Read the instructions on the other side before filling out this form
República de Chile
Ministerio de Economía
Dirección de Estadística y Censos
____ Zone
____ Revision
____ Department
____ Form
____ Code
____ County
____ Urban or Rural
____ Suburbs
____ District
____ Part or Complete
____ Verify
5. ____ Zone number
[] 2 Rural
7. ____ Control sheet line number
8.
[] 2 Non-family group or collective
b) ____ Category
Indicate whether a city, town, village, hamlet, farm, mine, camp, fishermen wharf, island, lighthouse, sulfur mine, nitrate mine, station, railroad station, station, indigenous settlement, etc.
____ Number
____ Floor
____ Apartment
Rural:
____ Route
1. Dwelling type
[] 02 Apartment in an apartment building
[] 03 Shack (casita de cité)
[] 04 Apartment or room in a house
[] 05 Apartment or room in a school, factory, workshop, collective dwelling, etc.
[] 06 Room in a high-density slum dwelling
[] 07 Improvised dwelling (callampa, squatter settlements)
[] 08 Shack in a farm (rancho), Indian dwelling, rustic huts
[] 09 Trailer, boat, boxcar
[] 10 Others (tents, parked cars, etc.)
[] 12 Hotel
[] 13 Lodge
[] 14 Hospitals and asylums
[] 15 Convent
[] 16 Boarding school
[] 17 Regiment or military camp
[] 18 Prison
[] 19 Workers' camps, cabins, etc.
[] 20 Others
a) Exterior walls
Material
[] 2 Brick, cement block or stone
[] 3 Mortared adobe
[] 4 Wood
[] 5 Exterior brick covered with galvanized, asbestos/cement or other type of siding boards bricks.
[] 6 Bricks placed on edge. Flat adobe, or cement brick
[] 7 Stick-and-mud, clay, straw, waste materials, tin, cardboard
[] 8 Other material
Condition
[] 2 Acceptable
[] 3 Poor
b) Roof covering
Material
[] 2 Clay or cement roof-tile
[] 3 Asbestos/Cement boards
[] 4 Wooden tile
[] 5 Tar corrugated paper sheets
[] 6 Reeds stick-and-mud, cardboard, tin or wood waste material
[] 7 Other material
Condition
[] 2 Acceptable
[] 3 Poor
c) Floor
Material
[] 2 Paving stone or polished cement
[] 3 Brick
[] 4 Plastic, linoleum, rubber, etc
[] 5 Other material
[] 5 Earth
Condition
[] 2 Acceptable
[] 3 Poor
3. Water supply
a) The dwelling is supplied with water:
[] 2 By tank truck
b) The water comes from:
[] 2 Well or chain pump
[] 3 Other source
4. Bath facilities
a) The dwelling has an installed bath with:
[] 2 Cold water only
[] 3 Doesn't have a bath
b) The bath is used:
[] 2 By two or more families
5. Toilet facilities
a) System of waste removal
[] 2 Septic tank
[] 3 Pit/latrine
[] 4 Drain to irrigation canal (acequia)
[] 5 Other system
[] 6 None
b) The toilet is used:
[] 2 By two or more families
6. Lighting
[] 2 Other
Does this dwelling have a radio receiver?
[] 2 No
7. Cooking
a) Fuel
[] 2 Liquid gas
[] 3 Electricity
[] 4 Paraffin (kerosene)
[] 5 Charcoal
[] 6 Wood
[] 7 Other
b) Is the cooking stove in a room or place where people sleep?
[] 2 No
8. Tenure
[] 2 Renter or subletter
[] 3 Usufructuary
[] 4 Other
9. Rooms
____ Write the number of rooms in the dwelling, but without including the kitchen, bathroom, porches, garage, nor rooms used exclusively for commercial or industrial purposes.
