CENSUS OF POPULATION AND HOUSING 1971
NAME OF ISLAND: ....................................................................................
WESTERN SAMOA
POLITICAL DISTRICT No.: .....-...._.................. ........................
NAME: .........................................................
POPULATION INTERVIEW SCHEDULE
CONFIDENTIAL
This inquiry is authorised by Law.
All information will be treated as strictly confidential
READ INSTRUCTIONS CAREFULLY BEFORE MAKING ENTRIES
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P- 1 SERIAL NUMBER O F PERSON
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P- 2 NAME: Enter names of all persons likely to reside in the unit on the Final Census night in this order:Head, wife, unmarried sons and daughters by order of their age, married sons and daughters and family
members, other relatives, and other persons, using one column for each person.
P- 3 RELATIONSHIP TO HEAD: State relationship to Head or Person-in-charge, e.g., Head, wife, son,
daughter, daughter-in-law, father, mother, brother, sister, nephew, niece, or boarder, guest, employee,
employee's wife. When the Head of the Household is a Matai, enter Matai instead of Head.
U Y
P- 4 UNDER A MATAI: Tick ( 1) Box. Y for YES N for NO,
U N
P- 5 HOUSEKEEPING AltRAN6EhlENT : State whether the person has housekeeping arrangements
common with the other occupants of- the unit for providing himself or herself with food.
Tick ( J ) Box. Y for YES, N for NO.
P- 6 SEX: Tick (v')
/ y
UN
Box. M for MALE, F for FEMALE.
P- 7 AGE AND DATE OF B I R T H : ( a ) Enter age in completed years as a t last birthday. If less than one
year, write 'o'
day
month
year
( b ) Enter date of birth.
P- 8 MARITAL STATUS : Indicate Marital Status by using the following codes :-Tick
N - Never Married. M - Now married. S - Married but living separately.
D - Legally divorced and not reharried. W - Widowed and not remarried.
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( Y ) appropriate BOX
P- 9 RELIGIOUS AFFILIATION: Use the following codes to indicate the peqon's religious affi1Ìation:Tick t V 7 ) appropriate Box.
RC - Roman Catholic.
CC - Congregational Christian.
LDS - Latter Day Saints,
M - Methodist.
CE - Church of England.
SDA - Seventh Day Adventist
O - Objection to the question.
N - No religious dehomination.
Other religious affiliation (specify)
Village
P-10 PLACE; OF BIRTH: If born in Western Samoa, name VILLAGE and FAIPULE DISTRICT. If born outside Western Samoa, naine COUNTRY,
Faipule Dist.
Country
P-11 I'Li1CE O F USUAL RESIDENCE : Usual residence is the geographical location, i.e.,
Village and Faipule district in which the person usually resides at present and from
where he/she goes to work, school, etc. If the place of usual residence is outside West- Faipule Dist.
ern Samoa, name the country of usual residence. In respect of persons who are enumeratCountry
ed at their place of usual residence. Tick ( J ) Box PE.
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(IRC
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U M DLDS
USDA D C E
DSDA O C E
LP /70
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P-12 PLACE OF PREVIOUS USUAL RESIDENCE: (in November 1970) State the
Village
Village and Faipule district in Western Samoa, or the Country overseas where the ~
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person resided in Novcmber 1970. In respect of persons whose place of usual residence
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Country
in November 1970 was the same as in November 1971. Tick ( J ) Box SP.
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DSP
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P-13 CITIZENSHIP: (Legal Nationality) Tick ( J ) appropriate Box. State the citizenship
of the person using the following codes:CB - Citizen of Western Samoa by Birth.
C D - Citizen by Descent.
CN - Citizen by Naturalisation.
If the person is a alien, state the Country of his citizenship.
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UCD
/GN
Country
P-14 LANGUAGE:
If the person i s able to speak Samoan, tick ( / ) Box SA.
English, tick (Y)Box EN.
Speak any other language, enter the name of the language.
P-15 LITERACY (For persons 10 years and over) : If the person is able to read and write a short stetament
with understanding, in Samoan tick ( /) Box SA, if in English tick ( Y ) Box EN. .If the person can
read and write any other language with understanding, write the name of the language.
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PH-2
CENSUS No.:
Schedule Na: .............................".....
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FAIPI JLE DISTklCT NAME:
HOUSING UNI?'
COLLECTIVE LIVING UNIT
& not applicable)
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6
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VILLAGE NAME: ................................................................
No.: ......................_...........
CENSUS BLOCK No.: ..........................................................
NON-HOUSING UNIT
(Strike off what
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No.: ................................
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10
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P-16 ATTENDANCE AT AN EDUCATIONAL INSTITUTION:
(For persons 5 years and over). If the person is attending an educational institution from 1 August
1971 as a full-time student, you will use the following codes to specify the type of institution in which
he/she is enrolled as a student. Tick ( Y) appropriate Box.
TT - Teachers Training College.
