Questionnaire of SIEM (DL no.62/96/M
of October 14), for mandatory reply.
Registered no. of DSEC: 8/2006
Expiry date: 31/12/2006
Conf i dent i al
Go v er n m en t o f Mac ao Sp ec i al A d m i n i s t r at i v e Reg i o n
Statistics and Census Service
By-census 2006
D6DE
VR
Qs_No.
OP
Ref. No.
Dear Sir / Madam,
With the objective to collect up-to-date information on the population of Macao, Statistics and Census Service (DSEC)
is conducting the "By-census 2006". Your household has been selected to participate in this survey, we would
appreciate your cooperation in completing this questionnaire. Please read the following instructions before filling in the
information.
． Every household will answer one questionnaire. If more than one household is living in this unit or your household has
more than 4 members, please call our By-census Hotline 707070 for additional questionnaire(s).
A household refers to individuals who live together and share common provisions of living, e.g.
- A family, including live-in domestic helper or non-relatives;
- Friends who live together and make common provisions for food and other essentials for living;
- A person living alone, etc.
． This questionnaire consists of 7 parts. Parts 1 and 7 will collect information on the household, which are to be
completed either by household head or member who is familiar with the information on this household.
Household head refers to a person aged 16 or above that is acknowledged by other member(s) as the representative.
． Parts 2 to 6 will collect information on every household member and person who stayed in your household at the
reference moment, i.e. 19 August 2006 at 3:00 a.m.
． Please fill in the name(s) of your household member(s) in Question 4 (in full or initials) and respective information in
each corresponding column (every questionnaire has 4 columns).
． Personal details are more preferable to be completed by individual member. For the infant, person that has difficulties in
answering this questionnaire, member that is outside Macao at the reference period or person that gives consent, the
household head or other member may help to provide his/her information.
． Please complete this questionnaire with a blue or black ballpoint pen, the shaded squares are reserved for official use.
Answers can be given in two forms:
a) Written answer, which includes year, occupation, etc. Please write on the line provided, e.g.______
b) Multiple choice answer, which should be marked on the appropriate box with " " to indicate the answer selected,
e.g. 2
． You may also read this questionnaire and wait for our visiting enumerators, from 19 to 31 August 2006, that will assist
you in completing this questionnaire.
We would like to thank you in advance for your cooperation and support to this survey.
Statistics and Census Service
August 2006
Reser ved f or of f i ci al use
Recor d of vi si t r esul t (each f or m)
Date
19/8
20/8
21/8
22/8
23/8
24/8
25/8
26/8
27/8
28/8
29/8
30/8
31/8
Visit Result
Ques. Submit (
)
61.1 T ype of const r uct i on
61.2 T ype of househol d
11
1
12
2
13
19
E：
DSEC - 0289
0
20
H ousehol d i dent i t y (each f or m)
7A Total no. of questionnaire
30
38
sheet
7B No. of persons in this questionnaire
40
50
V：___________________
1
0
50
80
100
Form. A2-01/2006
1. How many households are living in this unit?
Par t 1
A household refers to individuals who live together and share common provisions of living, e.g.
- A family, including live-in domestic helper or non-relatives;
- Friends who live together and make common provisions for food and other essentials for living;
- A person living alone, etc.
No. of household
2. How many members are there in your household?
Note: Please include infant, elderly, live-in domestic helper and household member who is temporarily outside Macao for reason of
studying, working, travelling or visiting relatives.
No. of members
3. Besides the above-mentioned member(s), how many other persons stayed in this household on 19 August 2006 at 3:00
a.m.?
"Other persons" refers to non-household member staying in this household at the reference moment, e.g. relatives and friends who were
staying temporarily in your household while visiting Macao.
No. of persons
Pl ease pr ovi de i nf or mat i on on al l per sons t hat ar e i ncl uded i n Quest i ons 2 and 3
Every household answers one questionnaire. If more than one household is living in this unit or your household has more than 4 members,
please contact 707070 for additional questionnaires.
Par t 2
A l l per sons
4. Name of household head, household member and person staying in this
household on 19 August 2006 at 3:00 a.m.
Household head
Household head refers to a person aged 16 or above that is acknowledged by other member(s) as representative of the household.
