IMPORTANT!!!
Transfer ED and Household Numbers to
the top of EACH individual questionnaire
From Household Questionnaire
Draft
1000 0007
Household Number
ED Number
INTERVIEWER:
Whenever a dotted line (...) appears in a question, call the name of the person to whom the information relates, if it is
not the respondent himself/herself. Else say "You"/"Your". Fill the appropriate oval. Please do not write over the
responses:
Remember to mark multiple choice boxes like this
SECTION 4
CHARACTERISTICS
PLEASE FILL IN THIS PERSON'S ASSIGNED NUMBER
FOR ALL PERSONS
43. What is your/....'s religious affiliation/denomination?
1 Anglican
11 Muslim
2 Baptist
12 Pentecostal
3 Bahai
13 Presbyterian
3 Partner of Head
4 Brethren
14 Rastafarian
4 Child of Head and Spouse/Partner
5 Church of God
15 Roman Catholic
6 Evangelical
16 Salvation Army
7 Spouse/Partner of child of head/Spouse/Partner
7 Hindu
17 Seventh Day Adventist
8 Grandchild of Head/Spouse/Partner
8 Jehovah Witnesses
18 Morman
9 Methodist
19 None
10 Moravian
20 Other (Specify.................)
39. What is your/ .....'s relationship to the head of household?
1 Head
2 Spouse of Head (Husband/Wife)
5 Child of Head only
6 Child of Spouse/Partner only
9 Parents of Head/Spouse/Partner
10 Other relative of Head/Spouse/Partner(Specify...........................)
11 Domestic Employee
12 Other Non-Relative
40. INTERVIEWER: Fill the appropriate oval.
FOR PERSONS NOT SEEN ASK:
Is....male or female?
1 Male
44. Where do you/does (N) usually live?
2 Female
41. What is your/.......'s date of birth?
Day
Month
Year
/
1 At this address
Parish
Village
2 In another village
/
Village
If not known, ask:
How old was..........on his/her last birthday?
Age
SECTION 5 MIGRATION (BIRTH PLACE AND
RESIDENCE)
FOR ALL PERSONS
If age is not stated please estimate age if
you see the person.Otherwise ask the
respondent to estimate the person's age.
If age is not known use code 999.
If estimated please put an X in the box.
42. To which ethnic, racial or national group do you/does (N)
belong?
1 African Descent/Black
6 Syrian/Lebanese
2 Indigenous People
7 White/Caucasian
3 East Indian
8 Mixed
4 Chinese
9. Hispanic
5 Portuguese
Parish
3 Abroad
Name of Country
45. Where were you/was (N) born?
1 In St Kitts and Nevis
Parish
Community
2 Foreign/Abroad
Name of Country
INTERVIEWER: For persons born in St. Kitts and Nevis what
is required is the mother's usual residence at the time of
birth.
46. In what year did you/(N) last come to live in St. Kitts and
Nevis? For foreign born persons only.
Year
10 Other (Specify.............................................)
Remember to mark multiple choice boxes like this
Page 1
Draft
1000 0007
Remember to mark multiple choice boxes like this
47. In which Parish/Village did you/ (N) last live?
1 Never Moved (GO TO Q.49)
2 Parish ______________
Village
48. In what year did you/(N) last come to live in this Parish?
Foreign Born Go to Q53
Year
Q49 to Q52 are for local borns only
50. In which country did you/ (N) last live? For local born
only.
Name of Country
Questions 51 and 52 are for local borns who
answered yes in Q49
51. In what year did you/ (N) return to live in St. Kitts and
Nevis?
Year
52. What is the main reason for your return to St. Kitts and
Nevis?
1 Regard it as home
5 Education
2 Family is here
6 Involuntary return/deported
3 Retired
7 To start a business/employment
4 Homesick
8 Other (specify..........................)
Q53 to Q57 are for five years and over
DISABILITY STATUS : Respond only if you have a
permanent disability or where the disability has been
continuous for six months or more.