10. Monthly rent
____ $ (in pesos)
2. Furnished
____ $ (in pesos)
11. Home-based industry (family production done at home)
____ Write the articles produced for sale. [3 lines]
12. For office use
[12 empty boxes]
[The following section, questions, 1 -- 18, are in the format of a table. The question appears as a column heading, with blank spaces below to write the answers for a series of individuals. Thus only the questions are translated here.]
I. -- Personal characteristics
1. Person order number ____
Name and surnames ____
Write them in the following order:
Head of family, wife, single children, married children and their family members, other relatives, guests, boarders, domestic employees, others.
Do not forget to include infants born before 12 midnight on the 28th of November and those deceased after that time.
If a person's name is unknown, write N.N.
If a collective dwelling, write the people down in the order given by their category within the dwelling. For example, in a hospital: Director, Doctor, Nurse, Patient.
Be sure that no person is left unenumerated.
2. Sex. ____
Write H if male and M if female.
3. Relationship ____
On the first line the word "head" is already printed following the spaces for name and sex of the person recognized as head of the family. For the rest, write the relationship that person has to the above-specified head. Examples: wife, son, uncle, guest, boarder, domestic servant, etc.
4. Age. ____
Write the age in years completed. For those under 1 year write the months completed. For those under 1 month write 0 months.
0 months
1 month
2 months
3 months
5. Marital status ____
Write as appropriate: S single, C married, CV consensual union, V widowed, SP separated de facto or legally, A annulled
6. Number of children. ____
For women 12 years of age and older.
Write the number of children born alive, excluding those stillborn.
7. Place of birth. ____
If the person was born in Chile, write the province where born. If born abroad, write the name of the country where born.
8. Year ____
Write the year in which the person came to live in the place of enumeration. If the person has always lived in the place of enumeration, write "always." If the person is a resident in transit, write "in transit."
9. Previous residence ____
Write the name of the province or country of where you came from.
Valdivia
Tarapacá
Magallanes
Argentina
España
If the person changed residence due to earthquakes add the letter "D."
10. Area ____
If migrating from a city, town or village, write "U." If migrating from a rural area (countryside), write "R."
11. Religion ____
Write the religion as given by the informant. If the person doesn't have a religion, write "none."
12. Literacy ____
If able to read and write, write "yes." If unable to read and write, write "no."
13. Educational level ____
For all individuals, write the highest course completed and the type of instruction received.
2nd year Feminine technical
1st year High school or primary
2nd year Business school
4th year Medical
2nd year Social sciences
3rd year Law
14. School attendance ____
For those currently attending an educational establishment, write the level and type of instruction receiving.
3rd year High school or primary
2nd year Technical or trade school
3rd year Social sciences
3rd year Civil engineering
3rd year Business school
2nd year Metallurgy/mining technician
IV -- Occupational characteristics.
For all individuals 12 years of age and older. [applies to questions 15-18]
15. Type of activity ____
Write as appropriate:
CE = Unemployed
BT = Looking for work for the first time
QH = Domestic duties
ES = Student
RT = Rentier (rentista)
JB = Retired or pensioner
IR = Disabled or confined
OT = Others
16. Occupation ____
If an Employed person has more than one job, write the one that produces the greatest income.
For those Unemployed, write the last occupation held.
For those Looking for work for the first time, write the profession, or if none, write "none."
Avoid using vague terms, like "professional," "worker," and so on. Give concrete occupations such as Lawyer, Bricklayer, Taxi driver, Doctor, Soldier, Cashier, etc.
17. Industry ____
Specify clearly the type of establishment in which the employed person works or, if unemployed, the last place of employment, such as:
Boys' school, wool blanket factory, commercial bank, general store, nail factory, livestock ranch, children's hospital, postal and telegraph office, armed forces, police, etc.
Avoid vague terms such as: factory, office, workshop, etc.
18. Occupational category [employment status] ____
Write the Occupational category in the following manner:
TCP = Own-account worker
EM = Professional employee
OB = Manual laborer
ED = Domestic employee
FR = Paid family worker
FNR = Unpaid family worker
OT = Other