Minister of Economy and Finances, Burkina Faso
National Institute of Statistics and Demography
Central Census Bureau
General Population and Habitation Census 1996
Decree Number____
Census Notebook
Notebook number____
Number of notebooks____
Box to be filled out by the supervisor:
____1. Province
____3. Commune/Neighborhood
____4. Counting Zone Number
____5. Village/Sector
____6. Control Zone Number
II. Census Notebook Summary Table
Resident Status:
1. Present Residents (RP)
____ F
____ Total
2. Absent Residents (AP)
____ F
____ Total
Subtotal (1+2):
____ F
____ Total
3. Visitors (VIS)
____ F
____ Total
4. Emigrants (EM)
____ F
____ Total
Total Counted (1+2+3+4):
____ F
____ Total
____ Name of census agent
____ Date of counting
____ Name of supervisor
____ Date of supervisor check
____ Name of codification agent
____ Date of codification
____ Name of data entry agent
____ Date of data keying
Observations________
Summary Table
To be filled out throughout the counting of the population
____ Concession number
____ Household number
____ Name of Head of Household
Present Residents
____ F
____ Total
Absent Residents
____ F
____ Total
Emigrants
____ F
____ Total
Visitors
____ F
____ Total
____ Page number
____ Total number of pages
2. Household number (in the ZD) _ _
3. Household type
[] 2 Collective
4. Language currently spoken in the household _ _
Resident Status:
1. Present Residents (RP)
____ F
____ Total
2. Absent Residents (AP)
____ F
____ Total
3. Visitors (VIS)
____ F
____ Total
4. Emigrants (EM)
____ F
____ Total
Total Counted (1+2+3+4):
____ F
____ Total
H1. Housing zone
[] 2. Non-plotted zone
H2. Housing type
[] 2. Villa
[] 3. Single family home
[] 4. Multiple family dwelling (not apartments)
[] 5. Hut
[] 6. Other
H3. Type of walls
[] 2. Partly hard material (structure made with both hard material, such as cement, and something more removable, such as earthen plaster, wood, etc.)
[] 3. Fortified dried red earth
[] 4. Dried red earth
[] 5. Straw
[] 6. Other
H4. Type of roof
[] 2. Sheet metal
[] 3. Tiles
[] 4. Clay
[] 5. Sand
[] 6. Other
H5. Type of floor
[] 2. Cement
[] 3. Earth
[] 4. Sand
[] 5. Other
H6. Main light source
[] 2. Gas lamp
[] 3. Kerosene lamp
[] 4. Flashlight
[] 5. Oil lamp
[] 6. Candles
[] 7. Wood/Straw
[] 8. Other
H7. Principal water source
[] 2. Public tap
[] 3. Drilled pump
[] 4. Cased well
[] 5. Ordinary well
[] 6. River, marshland, dam
[] 7. Other
H8. Sanitary equipment
[] 2. Ventilated pit latrine
[] 3. Ordinary latrine
[] 4. Outdoors
[] 5. Other
H9. Trash disposal method
[] 2. Trash heap
[] 3. Ditch
[] 4. Dumpster
[] 5. Street
[] 6. Other
H10. Used water disposal method
[] 2. Street
[] 3. Ditch
[] 4. Gutters
[] 5. Septic tank
[] 6. Other
H11. Principal source of cooking energy
[] 2. Natural gas
[] 3. Petrol
[] 4. Coal
[] 5. Wood (reinforced hearth)
[] 6. Wood (simple hearth)
[] 7. Other
[] 8. Not applicable
H12. Occupation status
[] 2. Rent-to-own
[] 3. Rent
[] 4. Lodged for free
[] 5. Other
H13. Number of rooms occupied by household _ _
IV. Deaths in the last 12 months
Has anyone in your household died within the last 12 months?
[] 2. No
If yes, how many? _ _
[Questions asked for each deceased member of the household.]
Full name____
Sex:
[] 2 Female
Age at time of death:
Code____
Entire Population
[Questions P01 to P14 were asked for all persons.]
Record all persons in the household beginning with the head of household.
P03. Sex
[] 1 - Male
[] 2 - Female
Relationship to head of household
P04. What is [person]'s relationship to the head of household?
[] 1 = head of household
[] 2 = spouse
[] 3 = son/daughter
[] 4 = brother/sister
[] 5 = father/mother
[] 6 = cousin
[] 7 = nephew/niece
[] 8 = other relative
[] 9 = no relation
P05. Resident status
[] 1 - RP if the person typically lives in the household and spent the preceding night in the household
[] 2 - RA for persons that typically live in the household, but were absent the preceding night
[] 3 - VIS for visitors
[] 4 - EM for emigrants
P06. Date of birth
What is [person]'s date of birth? Write the month and year of birth.