Rate responses as follows:
1 No - No Difficulty
3 Yes - Lots of Difficulty
2 Yes - Some Difficulty
4 Cannot do (it) at all
1. Seeing (even with glasses)?
1
2
3
4
2. Hearing (even using hearing aid)?
1
2
3
4
3. Walking or climbing stairs?
1
2
3
4
4. Remembering or concentrating?
1
2
3
4
5. Self care (washing, dressing, feeding)?
1
2
3
4
6. Upper body function?
1
2
3
4
7. Lower body function (legs, etc)?
1
2
3
4
8. Communicating and speaking?
1
2
3
4
9. Behavioral (psychological, emotional)?
1
2
3
4
58. What is the origin of disability?
2 No
54. If 'NO' Where did you/ (N) live five years ago?
1. From Birth
Rate responses as follows:
2. Illness
3. Accident
4. Other (Specify)
Specify
Parish
1. Seeing (even with glasses)?
Country
For Ten years and over
55. Did you/ (N) live at this address in 2001?
1 Yes (Go to Q.57)
2. Hearing (even using hearing aid)?
2 No
3. Walking or climbing stairs?
56. If 'NO' where did you/ (N) live in 2001?
Village
Country
FOR ALL PERSONS
If No Difficulty for all options, SKIP TO Q60.
53. Did you/ (N) live at this address five years ago?
Village
DISABILITY
57. Do you/does (N) have difficulty with any of the following?
49. Have you/has (N) ever lived in another country?
2 No (GO TO Q.53)
1 Yes
1 Yes (GO TO Q.55)
SECTION 6
Parish
4. Remembering or concentrating?
5. Self care (washing, dressing, feeding)?
6. Upper body function (arms, neck)?
7. Lower body function (legs, etc)?
8. Communicating and speaking?
9. Behavioral (psychological, emotional)?
Remember to mark multiple choice boxes like this
Draft
Remember to mark multiple choice boxes like this
59. Are you/ is (N) required to use any of the following aids?
(X all that apply).
1 Wheelchair
7 Prosthesis/artificial body part
2 Walker
8 Orthopedic Shoes
3 Crutches
9 Hearing Aid
4 Brailler
10 Other (specify.............................)
5 Adapted Car
11 None
6 Cane
12 Not Stated
SECTION 7 HEALTH
SECTION 8 EDUCATION AND INTERNET
ACCESS
FOR ALL PERSONS
65. Are you / (N) currently attending an Educational Institution?
1 Yes
FOR ALL PERSONS
60. Do you/does (N) have any of the following illnesses?
(X all that apply)
1 Arthritis
10 Sickle Cell
2 Kidney Disease
11 Anemia
3 Asthma
12 Lupus
4 Diabetes
13 HIV/AIDS
5 Hypertension
14 Other (specify....................)
6 Carpal Tunnel Syndrome
15 None
7 Cancer
16 Anaemia
8 Heart Disease
17 Stroke
9 Glaucoma
18 Not Stated
61. When was the last time that you used a medical facility?
(hospital, clinic, doctor, etc)
1 Less than a month
4 Over one year
1000 0007
2 No (GO TO Q.68)
66. What type of school or institution are you/ (N) attending?
1 Daycare/Nursery
7 Sixth Form
2 Preschool
8 Prof/Tech/Voc
3 Infant/Kindergarden
9 Tertiary (Univ/college)
4 Primary
10 Adult continuing Ed
5 Special Education
11 Other (specify.......................)
6 Secondary
67. Please give the name and address of the school or
institution.
Name
Address
68. What is the highest level of education that you have/......has
completed?
1 Daycare/Nursery
2 1-6 months
5 Never
3 7-12 months
6 Not Stated
62. What was the main medical facility used in the past 12
months?
