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_________ 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_________ 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_________ 7
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
TOTAL NUMBER OF VISITS
LANGUAGE OF INTERVIEW
DARI 1
PASHTO 2
OTHER________6
NATIVE LANGUAGE OF RESPONDENT
DARI 1
PASHTO 2
OTHER________6
TRANSLATOR USED?
YES 1
NO 2