NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 7

INTERVIEWER 3
DATE _____
DAY _____
MONTH _____
YEAR 1998
INTERVIEWER NAME __________
RESULT * __________

COMPLETED 1
NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 7

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Niger 2012
Survey form view entire document:  text 
INTERVIEWER VISITS

DATE _____________
INTERVIEWER'S NAME ______________
RESULT* ____________

FINAL VISIT
DAY _______________
MONTH ______________
YEAR 2012 ____________
INTERVIEWER _____________
RESULT _____________

NEXT VISIT
DATE _________
TIME _________


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Nigeria 1990
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT***

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS


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Nigeria 1999
Survey form view entire document:  text 
INTERVIEWER'S VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT _____________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
DWELLING DESTROYED 7
OTHER (SPECIFY) ___________ 8

NEXT VISIT:
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT _____


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Nigeria 2003
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT _____________

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _________________

NEXT VISIT:
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ____
RESULT _____

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _________________

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Nigeria 2008
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT _____________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR 2008
INT. NUMBER ____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

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Nigeria 2013
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*


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Nigeria 2018
Survey form view entire document:  text 
INTERVIEWER VISITS

VISIT 1

DATE_____
INTERVIEWER'S NAME_____
RESULT*_____

NEXT VISIT:

DATE_____
TIME_____

FINAL VISIT

DAY____
MONTH_____
YEAR_____
INT. NO._____
RESULT*_____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4


PARTLY COMPLETED 5
INCAPACITATED 6
OTHER_____ 7

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Pakistan 1991
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT***

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS


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Pakistan 2006
Survey form view entire document:  text 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Pakistan 2012
Survey form view entire document:  text 
INTERVIEW VISITS:

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
NAME_____
RESULT____


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Pakistan 2017
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

NEXT VISIT DATE _____
TIME ______

SECOND VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

NEXT VISIT DATE _____
TIME ______

THIRD VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

NEXT VISIT DATE _____
TIME ______

FINAL VISIT
DAY _____
MONTH ______
YEAR _____
INT. NO. _______
RESULT _______

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

TOTAL NUMBER OF VISITS _________


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Rwanda 1992
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER NAME__________
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)_____ 6

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____
TIME____

FINAL VISIT
DAY__________
MONTH__________
YEAR_____
NAME__________
RESULT__________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)_____ 6

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Rwanda 2000
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____
RESULT*____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE___
TIME___

FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT*_____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7

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Rwanda 2005
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
RESULT* _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____

FINAL VISIT
DAY____
MONTH___
YEAR 200__
CODE ____
RESULT ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

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Rwanda 2008

No questionnaire text is available for this sample.


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Rwanda 2010
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT:
DATE:
TIME:

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

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Rwanda 2014
Survey form view entire document:  text 
INTERVIEWER VISITS:

FIRST VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT:
DATE_____
TIME____

SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT:
DATE____
TIME____

THIRD VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

FINAL VISIT
DAY____
MONTH____
YEAR____
INT. NUMBER____
RESULT____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

TOTAL NUMBER OF VISITS


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Senegal 1992
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
INTERVIEWER NAME____
RESULT*___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR _____
INTERVIEWER_____
RESULT*_____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ____ 7

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Senegal 1997
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE______
INTERVIEWER NAME______

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR _____
INTERVIEWER_____
RESULT_____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ______ 7

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Senegal 2005
Survey form view entire document:  text 
INTERVIEWER VISITS

INTERVIEW 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER NAME_____
RESULT*___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR 2005
INTERVIEWER_____
RESULT*_____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7

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Senegal 2010
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

NEXT VISIT
DATE____
TIME____

FINAL VISIT
DAY____
MONTH_____
YEAR 201___
INT. NUMBER _____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

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Senegal 2012
Survey form view entire document:  text 
INTERVIEWER VISITS

DATE _____________
INTERVIEWER'S NAME _____________
RESULT____

FINAL VISIT

DAY ______________
MONTH __________
YEAR 201__
INT. NUMBER__________
RESULT ____________

NEXT VISIT

DATE ___________
TIME ___________


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Senegal 2014
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE_________
INTERVIEWER'S NAME___________
RESULT* ___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

FINAL VISIT
DAY ____
MONTH ____
YEAR 201__
INT. NUMBER_____
RESULT* _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