1
Sequence No. of respondent
5. Relationship to household head
2 Spouse
3 Son/daughter
4 Son-in-law/daughter-in-law
6 Grandchild/grandchild-in-law
8 Other relatives
1 Household head
6. Gender
4
3
2
3
2
3
2
3
5 Parents/parents-in-law
4
5
4
5
4
5
4
5
7 Brother/sister
6
7
6
7
6
7
6
7
9 Non-relatives
8
9
8
9
8
9
8
9
1
M
1
M
1
M
1
M
(e.g. live-in domestic helper)
3 Female
1 Male
3
F
Year_______
7. Year and month of birth
3
F
3
F
3
F
Year_______ Year_______ Year_______
Month______ Month______ Month______ Month______
8. Place where you were on 19 August 2006 at 3:00 a.m.
Macao
3
2
(include stepson/stepdaughter or adopted son/daughter)
(e.g. grandparents, uncles, cousins, etc.)
2
1
9
9
9
20 This unit/on duty/public place in Macao
20
20
20
24 Other housing unit in Macao (include elderly home, hospital, etc.)
24
24
24
30 Mainland China
50 Hong Kong
60 Taiwan, China
70 Portugal
(Please specify on the line provided)
9 Other country, __________________________
30
9
50
60
70
_______
9. Place of usual residence in the past 6 months
30
9
50
60
70
_______
9
30
9
9
20
24
50
60
70
_______
9
30
9
50
60
70
_______
9
9
For infant who is less than 6 months old, "past 6 months" refers to the date of birth till
today
20 This unit
24 Other places in Macao
30 Mainland China
50 Hong Kong
60 Taiwan, China
70 Portugal
(Please specify on the line provided)
9 Other country, __________________________
Reason of staying outside Macao:
20
24
30
50
9
20
24
70
30
50
_______
9
60
20
24
70
30
50
_______
9
60
20
24
70
30
50
_______
9
60
60
_______
1 Studying/training
Reason:
1
Reason:
1
Reason:
1
Reason:
1
3 Working/seeking work
5 Travelling/visiting relatives
3
5
3
5
3
5
3
5
7 At home/having immigrated
8 Others
7
8
7
8
7
8
7
8
Total length of stay in Macao in the past 6 months
1 One to three months
0 Less than one month
Total length stayed:
Total length stayed:
Total length stayed:
Total length stayed:
1
1
1
1
0
10. Place of usual residence in the next 6 months
20 This unit
24 Other places in Macao
30 Mainland China
50 Hong Kong
60 Taiwan, China
0
9
20
70 Portugal
(Please specify on the line provided)
9 Other country, __________________________
30
9
9
24
20
70
30
_______
9
50
60
0
9
24
20
70
30
_______
9
50
60
0
9
24
20
70
30
_______
9
50
60
24
50
60
1 Studying/training
Reason:
1
Reason:
1
Reason:
1
Reason:
1
5 Travelling/visiting relatives
3
5
3
5
3
5
3
5
7 At home/having immigrated
8 Others
7
8
7
8
7
8
7
8
Total length of stay in Macao in the next 6 months
1 One to three months
0 Less than one month
DSEC - 0289
2
70
_______
3 Working/seeking work
Reason of staying outside Macao:
70
Total length of stay:
Total length of stay:
Total length of stay:
Total length of stay:
1
1
1
1
0
0
0
0
For i ndi vi dual s t hat have st ayed i n M acao f or l ess t han one mont h si nce Febr uar y 2006 and expect t o st ay i n M acao f or
l ess t han one mont h i n t he next 6 mont hs, " Y ou have compl et ed t he quest i onnai r e, t hank you f or your cooper at i on."
For t he ot her r espondent (s), pl ease pr oceed wi t h t he quest i onnai r e.
Par t 3
1
Sequence No. of respondent
2
3
4
11. What is your ethnicity? (What is your descent?)
Ethnicity or descent bears no relationship with one's nationality or place of birth, it is
determined by the ethnicity or descent of one's parents.
If one's parents are of Chinese descent, the ethnicity of their children is "Chinese".
If one's father is of Portuguese descent and mother is of Chinese-British descent, the
ethnicity of their children is "Chinese, Portuguese & other".