1 Local Hospital
2 Pre-school
3 Infant/Kindergarten
4 Primary (grade 1-3)
2 Private Local Doctor
5 Primary (4-6)
3 Public Health Center
6 Secondary (1-3)
4 Overseas Hospital or Clinic
7 Secondary (4-5)
5 Overseas Doctor
8 Sixth Form
6 Other (specify........................)
9 12th Grade (US)
7 Not Stated
10 Post secondary/college
63. Is (N) covered by health/life insurance?
1 Yes
2 NO
3 Not Stated
4 Don't Know
(IF NO GO TO Q.65)
11 University
12 Other (Specify...........................)
64. Which of the following insurance do you/does (N) have?
(X all that apply)
1 Soc Security
6 Endowment only
2 Life with Health
7 Endowment with Health
3 Life only
8 Other (specify................)
4 Group Health
9 None
13 None
14 Not Stated
5 Individual Health
Remember to mark multiple choice boxes like this
Draft
1000 0007
Remember to mark multiple choice boxes like this
74. What was the main method used by you/ (N) to train in this
1 School leaving (e.g. Standard Six or Seven School Leaving exam) field?
69. What is the highest examination that you have/...passed?
1 On the job
8 Business/Computer School
2 Private Study
9 University (on campus)
4 High School Certificate (HSC)
3 Apprenticeship
10 Distance Learning
5 High School Diploma
4 Correspondence Course
11 On-line/Virtual Learning
5 Secondary School
12 Private
6 Vocational/Technical Inst
13 Other (specify)
7 Commercial/Secretarial School
14 Not Stated
2 Cambridge School Certificate
3 CCSLC
1 2 3 4 5 6 7 8 9+ Not stated
6 GCE 'O' Levels or CXC
1 2 3 4 5 6 7 8 9+ Not stated
7 GCE 'A' Level
1 2 3 4 5 6 7 8 9+ Not stated
8 CAPE
9 College Certificate
75. How long was the period of your / (N) highest level of
training?
Months
10 College Diploma
11 Associate Degree
12 Professional Certificate eg RSA, City and Guilds etc.
13 Bachelor's Degree
76. What type of qualification /certification did you/ (N) receive
on completion of the training at the highest level?
14 Post Graduate Certificate
1 None
7 First Degree
15 Post Graduate Diploma
2 Certificate with examination
8 Post Graduate Degree
3 Certificate without examination
4 Diploma
5 Advanced Diploma
6 Associate Degree
9 Professional Qualification
10 Other Specify
16 Higher Degree (Master's)
17 Higher Degree (Doctoral)
18 Other (Specify..............................................................)
19 None
SECTION 11 ECONOMIC ACTIVITY
FOR PERSONS 15 YEARS AND OVER
20 Not Stated
SECTION 9
INTERNET ACCESS
FOR ALL PERSONS
70. Have you/ has ....... /had access to the Internet within the past
3 months?
1 Yes
2 No (GO TO Q.72)
71. Where did you/ (N) mainly use the Internet in the past 3
months?
1 Home
2 Work
3 School
4 Internet Cafe'
5 Cellular Phone / PDA
6 Family or Friend's House
7 Community Facility
8 Did not use
9 Other (specify..........................)
77. What did you/ (N) do most during the past week?
(This includes work for pay, profit, or family gain during the
past month but excludes house work).
1 Worked
7 Retired - did not work
2 Had a job but did not work
8 Disabled, unable to work
3 Looked for work (GO TO Q85)
4 Wanted work and available (GO TO Q85)
5 Home Duties
6 Attended School ( ANSWER TO 5 - 9 GO TO Q86)
9 Other (Specify.............................................................)
78. What category of worker are you in your main job?
1 Paid employee, Government
(GO TO Q81)
2 Paid employee, Statutory Board
(GO TO Q81)
3 Paid employee, Private Establishment/Business
SECTION 10 TRAINING
FOR PERSONS 15 YEARS AND OVER
72. Have you/has.....ever received/attempted any skills training
to equip you/ (N) for employment or occupation/profession?
1 Yes
2 No (GO TO Q.77)
73. What is the field for which the highest level of training was
completed/attempted or is undergoing by you/ (N)?
