Professional Documents
Culture Documents
l_l_l_l_l l_l_l_l_l
Person’ Can you please provide Which What is What is How old Indicate What is For all household members
s serial full names of all persons house- (NAME)’s the sex of was With “1” (NAME)’s
number who are part of this hold relationship to each of (NAME) if person is marital status
in household, beginning with member head of the these at (his/her) between 5- (for persons 12
house- the Head of the provided household indivi- last 17 years years or above) Please indicate (NAME)`s serial
hold Household? informati 1. Household Head dual birthday? old, “0” 1. Single or never number.
(A Household is defined as on on the 2. Spouse House- (In otherwise married (Write 99 if absent or not
a person or group of indivi- 3. Son / Daughter hold completed 2. Married applicable)
persons who live together in dual 4. Brother / Sister member? civil/religious Spouse Natural Natural
the same house or (write 5. Daughter-in- 1. Male 3. Married but (if Mother Father
compound, share the same serial law / son-in-law 2. Female separated applicable (if she is (if he is
housekeeping arrangements number 6. Grandchild 4. Polygamous and s/he among among the
and are catered for as one from Q1) 7. Niece / Nephew marriage is the household
unit. Members of a 8.Step child 5. Living together among the house- members)
household are not 9.Aged parent / as married household hold
necessarily related (by parent-in-law partners members) member)
blood or marriage) and not 10.Servant (live-in) 6. Divorced
all those related in the same 11. Other relative 7. Widowed
house or compound are 12.Non-relative
necessarily of the same
household)
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q7 Q9 Q10 Q11
01
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
02
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
03
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
04
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
05
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
06
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
07
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
08
|__|__| |__|__| |__| |__|__| |__| |__| |__|__| |__|__| |__|__|
SECTION II Educational Attainment of All Household Members aged 5 and above
Serial No in Q1 |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| Skip
To
Question
Name of household member
6. Non standard curriculum… 6 |__| 6 |__| 6 |__| 6 |__| 6 |__| 6 |__| 6 |__| 6 |__| Q18
7. Don’t know…….……………… 7 |__| 7 |__| 7 |__| 7 |__| 7 |__| 7 |__| 7 |__| 7 |__|
7. Don’t Know……...... 7 |___| 7 |___| 7 |___| 7 |___| 7 |___| 7 |___| 7 |___| 7 |___|
Q20. At what age did (NAME) leave school?
(Age in completed years)....... |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| Q21
SECTION III Current Activity Status of All Household Members (5 and above) during the reference week
A. Economic Activity
Serial No in Q1 Skip to
|___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| Question
Name of household member
Q21. Did (NAME) engage in any work at least one
hour during the past week?
(As employee, self employed, employer or unpaid
familyworker)
1. Yes……………………. 1 1 1 1 1 1 1 1 Q24
2. No……………………… 2 2 2 2 2 2 2 2 Q22
Q22. During the past week, did (NAME) do any of the Y= YES Y= YES Y= YES Y= YES Y= YES Y= YES Y= YES Y= YES
following activities, even for only one hour? (Read each of
N= NO N= NO N= NO N= NO N= NO N= NO N= NO N= NO
the following questions until the first affirmative response is
obtained.)
(h) Fetch water or collect firewood for household use? |___| |___| |___| |___| |___| |___| |___| |___|
(i) Produce any other good for this household use?
Examples: clothing, furniture, clay pots, etc. |___| |___| |___| |___| |___| |___| |___| |___|
Serial No in Q1 |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| Skip to
Question
Name of household member
OCCUPATION CODE
|___|___|___| |___|___|___| |___|___|___| |___|___|___| |___|___|___| |___|___|___| |___|___|___| |___|___|___|
For official use
Q25. Describe briefly the main activity i.e. goods produced and services rendered where (NAME) is working.
Activity/Type
INDUSTRY CODE
For official use |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__|
Q26. Where did (NAME) carry out
his/her main work during the past
week?
Other (specify)
Q30. In addition to (NAME)’s main
work, did (NAME) do other work?
1. Yes…………………………….. 1 1 1 1 1 1 1 1
2. No……………………………… 2 2 2 2 2 2 2 2
Serial No in Q1 Skip
|___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| |___|___| To
Name of household member Question
Q34. During the past week did (NAME) Y= YES Y= YES Y= YES Y= YES Y= YES Y= YES Y= YES Y= YES
do any of the tasks indicated below for N=NO N=NO N=NO N=NO N=NO N=NO N=NO N=NO If any
this household? ”YES”
(Read each of the following options and →Q35
mark “YES” or “NO” for all options) Otherwise
1. Shopping for household.... 1|___| 1|___| 1|___| 1|___| 1|___| 1|___| 1|___| 1|___| END
2. Repairing any household equipment 2|___| 2|___| 2|___| 2|___| 2|___| 2|___| 2|___| 2|___| for this
3. Cooking........................................... 3|___| 3|___| 3|___| 3|___| 3|___| 3|___| 3|___| 3|___| HH
4. Cleaning utensils/house.................. 4|___| 4|___| 4|___| 4|___| 4|___| 4|___| 4|___| 4|___| member.
5. Washing clothes........................... 5|___| 5|___| 5|___| 5|___| 5|___| 5|___| 5|___| 5|___| Go to the
6. Caring for children/old/sick.......... 6|___| 6|___| 6|___| 6|___| 6|___| 6|___| 6|___| 6|___| next HH
7. Other household tasks..... 7|___| 7|___| 7|___| 7|___| 7|___| 7|___| 7|___| 7|___| member in
Other (Specify) Section II.