1 Chinese
2 Portuguese
3 Chinese & Portuguese
1
2
3
1
2
3
1
2
3
1
2
3
4 Chinese, Portuguese & other
5 Chinese & non-Portuguese
4
5
4
5
4
5
4
5
7 Portuguese & non-Chinese
9 Other
6
9
6
9
6
9
6
9
1
3
5
1
3
5
1
3
5
1
3
5
7
8
9
7
8
9
7
8
9
7
8
9
12. Nationality
1 Chinese
3 Portuguese
5 British
7 Thai
8 American/Canadian
9 Other
13. Place of birth
21 Macao
31 Guangdong
32 Fujian
6 Filipino
21
31
(Please specify on the line provided)
33 Other province of Mainland China, __________________________
50 Hong Kong
60 Taiwan, China
70 Portugal
93 Thailand
33
32
95 Philippines
Year of coming to reside in Macao
Year
31
33
(Please specify on the line provided)
33 Other province of Mainland China, __________________________
50 Hong Kong
60 Taiwan, China
70 Portugal
93 Thailand
50
95 Philippines
70
_______
3
_______
9
60
93
32
60
9
93
95
31
32
70
3
_______
9
60
93
32
60
9
93
95
31
32
70
9
_______
9
1
3
1
3
_______
9
60
93
32
95
9
60
93
95
_______
9
Year
_______
31
32
33
50
70
_______
3
_______
70
_______
33
33
50
Year
50
95
31
3
_______
9
6
21
_______
70
_______
33
33
50
Year
50
95
31
3
_______
9
6
21
_______
70
_______
9
(Please specify on the line provided)
9 Other, __________________________
95
32
33
50
_______
9
32 Fujian
9
93
70
Previous place of residence before residing in Macao
31
3
60
50
6
21
_______
(Please specify on the line provided)
9 Other, ___________________________
31 Guangdong
6
3
_______
9
60
93
95
_______
9
14. After you were born or coming to reside in Macao, have you been staying
outside Macao continuously for 6 months or more?
1 No
3 Yes
1
How long have you been staying outside Macao?
Absence (in year)
________
________
________
________
Year return
Year return
Year return
Year return
________
31
60 Taiwan, China
50
60
70 Portugal
93 Thailand
70
93
9
Reason for residing in the above-mentioned place:
3 Working/seeking work
8 Others
7 At home/having immigrated
Macao
20 This unit
5 Travelling/visiting relatives
3
7
8
10 Not yet born
26 Other unit in Taipa
28 Other unit in Coloane
26
28
31 Guangdong
32 Fujian
31
32
(Please specify on the line provided)
33 Other province of Mainland China, __________________________
93 Thailand
33
60
70
93
5
95 Philippines
(Please specify on the line provided)
9 Other, __________________________
60
70
93
9
16. Are you living with your father or mother in this household?
1 Yes (Are their names included in Question 4? If not, please fill in.)
1
3 No
3
3
9
95
_______
33
60
70
93
3
7
8
3
9
95
_______
Form
No
24
26
28
31
32
33
5
60
70
93
9
1
3
33
50
95
70
_______
9
_______
3
7
8
3
9
95
_______
Form
No
24
26
28
31
32
33
5
93
60
70
93
9
1
3
95
_______
1
3
7
8
5
10
3
_______
50
9
60
Reason:
1
20
3
32
10
_______
50
9
Reason:
1
20
31
_______
50
9
________
Previous
residence
3
32
10
_______
50
31
_______
50
9
3
32
10
24
70 Portugal
33
________
Previous
residence
Reason:
1
20
60 Taiwan, China
95
_______
24 Other unit in Macao Peninsula
50 Hong Kong
9
Reason:
1 Studying/training
15. Place of residence 5 years ago (i.e. August 2001)
31
_______
33
50 Hong Kong
95 Philippines
________
Previous
residence
3
32
(Please specify on the line provided)
33 Other province of Mainland China, __________________________
(Please specify on the line provided)
9 Others, __________________________
3
Absence (in year)
Previous
residence
32 Fujian
1
Absence (in year)
Year of returning to reside in Macao after your last absence for a
continuous period of 6 months or more
Your previous place of residence before returning to reside in Macao?
3
Absence (in year)
Please add up all the periods that lasted continuously for 6 months or more.
Please write "0" if the cumulative period is less than one year.
31 Guangdong
3
9
95
_______
Form
No
20
24
26
28
31
32
33
_______
50
60
70
93
9
1
3
3
9
95
_______
Form
No
For r espondent (s) aged 3 and above
Par t 4
(For individuals born after August 2003, please proceed to Part 6 - Health Status)
1
Sequence No. of respondent
2
3
4
17. Your usual language spoken at home
1 Cantonese
2 Mandarin
3 Hokkien
4 Other Chinese dialect(s)
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
5 Portuguese
6 English
7 Tagalog
9 Others
5
6
7
9
5
6
7
9
5
6
7
9
5
6
7
9
18. Besides your usual language, other language or dialect that you can speak
fluently to communicate with others (with a maximum of 3 answers)
0 None
0
0
0
0
1 Cantonese
2 Mandarin
3 Hokkien
4 Other Chinese dialect(s)
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
5 Portuguese
6 English
7 Tagalog
8 Japanese
5
6
7
8
5
6
7
8
5
6
7
8
5
6
7
8
9 Others
9
19. Are you able to read the headline in newspapers?
1 Yes
3 No
1 Yes
3 No
Are you able to write a simple note?