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Senegal 2015
Survey form view entire document:  text 
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:

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __
RESULT* __

TOTAL NUMBER OF VISITS __

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Senegal 2016
Survey form view entire document:  text 
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:

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __
RESULT* __

TOTAL NUMBER OF VISITS __

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Senegal 2017
Survey form view entire document:  text 
INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE: _______
INTERVIEWER'S NAME _________
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

FINAL VISIT
DAY ____
MONTH ____
YEAR _____
INT. NUMBER ____
RESULT _____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7

NEXT VISIT
DATE _____
TIME _____


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South Africa 1998
Survey form view entire document:  text 
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NAME
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7

top
South Africa 2016
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT:
DATE ____
TIME ____

SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

NEXT VISIT:
DATE____
TIME____

THIRD VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

FINAL VISIT
DAY____
MONTH____
YEAR 201__
INT. NUMBER____
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7

TOTAL NUMBER OF VISITS____


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Tanzania 1991
Survey form view entire document:  text 
INTERVIEWER VISITS

INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
ID NO. ____
RESULT* ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

TOTAL NUMBER OF VISITS __


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Tanzania 1996
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

FINAL VISIT
DAY ____
MONTH ____
YEAR 96
ID NO. ___
RESULT ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

top
Tanzania 1999
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)__________7

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE______
TIME______

FINAL VISIT
DAY____
MONTH____
YEAR 19___
INTER. ID NUMBER___
RESULT___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)__________7

top
Tanzania 2004
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR 200_
INT. NUMBER
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7

top
Tanzania 2010
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME


top
Tanzania 2015
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _____
INTERVIEWER'S NAME _____
RESULT
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

NEXT VISIT:

DATE: _____
TIME: _____

FINAL VISIT

DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7

TOTAL NUMBER OF VISITS _____


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Togo 1998

No questionnaire text is available for this sample.


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Togo 2013

No questionnaire text is available for this sample.


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Uganda 1995
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7

NEXT VISIT:
DATE ___________
TIME ___________

SECOND VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7

NEXT VISIT:
DATE ___________
TIME ___________

THIRD VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7

FINAL VISIT:
DAY
MONTH
YEAR
NAME
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7

TOTAL NUMBER OF VISITS


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Uganda 2001
Survey form view entire document:  text 
INTERVIEWER VISITS
DATE _____
INTERVIEWER'S NAME __________
*RESULT

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT


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Uganda 2006
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER NUMBER
RESULT


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Uganda 2011
Survey form view entire document:  text 

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

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __


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Uganda 2016
Survey form view entire document:  text 
INTERVIEW VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT


COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT


COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT


COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT


COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07

DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT


COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR


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Yemen 2013
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 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

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 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

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ____ 9

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ____ 9

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Zambia 1992
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT ____


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Zambia 1996
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISIT)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT* ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

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Zambia 2001
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT* ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

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Zambia 2007
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INT. NUMBER ___
RESULT* ____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7

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Zambia 2013
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS):
DATE_________
INTERVIEWER'S NAME______________
RESULT*_____

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) ___________________

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____________
TIME______________

FINAL VISIT
DAY________
MONTH__________
YEAR____________
INT. NUMBER__________
RESULT*

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) ___________________

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Zambia 2018
Survey form view entire document:  text 
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _______________
INTERVIEWER'S NAME _______________

RESULT* _______________
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _______________

NEXT VISIT:

DATE _____
TIME _____

FINAL VISIT:

DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____

TOTAL NUMBER OF VISITS _____


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Zimbabwe 1994
Survey form view entire document:  text 
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

DAY
MONTH
YEAR
NAME
RESULT


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Zimbabwe 1999
Survey form view entire document:  text 
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE__
INTERVIEWER'S NAME___
RESULT ____

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Zimbabwe 2005
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS

*RESULT CODES:

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT IN HOUSEHOLD AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _________

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Zimbabwe 2010
Survey form view entire document:  text 
INTERVIEW VISITS:

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
NAME_____
RESULT____


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Zimbabwe 2015
Survey form view entire document:  text 
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

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __
RESULT*___

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD __ __
TOTAL ELIGIBLE WOMEN __ __
TOTAL ELIGIBLE MEN __ __
LINE NO. RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __