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Bangladesh Bureau of Statistics
Population and Housing Census 2001

Short Questionnaire
Form-01/PC-2001

Housing Module

1 Part of previous household? _

2 Address ____

3 Household number _ _ _

4 Is this floating? _

5 Is this a slum household? _

6. Is this a tribal household? _

7. Household type

[] 1 General
[] 2 Institutional
[] 3 Others

8. Number of structure of Household
("9" if part of the household and "0" otherwise)

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

9. Household types of main house

[] 1 Jhupri/Slum
[] 2 Katcha
[] 3 Semi Pucca
[] 4 Pucca

10. Ownership of house

[] 1 Own
[] 2 Rented
[] 3 Rent-free

11 Source of drinking water

[] 1 Tap
[] 2 Tube well
[] 3 Deep tube well
[] 4 Pond/tank
[] 5 Others

12 Toilet facilities

[] 1 Sanitary
[] 2 Others
[] 3 None

13 Electricity connection

[] 1 Yes
[] 2 No

14 Own agriculture land

[] 1 Yes
[] 2 No

15 Has disabled persons?
(Check “Yes if the household has disabled persons)
[] Yes
[] No

Number of people who are blind/night blindness
[] 0
[] 1
[] 2
[] 3

Number of people who are deaf or dumb
[] 0
[] 1
[] 2
[] 3+

Number of handicap persons
[] 0
[] 1
[] 2
[] 3
[] 4+

Number of mentally disabled persons
[] 0
[] 1
[] 2
[] 3+

16. Main source of income of the household

[] 1 Agriculture/Forestry/Livestock
[] 2 Fisherman/Fish farming
[] 3 Agriculture labor
[] 4 Non-Agriculture labor
[] 5 Handloom
[] 6 Industry/Factory
[] 7 Business
[] 8 Hawker
[] 9 Transport
[] 10 Construction
[] 11 Religious work
[] 12 Service
[] 13 Rent
[] 14 Remittance
[] 15 Others

Persons Module

17. Name of the members of the Household
(Starting with the name of the head of the household)
Serial number _ _
Name ____

18. Age (in complete years)
(Written the age by verifying with others)
Age _ _

19. Relationship to the head of the household

[] 1 Household head
[] 2 Wife/husband
[] 3 Children
[] 4 Others

20. Sex

[] 1 Male
[] 2 Female

21 Marital status

[] 1 Unmarried
[] 2 Married
[] 3 Widow/widower
[] 4 Divorced/Separated

22 Religion

[] 1 Islam
[] 2 Hindu
[] 3 Christian
[] 4 Buddhist
[] 5 Others

[Questions from 23 to 28 is applicable for persons aged 5 years and above]

23 Highest grade passed

[] 0 No class passed
[] 1 Class I
[] 2 Class II
[] 3 Class III
[] 4 Class IV
[] 5 Class V
[] 6 Class VI
[] 7 Class VII
[] 8 Class VIII
[] 9 Class IX
[] 10 Secondary school certificate (SSC)/ Dakhil
[] 11 Training
[] 12 Higher secondary certificate (HSC)/ Alim
[] 13 Diploma
[] 14 Bachelor/ Fazil
[] 15 Bachelor honors
[] 16 Master/ Kamil
[] 17 Master (MS)/ Phd.

24 Field of education

[] 1 General
[] 2 Vocational/Technical
[] 3 Religious

25 Student?

[] 1 Yes
[] 2 No

26. Can write a letter?

[] 1 Yes
[] 2 No

27. Main field of Profession/work (last one week)

[] 1 Not working
[] 2 Looking for work
[] 3 Household work
[] 4 Agriculture
[] 5 Industry
[] 6 Water/Electricity/Gas
[] 7 Construction
[] 8 Transport/communication
[] 9 Hotel/restaurant
[] 10 Business
[] 11 Service
[] 12 Others

28. Work status

[] 1 Employer
[] 2 Family worker
[] 3 Self-employed
[] 4 Day labor
[] 5 Servant at home
[] 6. Others