20. Please indicate your educational attainment in regular education (i.e. preprimary, primary, secondary or higher education) or the highest level completed
(e.g. no schooling, Primary 5, Form 4, 2nd year at university, bachelor degree or 2nd
year of a master degree programme, etc.)
If you have taken different courses of similar qualification, please provide information
on one of them.
9
21 Macao
30 Mainland China
50 Hong Kong
70 Portugal
90 USA
91 Canada
(Please specify on the line provided)
9 Other, __________________________
60 Taiwan, China
92 Australia/New
Zealand
3
1
3
1
3
1
1
3
1
3
1
3
1
The course ought to have admission pre-requisite, exam or similar procedure for
performance evaluation
1Yes
Highest level
completed
Highest level
completed
_________
_________
_________
_________
9
9
9
9
Curso
Curso
Curso
Curso
Study place:
Study place:
50
60
21
30
50
60
21
30
50
60
21
30
50
60
70
90
91
92
70
90
91
92
70
90
91
92
70
90
91
92
9
_______
30 Mainland China
70 Portugal
(Please specify on the line provided)
9 Other, __________________________
60 Taiwan, China
7 No
22. Did you use a computer in the past 3 months?
9
_______
Course:
Yes
9
_______
Yes
Course:
_________
1
Year attending:
_______
9
Course:
_________
1
Yes
4
No
Place studying: 9
Main location where the class is conducted:
50 Hong Kong
1
2
4 No
21 Macao
Study place:
30
_________
Yes
Yes
1
Year attending:
Year attending:
__________ __________ __________ __________
Is this a distance learning or internet learning course?
2 Yes
Study place:
21
Year attending:
(Please specify on the line provided)
Level or name of course _______________________
3
Highest level
completed
_________
21. Are you going to attend course in school/institute that lasts for one year or
more in the coming academic year 2006/2007?
3
Highest level
completed
Course:
(Please specify on the line provided)
Major field of study: ________________________
9
1
If information provided is of higher education, please specify:
Place where you are studying or have obtained the qualification. If the course is
organized jointly by two or more institutes, you can choose multiple answers.
9
21
30
70
9
3
No
9 No
50
60
_____
9
Yes, at places below (can choose multiple answers) :
2 At home
4 At work place
6 At school or other places
2
4
6
1
Yes
9
2
Yes
4
No
Place studying: 9
21
30
70
9
3
No
No
50
60
_____
9
2
4
6
1
Yes
9
2
Yes
4
No
21
30
70
9
3
No
50
9
2
4
6
1
Yes
9
4
No
Place studying: 9
60
_____
No
Yes
2
Place studying: 9
21
30
70
9
3
No
50
60
_____
No
9
2
4
6
1
Yes
9
No
Did you access the Internet in the past 3 months?
1 Yes
2 No
Places of accessing the Internet (can choose multiple answers)
11 At home
12 At work place
13 At school/class
(Please specify on the line provided)
14 Other place, __________________________
21 Receive/send e-mail
22 Chat room/ICQ
23 Browse/read newspapers and magazines
24 Search for information
(Please specify on the line provided)
26 Other, ___________________________
Place of acessing:
Place of acessing:
Place of acessing:
11
11
11
23. Please indicate the number of computer equipment owned by all
members of this household (can choose multiple answers)
12
_______
14
12
13
______
14
12
13
______
14
12
Purpose:
Purpose:
21
21
21
22
21
24
23
23
1
22
24
23
______
Yes
9
26
No
1
22
24
23
______
Yes
9
26
No
1
______
Yes
9
26
No
1
No
13
______
Purpose:
22
24
______
Yes
9
No
(Can be answered by household head or member who is familiar with the information on this
household)
0 None
1 Desktop
0
None
2 Laptop/notebook
3 PDA
2
Laptop/notebook
4
Other,
(Please specify on the line provided)
4 Other, __________________________
13
Purpose:
26
9 No
No
11
Did you browse the website of the Macao SAR Government in the past 3
months?
