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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:

I. Identification

____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)

____ M
____ F
____ Total

2. Absent Residents (AP)

____ M
____ F
____ Total

Subtotal (1+2):

____ M
____ F
____ Total

3. Visitors (VIS)

____ M
____ F
____ Total

4. Emigrants (EM)

____ M
____ F
____ Total

Total Counted (1+2+3+4):

____ M
____ 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

____ M
____ F
____ Total

Absent Residents

____ M
____ F
____ Total

Emigrants

____ M
____ F
____ Total

Visitors

____ M
____ F
____ Total

Household Form

____ Page number
____ Total number of pages

I. Identification

1.Concession number _ _ _

2. Household number (in the ZD) _ _

3. Household type

[] 1 Ordinary
[] 2 Collective

4. Language currently spoken in the household _ _

II. Household Summary Table

Resident Status:

1. Present Residents (RP)

____ M
____ F
____ Total

2. Absent Residents (AP)

____ M
____ F
____ Total

3. Visitors (VIS)

____ M
____ F
____ Total

4. Emigrants (EM)

____ M
____ F
____ Total

Total Counted (1+2+3+4):

____ M
____ F
____ Total

III. Housing Characteristics

H1. Housing zone

[] 1. Plotted zone
[] 2. Non-plotted zone

H2. Housing type

[] 1. Apartment building
[] 2. Villa
[] 3. Single family home
[] 4. Multiple family dwelling (not apartments)
[] 5. Hut
[] 6. Other

H3. Type of walls

[] 1. Hard material, such as cement, brick, etc.
[] 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

[] 1. Concrete
[] 2. Sheet metal
[] 3. Tiles
[] 4. Clay
[] 5. Sand
[] 6. Other

H5. Type of floor

[] 1. Tile
[] 2. Cement
[] 3. Earth
[] 4. Sand
[] 5. Other

H6. Main light source

[] 1. Electricity
[] 2. Gas lamp
[] 3. Kerosene lamp
[] 4. Flashlight
[] 5. Oil lamp
[] 6. Candles
[] 7. Wood/Straw
[] 8. Other

H7. Principal water source

[] 1. Running water
[] 2. Public tap
[] 3. Drilled pump
[] 4. Cased well
[] 5. Ordinary well
[] 6. River, marshland, dam
[] 7. Other

H8. Sanitary equipment

[] 1. Flush toilet with septic system
[] 2. Ventilated pit latrine
[] 3. Ordinary latrine
[] 4. Outdoors
[] 5. Other

H9. Trash disposal method

[] 1. Trash can
[] 2. Trash heap
[] 3. Ditch
[] 4. Dumpster
[] 5. Street
[] 6. Other

H10. Used water disposal method

[] 1. Courtyard
[] 2. Street
[] 3. Ditch
[] 4. Gutters
[] 5. Septic tank
[] 6. Other

H11. Principal source of cooking energy

[] 1. Electricity
[] 2. Natural gas
[] 3. Petrol
[] 4. Coal
[] 5. Wood (reinforced hearth)
[] 6. Wood (simple hearth)
[] 7. Other
[] 8. Not applicable

H12. Occupation status

[] 1. Owner
[] 2. Rent-to-own
[] 3. Rent
[] 4. Lodged for free
[] 5. Other

H13. Number of rooms occupied by household _ _

Only count the living room and bedrooms, including those of dependents.

IV. Deaths in the last 12 months

Has anyone in your household died within the last 12 months?

[] 1. Yes
[] 2. No

If yes, how many? _ _

[Questions asked for each deceased member of the household.]

Number____

Full name____

Sex:

[] 1 Male
[] 2 Female

Age at time of death:

Age ____
Code____

V. Individual Characteristics

Entire Population
[Questions P01 to P14 were asked for all persons.]

P01. Order Number _ _

P02. Full name____

Record all persons in the household beginning with the head of household.
P03. Sex

Circle the corresponding code.
[] 1 - Male
[] 2 - Female

Relationship to head of household
P04. What is [person]'s relationship to the head of household?

Circle the corresponding code.

[] 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

Circle the corresponding code.

[] 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

Date of Birth or Age

P06. Date of birth

What is [person]'s date of birth? Write the month and year of birth.

_ _ Month
_ _ 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?

Write the name of the province and the department if the person was born in Burkina Faso, or the name of the country if they were born outside of Burkina Faso.

____

Place of residence one year ago

P09. In which province and department, or in which country, did [person] live a year ago?

Write the name of the province and the department or country in which [person] lived one year ago.
____

P10. Principal nature of handicap

[] 00. No 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

All Residents:

Survival of parents

P11. Father: Is [person]'s father still alive?

Circle the corresponding code.

[] 1. Yes
[] 2. No
[] 3. Don't know

P12. Mother: Is [person]'s biological mother still alive?

Circle the corresponding code.

[] 1. Yes
[] 2. No
[] 3. Don't know

Religion:

P13. What is [person]'s religion?

Circle the corresponding code.

[] 1 = Animist
[] 2 = Muslim
[] 3 = Catholic
[] 4 = Protestant
[] 5 = Other
[] 6 = Not religious

Nationality:

P14. What is [person]'s nationality?

Circle the corresponding code.

[] 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?

Circle the corresponding code.

[] 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:

[] 0 = None
[] 1 = French
[] 2 = Arabic
[] 3 = English
[] 4 = Other foreign language

P17. National:

[] 0 = None
[] 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 yes, circle code 1.
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?

Write in clearly in the column.

____

Situation within principal occupation:
P20. What is/was [person]'s situation within this occupation?

Circle the corresponding code.

[] 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?

Write in clearly in the column.
____

Secondary occupation:

P22. What occupation takes the most of [person]'s time after the primary occupation?

Write in clearly in the column.
____

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)?

Circle the corresponding code.

[] 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?

Write the given number, divided by sex.

_ _ Male
_ _ Female

P25. Living children: Of those births listed above, how many of the children are still alive?

Write the given number, divided by sex.

_ _ Male
_ _ Female

P26. Births within the last 12 months: How many of [person]'s children were born alive during the last 12 months?

Write the given number, divided by sex.

_ _ Male
_ _ Female