Field Trained
4 Paid employee, Private home
(GO TO Q81)
5 Apprentice/Learner
(GO TO Q81)
(GO TO Q81)
7 Self-employed with paid employees
6 Volunteer Worker
8 Self-employed without employees
9 Unpaid Worker/employee
(GO TO Q81)
10 Contributing Family Member/Worker (GO TO Q81)
11 Other (specify.................................)
Remember to mark multiple choice boxes like this
(GO TO Q81)
Draft
1000 0007
Remember to mark multiple choice boxes like this
86. Why did you not seek work during the past week?
1 Own illness, disability, injury, pregnancy
2 Home duties, Personal, family responsibilities
3 In school, training
4 Retirement/old age
5 Already found work to start later
6 Already made arrangements for self employment
7 Awaiting recall to former job
8 Awaiting replies from employers
9 Awaiting busy season
10 Believe no suitable work available
11 Could not find suitable work
12 Not yet started to seek work
13 Do not know how or where to seek work
14 Discouraged
15 Other (Specify.........................................................)
1 Complete set of records/accounts
2 Informal records of orders, sales, purchases
3 Simplified written accounts
4 No records are kept
80. Are you registered with Social Security as a self employed
person or an employer?
1 Employer
2 Self Employed
3 Not registered
81. What kind of work do you do in your main job?
Give a brief description of main duties.
82. What is the main type of business carried out at your/ (N)
place of work, industry?
(All go to Q.95)
79. What kind of accounts do you keep for this
activity/business?
87. What did you/ (N) do most during the past 12 months?
1 Had a job and worked (GO TO Q.)
Industry
2 Had a job, but did not work (GO TO Q.)
3 Looked for work
Where is your/ (N) place of work?
1 Work at home
4 Wanted work and was available
2 No fixed place of work
5 Did home duties
3 Afixed place of work outside the home
6 Attended school
(GO TO Q.107)
7 Retired, did not work
83. What is the name and address of your/ (N) workplace?
8 Disabled, unable to work
1 Work name and address
9 Other (specify.............................................)
88. Did you do any work at all in the past 12 months?
(This includes work for pay, profit, or family gain during the
past month but excludes house work)
1 Yes
2 No
3 Don't know
2 No present workplace
84. How many hours did you/ (N) work during the past week?
(main jobs)
Hours
85. What steps did you/ (N) take during the past week to look
for work?
(X all that applies to this question)
89. Have you/he/she ever worked or had a job?
1 Yes
2 No (GO TO Q.)
90. How many months did you/ (N) work in the past 12
months?
Number of months
0
1
2
3
4
5
6
7
8
9
10
11
12
1 Did nothing
2 Direct application (sent out letters)
3 Checking at work sites, factory gates, etc.
91. Have you/ has (N) ever been laid off permanently or made
redundant during the past 2 years?
4 Seeking assistance from friends
5 Registered at public/private employment exchange
6 Other (specify................................................)
1 Yes
2 No
3 Not Stated
92. In which Industry were you working at the time of layoff or
redundency?
Industry
1 Not Stated
Remember to mark multiple choice boxes like this
Draft
1000 0007
Remember to mark multiple choice boxes like this
SECTION 12
INCOME AND LIVELIHOOD
93. How often do you/ does (N) get paid from your main job?
1 Weekly
2 Fortnightly
3 Monthly
4 Quarterly
5 Annually
6 Other Specify
7 Not applicable
94. What was your/ (N) gross pay/income during the last pay
period, from your current job, that is before income tax or other
deductions? (PRESENT FLASH CARD)
Income group
98. What is your / (N) current union status?
1 Never had a spouse or common-law partner (Skip to Q.91)
2 Married and living with spouse
3 Married and not living with spouse
4 Common Law
5 Visiting Partner
6 Not in union
For Persons Not In A Union
99. How old were you/ was (N) when you were/ (N) was first
married or in a union for the first time?
Age in years
ALL MALES Go to Q107
95. What are your/ (N's) sources of livelihood? (indicate as
many)
1 Paid Employment
SECTION 14
FERTILITY
WOMEN 15 YEARS AND OVER
2 Self Employment
3 Pension (local)
100. (a) How many live born children have you/ has (N)
ever
had and how many are males and females?