_ _ Year
P07. Age: If the date of birth is unknown, what is [person]'s age in full years?
Place of birth
P08. Where was [person] born?
____
Place of residence one year ago
P09. In which province and department, or in which country, did [person] live a year ago?
____
P10. Principal nature of handicap
[] 01. Paralysis of upper extremities
[] 02. Paralysis of lower extremities
[] 03. Quadriplegic
[] 04. Amputation of upper extremities
[] 05. Amputation of lower extremities
[] 06. Amputation of upper and lower extremities
[] 07. Leprosy
[] 08. Mental retardation
[] 09. Insanity
[] 10. Blind
[] 11. Deaf
[] 12. Mute
[] 13. Deaf-mute
[] 14. Other
P11. Father: Is [person]'s father still alive?
[] 1. Yes
[] 2. No
[] 3. Don't know
P12. Mother: Is [person]'s biological mother still alive?
[] 1. Yes
[] 2. No
[] 3. Don't know
Religion:
P13. What is [person]'s religion?
[] 1 = Animist
[] 2 = Muslim
[] 3 = Catholic
[] 4 = Protestant
[] 5 = Other
[] 6 = Not religious
Nationality:
P14. What is [person]'s nationality?
[] 01 = Burkinabe
[] 02 = Benin
[] 03 = Ivory Coast
[] 04 = Ghana
[] 05 = Mali
[] 06 = Niger
[] 07 = Nigeria
[] 08 = Senegal
[] 09 = Togo
[] 10 = Other African country
[] 11 = Europe
[] 12 = Other
Residents age 6 years or older:
[Questions P15 was asked for persons 6 years of age or older who were household residents.]
Education level:
P15. Did [person] attend school? If yes, what is the last year completed of the highest level achieved?
[] 0. None
[] 1. 1st and 2nd grades
[] 2. 3rd and 4th grades
[] 3. 5th and 6th grades
[] 4. Middle school
[] 5. High school
[] 6. Higher
Residents age 8 years or older:
[Questions P16 and P17 were asked for persons 8 years of age or older who were household residents.]
Literacy:
Does [person] know how to read and write a language fluently?
Circle the corresponding code.
P16. Foreign:
[] 1 = French
[] 2 = Arabic
[] 3 = English
[] 4 = Other foreign language
P17. National:
[] 1 = Mooré [Mossi language]
[] 2 = Dioula [Mande language]
[] 3 = Fufuldé [Fula or Fulani language]
[] 4 = Other national language
Residents age 10 years or older:
[Questions P18 to P22 were asked for persons 10 years of age or older who were household residents.]
Occupational status:
P18. Has [person] worked during the last seven days?
If no, circle the corresponding code and go to P21.
[] 1. Employed (OCC)
[] 2. Unemployed and looking (CHO)
[] 3. Looking for first job (QUE)
[] 4. Retired (RET)
[] 5. Housewife (FOY)
[] 6. Student (ETU)
[] 7. Shareholder (REN)
[] 8. Other inactive persons (AUT)
Principal occupation:
P19. What is the occupation at which [person] spent the most time over the last seven days?
____
Situation within principal occupation:
P20. What is/was [person]'s situation within this occupation?
[] 1. Employer, Boss (EMP)
[] 2. Independent (IND)
[] 3. Salaried (SAL)
[] 4. Apprentice (APP)
[] 5. Family helper (AIF)
[] 6. Other (AUT)
Type of economic activity:
P21. What is the primary activity of the company for which [person] works/worked?
____
Secondary occupation:
P22. What occupation takes the most of [person]'s time after the primary occupation?
____
Residents age 12 years or older:
[Question P23 was asked for persons 12 years of age or older who were household residents.]
Marital status
P23. Does [person] live with one or more women (a man)?
[] 0. Single
[] 1. Married and monogamous
[] 2. Married to two women
[] 3. Married to three women
[] 4. Married to four or more women
[] 5. Widowed (man or woman)
[] 6. Divorced or separated (man or woman)
[] 7. Civil union
Female residents age 12 years or older:
[Questions P24 to P26 were asked for females 12 years of age or older.]
Survival of children
P24. Live births: How many live births total has [person] had?
_ _ Male
_ _ Female
P25. Living children: Of those births listed above, how many of the children are still alive?
_ _ Male
_ _ Female
P26. Births within the last 12 months: How many of [person]'s children were born alive during the last 12 months?
_ _ Male
_ _ Female