FIRST VISIT
DATE_________
DAY___
MONTH___
INTERVIEWER'S NAME_________
RESULT
NEXT VISIT:
DATE_________
TIME_________
SECOND VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT
NEXT VISIT:
DATE____
TIME____
THIRD VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT
FINAL VISIT
DAY_________
MONTH_________
YEAR_____
INT. NO._________
RESULT
Language of interview
Native language of respondent
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
LANGUAGE OF QUESTIONNAIRE
LANGUAGE CODES:
FRENCH 01
OTHER (SPECIFY) 96
OLD KIRUNDI (FROM PAPER)
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
LANGUAGE OF QUESTIONNAIRE: FRENCH 01
LANGUAGE OF QUESTIONNAIRE ___
LANGUAGE OF INTERVIEW:
NATIVE LANGUAGE OF RESPONDENT:
TRANSLATOR USED?
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
LANGUAGE OF QUESTIONNAIRE: FRENCH 01
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
LANGUAGE CODES
LANGUAGE CODES:
TRANSLATOR USED?
TRANSLATOR USED
**LANGUAGE CODES
LANGUAGE OF QUESTIONNAIRE: ENGLISH 01
LANGUAGE OF INTERVIEW ____
HOME LANGUAGE OF RESPONDENT ____
TRANSLATOR USED
LANGUAGE OF INTERVIEW _____
TRANSLATOR USED
LANGUAGE OF INTERVIEW ____
NATIVE LANGUAGE OF RESPONDENT ____
TRANSLATOR USED
LANGUAGE OF QUESTIONNAIRE ______
LANGUAGE OF INTERVIEW__
NATIVE LANGUAGE OF RESPONDENT __
TRANSLATOR USED