FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
RESULT CODING:
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. NO.
RESULT
TOTAL NUMBER OF VISITS
TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED?
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
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 INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
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