1 Yes
No
Place of acessing:
14
Purpose of accessing the Internet (can choose multiple answers)
No
4
______ pc(s)
____________ ______ pc(s)
1
Desktop
3
PDA
______ pc(s)
______ pc(s)
Form A2-01/2006
For al l r espondent s aged 14 and above
Par t 5
(For individuals born after August 1992, please proceed to Part 6 - Health Status)
1
Sequence No. of respondent
24. Marital status
1 Never married
3 Married/living together
5 Separated
2
1
Form
3
9 Widowed
7 Divorced
5
25. Besides working/attending school/doing housework, please indicate the time
spent on the following activities in the past 7 days
3
1
9
7
Form
3
No.
5
Total in last 7 days
4
1
Form
3
No.
9
7
1
5
Total in last 7 days
9
7
Form
3
No.
5
Total in last 7 days
No.
9
7
Total in last 7 days
1 Attending training courses after work/after school, read extra-curricular books, etc.
(self-learning)
_______ Hours _______ Hours _______ Hours _______ Hours
2 Jogging, swimming, playing balls, exercising Tai chi, yoga etc. (sports or out-door
activities)
_______ Hours _______ Hours _______ Hours _______ Hours
3 Using computer/accessing Internet games, ICQ, sending & receiving e-mails, etc.
(excluding the time spent on using computer for work or study)
_______ Hours _______ Hours _______ Hours _______ Hours
4 Going to cinema, watching TV or VCD, going to karaoke, playing mahjong,
reading newspapers or magazines, playing video games, listening to music, etc.
(entertainment and leisure)
_______ Hours _______ Hours _______ Hours _______ Hours
5 Giving blood, repairing household goods of neighbours, participating in social
work, etc. (voluntary work)
_______ Hours _______ Hours _______ Hours _______ Hours
26. In the past 7 days, did you travel outside Macao? (excluding business travel)
0 No
(Total for past 7 days)
1 Yes
0
11 Day trip(s) in the past 7 days, totalling _____days
11
12 Trip(s) for two days or more in the past 7 days,
totalling _____days
12
(Total for past 7 days)
Yes
0
_____ days
11
_____ days
12
1
(day trip)
(Total for past 7 days)
Yes
0
_____ days
11
_____ days
12
1
(day trip)
(Total for past 7 days)
Yes
0
_____ days
11
_____ days
_____ days
12
_____ days
1
(day trip)
Yes
1
(day trip)
(trips for 2 days or more) (trips for 2 days or more) (trips for 2 days or more) (trips for 2 days or more)
27. Your main activity during the last 7 days
2 Working or doing business
2
2
2
2
3 - On paid leave (e.g. on holiday, on sick leave, training, etc.)
- On unpaid leave, but will resume work on an agreed date or within 30 days
3
3
3
3
4 Not having a job
5 Taking care of the house/child(ren)
4
5
4
5
4
5
4
5
6 Retired
7 With disability/ chronic illness
6
7
6
7
6
7
6
7
8 Attending school (including student on summer holiday who is not working)
8
(Please specify on the line provided)
9 Other, ______________________________
9
_______
9
_______
9
_______
9
_______
1
Please go to
question 28
1
Please go to
question 28
1
Please go to
question 28
1
Please go to
question 28
In the past 30 days, have you tried seeking for work?
3
3
Yes
Yes
3
Yes
months
3
8
months
Please go to question 28
8
months
1 Yes
3 No
months
During the past 7 days, have you worked for a paid job for one hour or more,
including part-time or causal work? Have you worked for other family member(s)
without a regular pay?
8
Yes
1 Yes, I have spent _____month(s) seeking for work
1
________ months
1
________ months
1
________ months
1
________ months
0 No
0
No
0
No
0
No
0
No
Why?
2 Have found a job and will start working on a specified date
3 Will resume current job within 30 days
Reason:
4 Will start own business shortly
2
5 Unavailability of a suitable job/Not meeting employer's requirements
3
6 Personal or family reason (taking care of the house/attending school/retired, etc.)
5
(Please specify on the line provided)
9 Other, ______________________________
9
During the past 7 days, if you were hired, were you available to work immediately?
