92
Please make sure you sign the front page of the questionnaire
•
STATISTICIAN
And for completing this form
Thank you for participating in the Norfolk Island Census of Population and Housing 2011
Please make sure you have not missed any pages or questions
•
FINISHED?
AnnexIII
2011 Census Form
31
Rec. No
C.D:
Date: ………………………….
…………………………………………………………………………………………………………………….
Address of Dwelling: …………………………………………………………………………………………………………………..
Signature of Head of Household………………………………………………………….
Or Person in Charge
I certify that to the best of my knowledge and belief this form has been correctly filled in.
6. The completed schedule should be signed ready to hand to the Census Collector who will call on
Wednesday, 10th August or as soon as possible after that day.
5. Please use ink or ball point pen.
4. If you do not know the exact answer to a question, give the best estimate you can.
3. IF ANY PERSON IN THE HOUSEHOLD, SUCH AS A VISITOR OR BOARDER, PREFERS TO FILL IN A SEPARATE
FORM TO MAINTAIN PRIVACY, ASK THE COLLECTOR FOR ANOTHER SCHEDULE. This private schedule should
be filled in by the person concerned and sealed in the envelope provided for delivery by you unopened to
the Census Collector with this schedule.
2. IF THERE IS MORE THAN ONE HOUSEHOLD OBTAIN EXTRA FORMS FROM THE CENSUS COLLECTOR WHEN
HE/SHE RETURNS. Also obtain extra forms if there are more than 7 persons in the household.
1. FILL IN A SEPARATE FORM FOR EACH HOUSEHOLD. A household is a domestic group living and eating
together. A person living alone is also a household.
INSTRUCTIONS
The information supplied on this form is CONFIDENTIAL. The Act provides that it cannot be seen by any persons other than
Census Staff.
Under the provision of the Census and Statistics Act 1961, you are required to fill in this form to the best of your knowledge
and belief. However, there is no liability for omitting information on a person’s religion.
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND
9th AUGUST 2011
SECTION B
Place in Envelope Provided
CENSUS OF POPULATION AND HOUSING
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
CONFIDENTIAL
93
P11
P10
P9
P8
P7
P6
P5
P4
P3
P2
P1
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

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
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CONFIDENTIAL
PLEASE COMPLETE ONE COLUMN
FOR EACH PERSON
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







[1]
[__]
PERSON 2
[__]
PERSON 1
[___________]
[__]
[__]
[___________]
[__]
[___________]
[___________]
[__]
[___________]
[__]
[__]
[__]






[__]
PERSON 3
[___________]
[__]
[__]
[___________]
[__]
[___________]
[___________]
[__]
[___________]
[__]
[__]
[__]






[__]
PERSON 4
[___________]
[__]
[__]
[___________]
[__]
[___________]
[___________]
[__]
[___________]
[__]
[__]
[__]






[__]
PERSON 5
[__]
PERSON 6
[___________]
[__]
[__]
[___________]
[__]
[___________]
[___________]
[__]
[___________]
[__]
[__]
[__]






HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011
[___________]
[__]
[__]
[___________]
[__]
[___________]
[___________]
[__]
[___________]
[__]
[__]
[__]






[__]
PERSON 7
94















P16
P17
P18
P19
P20 





P15
























 









• 
• 






















[___________]
[__]
[__]
[___________]
[__]
[__]
[__]
[___________]
[___________]
[__]
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 2
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 1
[___________]
[__]
[__]
[__]
[___________]
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 3
[___________]
[__]
[__]
[__]
[___________]
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 4
[___________]
[__]
[__]
[__]
[___________]
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 5
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011






















P14
•
P13 •



P12 
P1



CONFIDENTIAL
PLEASE COMPLETE ONE COLUMN
FOR EACH PERSON
[___________]
[__]
[__]
[__]
[___________]
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 6
[___________]
[__]
[__]
[__]
[___________]
[__]
[___________]
[__]
[__]
[___________]
[__]
[___________]
[__]
PERSON 7
95
•
P26 •





 

 

 


 

 
 
 

 


 


 

 
 

 








 







[__]
[__]
[__]
PERSON 2
[__]
[__]
[__]
PERSON 3
[__]
[__]
[__]
PERSON 4
[__]
[__]
[__]
PERSON 5
[__]
[__]
[__]
PERSON 6
[__]
[__]
[__]
PERSON 7
[__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__] 
[___________]
[___________]
[___________]
[__]
[___________]
[__]
[___________]
[__]
[___________]
[__]
[__] None
[__] None
[__] None
[__] None
[__] None
[__] None
[__] None
[____] Number of births [____] Number of births [____] Number of births [____] Number of births [____] Number of births [____] Number of births [____] Number of births
[___________]
[__]
[__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__] 

[__]
[__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__] 

[__]
[__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__] 

 [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__] 

1: [__] [__]  1: [__] [__]  1: [__] [__]  1: [__] [__]  1: [__] [__]  1: [__] [__]  1: [__] [__] 







 [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__]   [__] [__] 
[__]
[__]
[__]
PERSON 1
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011








P25




P23







P22
P24









P21
P1



CONFIDENTIAL
PLEASE COMPLETE ONE COLUMN
FOR EACH PERSON
96
•


P32
P33
• 
P34 









































P31 •


• 


P30









P29


2.




