4 Pension (overseas)
5 Investment
Total
6 Remittances (overseas)
7 Dividends/Savings/interest on savings
Male
Female
Number
8 Disability benefits
(b) How many of your live born children are still a
live?
Total
Male
Female
9 Social Security benefits
10 Other public assistance
11 Local contributions from friends/ relatives (cash/kind)
Number
12 Overseas contributions from friends/relatives (cash/kind)
13 Other money income, (specify...........................)
96. Approximately how much money did you/ (N) receive last
year (2010) from family and/or friends abroad in cash or in
kind e.g. barrels containing food, clothing, electronics.
101. How old were you/was (N) when you/ (N) had your/ her
first live born child?
Age
102. How old were you/ (N) when you/ (N) had your/ (N) last
live born child?
Age
$
SECTION 13 MARITAL AND UNION STATUS
FOR ALL PERSONS 15 YEARS AND OVER
97. What is your/ (N) marital status?
1 Never Married
2 Married
3 Divorced (and not remarried)
4 Widowed (and not remarried)
5 Legally Separated
6 Not Stated
103. What is the date of birth of the last child born alive?
DD
MM
YY
/
Remember to mark multiple choice boxes like this
/
Draft
1000 0007
Remember to mark multiple choice boxes like this
104. How many live births did you/ (N) have in the past 12
months?
0 1 2 3 4 5
Number
(IF ZERO GO TO Q.107)
What was the sex of the babies born in the last 12 months?
A. Number of Boys
B. Number of Girls
1
1
2
3
4
5
2
3
4
5
105. How many of the children who were born in the past 12
months have died?
Total Number
106. Of what sex and age in months were the children (in months) who died in the past 12 months?
Child Number
1.
2.
3.
4.
SECTION 14
Age in Months
Sex
1M
2F
1M
2F
1M
2F
1M
2F
CENSUS NIGHT
107. Where did you spend census night?
This question is for de facto count only.
1 This Household
2 Elsewhere in the country
3 Institution
4 Abroad
5 Other
6 Not stated
Remember to mark multiple choice boxes like this
END OF QUESTIONNAIRE
Draft
1000 0007
INTERVIEWER SAY:
I am the Census Interviewer assigned to this area and I would like to get some information about this household and its
members. Here is my identification card. (Please show card)
INTERVIEWER RESULTS
Interview Calls
1
RECORD OF VISITS
Date (DD/MM/YY)
/
Time Started
Confidential
Duration
*Results
/
2
3
4
*RESULTS CODES: 1 = Completed
2 = Partially Completed
3 = Refused
4 = No Suitable respondent at home 5 = No Contact 6= Vacant
Statistical Department, Church Street, St. Kitts: Tel: 869-465-2521 and Charlestown, Nevis
Tel: 869-469-5521
Confidential
Confidential
AREA SUPERVISOR
NAME
DATE
FIELD SUPERVISOR
NAME
DATE
INTERVIEWER
NAME
DATE
EDITOR/CODER
NAME
DATE
EDITOR/CODER
NAME
Confidential
DATE
Confidential
Draft
Confidential
LISTING OF HOUSEHOLD MEMBERS
INTERVIEWER SAY:
Please give me the names of all the persons who usually live and share one daily meal with your household
Sex
01
1M
2F
02
1M
2F
03
1M
2F
04
1M
2F
05
1M
2F
06
1M
2F
07
1M
2F
08
1M
2F
09
1M
2F
10
1M
2F
11
1M
2F
12
1M
2F
13
1M
2F
14
1M
2F
15
1M
2F
16
1M
2F
17
1M
2F
18
1M
2F
19
1M
2F
20
1M
2F
21
1M
2F
Confidential
Place X in box if person is under 5
First Name
Place X in box if person is under 5
Surname
Draft
COMMENTS
Draft
SECTION 1
MIGRATION
2. (a) Did any member of this household move to live abroad during the last ten years (1991 - 2001)?
1 Yes (continue)
2 No
(go to section 2)
(b) How many persons moved?