PS - Primary School.
TS - Trades School.
IS - Intermediate School.
AC - Agricultural College.
JHS - Junior High School.
OT - Other Type.
SS - Secondary School.
UNI - University.
If the person is not a full-time student, tick ( J ) Box N.
DUNI
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P-17 EDUCATIONAL AITAINMENT: (For persoiis 6 years and over).
(a) For person reported as a full time student at P-16, enter the highest class so far completed, e.g.,
Primer II, Standard IV, Form VI, etc. For persons who attend a foreign institution of general
education, enter the number of completed years he/she has up to now spent at school e.g. 6 years,
8 years.
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(b) For persan not reported as a full time student dt P-16, enter the highest class completed or the
highest professional, or technical qualifications obtained (e.g., Diploma in Education, Degree in
Engineering, etc.) , and also the Field of Training.
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( c ) If the person has never been to an :ducational institution or attended such institution for less than
one year, tick ( J ) Box N.
P-18 CHILDREN EVER BORN ALIVE: (Females 14 years and over)
Enter using codes B - Boys, G - Girls.
(a) Number of children born alive.
(b) Number of children still alive and living with mother.
(c) Number of children still alive and not living with mother.
(d) Age of mother when first child was born.
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Age .............................
..................B...............G ..................B...............C
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..................B...............G ..................B ..............C
Age ..............
Age ..............................
P-19 CHILDREN BORN ALIVE DURING THE TWELVE MONTHS PRECEDING THE CENSUS:
(Females 14 years and over).
Enter using codes B - Boys, G - Girls.
(a) .................. B...............G ..................B...............G ..................B...............G ..................B...............C
(a) Total number of children born alive.
..................B...............G .................. B...............G ..................B...............G ..................B...............C
(b)
(b) Total number of children living.
P-20 TYPE OF ACTIVITY (Persons 10 years and over) :
State the Activity in which the person spent most of his/her time during the week preceding the Preliminary Census, 17-23 October 1971. Using the codes given below indicate the type of the person's activity:- Tick ( J) appropriate Box.
WM - Working primarily to earn money.
WS - Working primarily to grow, gather or catch food to eat (not for sale).
J - Having a job, but not at work.
LK - Looking for money raising work for the first time.
PE - Previously employed but looking for work.
S - Attending School full time.
U& - Unable to work
H M - Home making. (unpaid)
OT - Other.
I R - Income Recipient
P-2 1 EMPLOYMENT STATUS: Refers to prson economically active during the week preceding the
Preliminary Census. 17-23 October 1971. By using the codes given below indicate the person's status:
Tick (J) appropriate Box.
UA - Unpaid family worker (Agriculture).
EM - Employer
U 0 - Unpaid family work (outside Agriculture).
EE - Employee.
NC - Person ilot classifiable by status.
OA - Own Account worker.
P-22 PRINCIPAL OCCUPATION: State the kind of occupation or kind of work regularly followed during
the week preceding the Preliminary Census 17-23 October 1971 which brings in the largest income to
this person (e.g. Accounts Clerk, Crane operator, Civil engineer teacher, etc).
P-23 KIND OF INDUSTRY, BUSINESS OR SERVICE: State the type of establishment in which the person
worked, or kind of industry, business or service carried out in the person's work place during most time
of the week preceding the Preliminary Census 17-23 October 1971 (e.g. Department of Agriculture,
Soap factory, Retail store, Motor engineering. etc.)
P-24 NAME OF EMPLOYER: State the name of the firm,department or individual employer for which the
person worked during the week preceding the Preliminary Census 17-23 October 1971 (eg., Department
of Education, Morris Hedstroms Ltd, Bank of Western Samoa, etc).
P-25 NUMBER OF HOURS WORKED: State the nur, ber of hours worked during the week preceding the
Preliminary Census 17-23
October 1971 in one or more jobs.
P-26 SECONDARY OR SUBSIDIARY OCCUPATION: (if any) State whether the person had a Secondary job, i.e., a job in addition to his/her principal occupation during the week preceding the Preliminary
Census 17-23 October 1971. ( J )Box Y for YES N for NO.
P-27 AGRICULTURAL OPERATOR: This cage will be entered for the person who operated a 'Holding'
individually or collectively on a family basis, duriñg the week preceding the Preliminary Census 17-23
October 1971. Tick ( J ) appropriate Box to indicate the tenure of the holding,
SL - Samoan Land
FO - Freehold land owned
FL - Freehold land Leased
You will enter the following codes within brackets to describe the type of holding.
CH - Crop Holding
LP - Livestock and Poultry Holding
MH - Mixed Holding
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P-28 MEANS OF LIVELIHOOD: Describe the principal source from which the person derived his/her
living during the 12 months preceding the Census, uslng the following codes:EA - Economic Activity
P - Pension
BA - Benefits and assistance
PI - Property or other Investments
SP - Support by other person or persons
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