[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 1
[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 2
[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 3
[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 4
[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 5
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011



 

• 



•













P28 •
P27
P1



CONFIDENTIAL
PLEASE COMPLETE ONE COLUMN
FOR EACH PERSON
[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 6
[__]
[__]
[__]
[___________]
[___________]
[___________]
[__]
[__]
[___________]
[__]
PERSON 7
97
•



















P42C


•




•
P42B 

•


•
P41 •



•




P40 •
P42A









•
•
•
P39 •
P38








P37 •


P36 
P35
P1



CONFIDENTIAL
PLEASE COMPLETE ONE COLUMN
FOR EACH PERSON


























[__]



[__]

[__]
[__]
[__]
[__]
[__]
[__]
[__]
PERSON 3

[__]
[__]
[__]
[__]
[__]
[__]
[__]
PERSON 4

[__]
[__]
[__]
[__]
[__]
[__]
[__]
PERSON 5

[__]
[__]
[__]
[__]
[__]
[__]
[__]
PERSON 6

[__]
[__]
[__]
[__]
[__]
[__]
[__]
PERSON 7
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]  [_______]
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]  [_______]
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]  [_______]
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]  [_______]
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]  [_______]
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]

[__]
[__]
[__]
[__]
[__]
[__]
PERSON 2
[_______] 

[__]
[__]
[__]
[__]
[__]
[__]



 








 






 

 



PERSON 1
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011
98






P44


•
•
•






P43 •


P42D 
P1



CONFIDENTIAL
PLEASE COMPLETE ONE COLUMN
FOR EACH PERSON




































[__]
[__]
[__]





[__]

[__]

[__]
[__]
[__]
[__]
[__]
[__]
[__]
[__]


PERSON 4
PERSON 5
PERSON 6
PERSON 7






[__]
[__]
[__]
[__]
[__]
[__]
[__]






[__]
[__]
[__]
[__]
[__]
[__]
[__]






[__]
[__]
[__]
[__]
[__]
[__]
[__]






[__]
[__]
[__]
[__]
[__]
[__]
[__]






[__]
[__]
[__]
[__]
[__]
[__]
[__]
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]  [_______]
[__]

PERSON 3
[_______]  [_______]  [_______]  [_______]  [_______]  [_______]
PERSON 2
[_______] 
PERSON 1
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011
99
H2

2. 

1. 
[_________]









[___]
[___]

3. 

4. 














•








1. 

2. 

H1



[___] [___] [___]





1. 
2. 
3. 
4. 
5. 
H4
[___]




1. 

2. 



[___]


1. 
2. 

[________]
[________]
























• 


• 




• 



H5

H8
[___]
H9





4. 


3. 

2. 
1. 



3. 

H10
[________]




[___]
[___]
1. 
2. 
3. 
4. 
5. 
[________]
[___]

















1. 
2. 
3. 
4. 
5. 
H11




1. 
2. 
3. 
4. 
5. 
H12

H13

H14
[________]




[___]




[________]




[___]






[_____]


[_____]
[________] [___] 




[___]




9. 

8. 

7. 

6. 

5. 
[___]










10.




11.



12.


 

 13.



14.








3. 





4. 



4. 

3. 

2. 

1. 


H15

 
  
 


 

 • 
 


 
  

 



• 






 
 

 • 
•  



• 
 1. 
  


  

2. 






















2. 
3. 
4. 
1. 
5. 
 2. 
H7
     

 

 












1. 


 

 

















4. 
5. 
6. 
H6
THE NEXT SET OF QUESTIONS (H1 – H15) RELATES TO YOUR DWELLING. THIS SHOULD PREFERABLY BE ANSWERED BY THE HEAD OF THE HOUSEHOLD
PLEASE ANSWER QUESTIONS ON THIS DWELLING
HOUSEHOLDER’S SCHEDULE
NORFOLK ISLAND CENSUS OF POPULATION AND HOUSING; 9th AUGUST 2011
 


  


 

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•  1. 


•  



2. 


 


3. 
H3
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THIS DWELLING IS THE PLACE (HOUSE, FLAT, ETC) IN WHICH
YOUR HOUSEHOLD SPEND THE CENSUS NIGHT OF TUESDAY,
TH
9 AUGUST 2011
CONFIDENTIAL
PLEASE COMPLETE EACH COLUMN ON
DWELLING QUESTIONS