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Person Number
Year moved
2001 - 2010
Highest education
attained when
moved
1 None
2 Primary
3 Secondary
4 Tertiary
(non-university
College)
5 University
6 Other
Sex
M=1
F=2
Age
when
moved
Occupation
when moved
Name of Country
of Migration
Main reason
for Migration
Write year
properly inside
the boxes
provided
0 if
less
than
1, 98
for 99
and
over
Describe as clearly as
possible the person(s)
occupation when he/she
moved.
[For persons 15 years
and over when moved]
Boxes in this column
are for official use
Write in the space
Provided
01
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
06
4
2
5
3
6
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
2
Name of Country
1
2
2
Name of Country
05
7
2
Name of Country
04
4
2
Name of Country
03
1
2
Name of Country
02
1 Higher income
2 Employment
3 Study
4 Medical
5 Marriage
6 Family reasons
7 Crime rate
8 Other
Specify
____________
1
2
Name of Country
Draft
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Person Number
Year moved
2001 - 2010
Highest education
attained when
moved
1 None
2 Primary
3 Secondary
4 Tertiary
(non-university
College)
5 University
6 Other
Sex
M=1
F=2
Age
when
moved
Occupation
when moved
Name of Country
of Migration
Main reason
for Migration
07
Write year
properly inside
the boxes
provided
1
4
2
5
3
6
0 if
less
than
1, 98
for 99
and
over
Describe as clearly as
possible the person(s)
occupation when he/she
moved.
[For persons 15 years
and over when moved]
Boxes in this column
are for official use
Write in the space
Provided
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
1
4
2
5
3
6
1
14
4
2
5
3
6
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
1
4
7
2
5
8
3
6
2
Name of Country
1
8
2
Name of Country
13
5
2
Name of Country
12
2
2
Name of Country
11
7
2
Name of Country
10
4
2
Name of Country
09
1
2
Name of Country
08
1 Higher income
2 Employment
3 Study
4 Medical
5 Marriage
6 Family reasons
7 Crime rate
8 Other
Specify
____________
1
2
Name of Country
Draft
INTERVIEWER SAY: Now I would like to ask a few questions about the
dwelling which your household occupies and the facilities that you have.
SECTION 2
HOUSING
INTERVIEWER: Ask this question only it the answer is
not obvious. Else, shade
the appropriate oval.
11. What type of dwelling does this household occupy?
1. Undivided private house
2. Part of a prive house/attached
3. Flat, apartment, condominium
4. Townhouse
18. How much Mortgage are you now paying per month?
To nearest dollar
2 Don't know
$
3 Not paying
,
19. What about the land - Is it freehold, leased, or some
other type of occupancy?
1. Owned/freehold
6. Sqautted
5. Double house/duplex
2. Lease-hold
7. Share cropping
6. Combined business and dwelling
3. Rented (paying)
8. Other (specify.............)
7. Barracks
4. Rent-free
9. Don't know
8. Other (Specify...................)
5. Permission to work land
10. Not stated
12. Is this dwelling insured?
1. Yes
2. No
3. Don't know
4. Not stated
13. Are the contents of this dwelling insured?
1. Yes, all
4. Don't know
2. No
5. Not stated
3. Partially
14. Is this dwelling unit owned, rented, or leased by
any member of the household?
1. Owned with mortgage
(Go to Q. H8)
2. Owned without mortgage
3. Rented
9. Plywood
4. Wood & Galvanise
10. Plywood & Concrete
5. Concrete
11. Makeshift (specify.................)
6. Concrete & Blocks
12. Other (specify.....................)
21. What is the main material used for roofing?
1. Sheet metal (zinc, aluminum, galvanise)
2. Shingle (asphalt)
3. Shingle (wood)
4. Concrete
7. Other (specify.........................)
6. Squatted
7. Other (specify....................)
8. Don't know/Not stated
15. What is the rental period for this dwelling?
3. Monthly
8. Bricks
3. Wood & Concrete
6. Thatch/makeshift
5. Leased
2. Fortnightly
2. Wood & Brick
5. Tile
4. Rent free
1. Weekly
20. What is the main material of the outer walls?
1. Wood
7. Stone
5. Half Yearly
6. Annually
7. Not stated
4. Quarterly
16. Is this dwelling rented as fully furnished,
semi-furnished or unfurnished?