1 Yes
0 No, because of:
Reason:
3 Illness/maternity
5 Attending school/training
7 Taking care of the house/
child(ren)
9 Other reasons
Pl ease go t o Par t 6 - H eal t h St at us
2
4
6
_______
Available to work
1
3
0
Reason:
7
5
9
9
2
3
4
5
6
_______
Available to work
1
0
Reason:
3
5
7
9
9
2
3
4
3
4
5
6
5
6
_______
Available to work
1
0
3
5
7
9
9
_______
Available to work
1
0
3
5
7
9
Please go to Part 6
Please go to Part 6
Please go to Part 6
Please go to Part 6
2
2
2
2
28. Your employment status (when working for a paid job or family member):
2 Employer (with fulltime employee)
8 Unpaid family worker
4 Self-employed (without full-time
employee)
6 Employee
8
(working for family member without a regular pay)
5
4
6
8
4
6
8
4
6
8
4
6
1
Sequence No. of respondent
29. Your total employment earnings in July 2006 (MOP)
2
3
4
For employee, it includes salary, commission, tips, overtime payment, bonuses, subsidies and rewards
paid by employer in cash. For employer and self-employed, it refers to the profit derived from business
operation
1 Less than MOP 3 000
2 MOP 3 001 - 4 000
3 MOP 4 001 - 6 000
1
2
3
1
2
3
1
2
3
1
2
3
4 MOP 6 001 - 8 000
5 MOP 8 001 - 10 000
6 MOP 10 001 - 12 000
4
5
6
4
5
6
4
5
6
4
5
6
7 MOP 12 001 - 14 000
8 MOP 14 001 - 20 000
9 MOP 20 001 - 40 000
7
8
9
7
8
9
7
8
9
7
8
9
10 Over MOP 40 000
11 Unpaid family worker
10
11
10
11
10
11
10
11
30. Principal business of the establishment where you are working
__________ __________ __________ __________
Industry
Your job title
Industry
Industry
Industry
__________ __________ __________ __________
Occupation
Your main duties
Occupation
Occupation
Occupation
__________ __________ __________ __________
Work and duty
Work and duty
Work and duty
Work and duty
The usual time you first leave home to work in the past 7 days
1 In the morning (0:00-11:59)
2 In the afternoon (12:00 - 23:59)
1
____:____
Hour
2
____:____
Minute
Hour
Principal means of transport to work
1 By bus
2 By car
3 By motorcycle
4 By taxi
5 On foot
6 Transportation provided by employer
(Please specify on the line provided)
9 Other, ______________________________
1
2
5
6
9
4
1
____:____
Hour
1
2
5
6
9
Minute
3
4
_______
2
1
____:____
Hour
1
2
5
6
9
3
4
2
____:____
Minute
_______
(For all respondents who have answered Part 3)
- Mobility, e.g. climbing stairs, using public transport facilities
- Self care, e.g. going to toilet, bathing, eating, etc.
- Communication, e.g. having conversation, using body language, etc.
- Other activities, e.g. daily activities such as personal interactions, doing housework, receiving
education, working, etc.
Hour
1
2
5
6
9
Minute
3
4
_______
1
2
Next
respondent
1
3
Next
respondent
1
4
Next
respondent
1
Next
respondent
1
end of the question on individual, please go to next member
3 Yes, still require assistance from others occasionally
5 Yes, always require assistance from others
3
32. Have the above-mentioned difficulties been continuously occurring or will
expect to continue for 6 months or more?
Par t 7
3
_______
Sequence No. of respondent
31. Even with the help of auxiliary equipment, do you still require assistance
from others in performing the following activities as a result of your physical,
mental or emotional conditions?
1 Yes
Minute
2
H eal t h St at us
Par t 6
1 No
1
3 No
3
5
1
3
3
5
1
3
3
5
1
3
5
1
3
H ousehol d
(Can be answer ed by househol d head or member who i s f ami l i ar wi t h t he i nf or mat i on on t hi s househol d)
H1 This unit is:
H2 Monthly mortgage/rent payment
(excluding water, electricity and telephone charges, management fee and
parking expenses)
1
Owner-occupied/owned by household member(s)
2
Mortgage free or rent free
3
Rented
4
Monthly mortgage/rent payment (MOP)__________________
5
Accommodation provided by employer
7
Other, ___________________________
H4 This household has ____motorcycle(s) or
H3 This household has ____ bedroom(s) for household
member(s)
bedroom(s)
H5 Main parking spot of car(s) at night in the past 7 days
____car(s) for use by the household member(s)
0
No car
1
____car(s) in private carpark
(excluding commercial vehicle)
2
_____car(s) in paid public carpark
3
____car(s) in street parking
T1 Tel. No. (for future follow-up) _____________________________
T1
T2 Convenient time of contact ______:______~ ______: ______
End of t he Quest i onnai r e. T hank Y ou f or Y our Suppor t and Cooper at i on
6