1. Fully Furnished
22. In which year/period was this building built?
1. Before 1980
2. 1980 - 1989
7. 2009
8. 2010
3. 1990 - 1999
9. 2011
4. 2000 - 2006
10. Don't know
5. 2007
6. 2008
11. Not stated
23. What is your main source of water supply?
1. Public piped into dwelling
2. Public piped into yard
2. Semi-furnished
3. Public standpipe
3. Unfurnished
4. Public well or tank
4. Not stated
5. Private catchment, not piped
17. How much rent are you now paying per month?
To nearest dollar
2 Don't know
$
3 Not paying
,
6. Private catchment, piped into dwelling
7. Private catchment piped
8. Other (specify.........................)
Draft
24. What in your main source of drinking water?
1. Public piped into dwelling
30. What is your main method of garbage disposal?
1. Dumping (land)
2. Public standpipe
2. Compost
3. Private piped into dwelling
3. Burning
4. Private catchment, not piped
4. Dumping/throwing into river/sea/pond
5. Private catchment, piped
5. Burying
6. Bottled water
6. Garbage truck/skip/bin - Public
7. Other (specify................................)
7. Garbage truck - Private
25. What type of toilet facility does this household have?
1. W.C. (flush toilet) Link to sewer
2. W.C. (flush toilet) Linked to septic tank/soak away
8. Other (specify.............................)
31. How many desktop computers does this household
have in use?
3. Pit latrine
4. Other (seceify............................)
5. None
32. How many laptop computers does this household
have in use?
6. Don't know
26. What is the main source of lighting for this
household?
1. Electricity - Public
2. Electricity - Private generator
3. Gas lantern
4. Kerosene
5. Solar
33. What type of internet connection does this
household use? (tick all that applies.)
1. DSL/ASL
2. Dial up
3. Wireless
4. Cellular wireless/mobile band
5. No internet connection
6. None
7. Other (specify.......................)
27. What type of fuel does this household use most for
cooking?
34. Which of the following does your household have in
use? (read categories)
1 Solar water heater
12 Washing machine
2 Electrical water heater
13 Water pump
3 Television
14 Computer
3. Electricity
4 VCR
15 Air conditioner
4. LPG (cooking gas)
5 Radio/stereo
16 Generator
5. Solar energy
6 Refrigerator
17 Dishwasher
6. Biogas
7 Freezer
18 DVD/MP3 player
8 Microwave
19 Clothes Dryer
9 Stove
20 Water tank
10 Landline phone
21 Satellite dish
1. Wood/charcoal
2. Kerosene
7. None
8. Other (specify........................)
28. How many rooms does this household occupy: (do
not include bathrooms and porches)
11 Cellular phone
29. How many bedrooms are there in this dwelling unit?
(Bedrooms are rooms mainly used for sleeping and
excludes temporary sleeping quarters. Count all bedrooms
including spares not occupied)
35. How many vehicles are kept at home for private
use by this household? (Excluding motor cycles)
Draft
SECTION 3
CRIME
36. Has any member of your household been a victim of crime during the last twelve (12) months?
1 Yes
2 No (Go to Section 4)
3 Not stated (Go to Section 4)
37. What was the nature of the crime?
1 Murder
6 Larceny (house breaking)
2 Kidnapping
7 Larceny (auto theft)
3 Wounding by firearm
8 Larceny other
4 Other wounding
9 Burglary
5 Rape/abuse
10 Other (specify...........................)
38. Did any member of this household die within the past twelve (12) months?
1 Yes
2 No (Go to Section 4)
3 Not stated (Go to Section 4)
AGE
Sex
1M
2F
1M
2F
1M
2F
1M
2F
TELEPHONE NUMBER
-