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Republic of Ecuador
III Population Census
and II Housing Census

June 8th, 1974

____ Form number
____ of ____

I . Geographic Location

____ 1. Province
____ 2. Canton
____ 3. Parish
____ 4. Name of the city, parish head, or populated area
____ 5. Zone number
____ 6. Sector number
____ 7. Block number
____ 8. Enumeration area number
9. Home address:

____ Street and number
____ Floor number
____ Apartment number
____ Route or highway

II. Dwelling

1. Dwelling type

Private
[] 01 House or villa
[] 02 Apartment
[] 03 Rooms in a tenement
[] 04 Mediagua (small unit with sloped roof )
[] 05 Rancho (poor construction possibly with cane or straw roof) or covacha (shack)
[] 06 Rustic cabin (choza)
[] 07 Others
[] 08 Places not intended for use as a dwelling
Collective
[] 10 Hotel, inn or boarding house
[] 11 Military or police barracks
[] 12 Hospital, sanatorium, etc.
[] 13 Convent, religious institution
[] 14 Boarding school
[] 15 Others
Skip to questions on population.

2. Occupancy of the dwelling

[] 1 Occupied, with people present
[] 2 Occupied, with people absent
[] 3 Unoccupied

3. Predominant materials in the dwelling

A. Roof or covering
[] 1 Reinforced cement roof (Losa de hormigón)
[] 2 Eternit, Ardex or similar
[] 3 Zinc or similar
[] 4 Tile
[] 5 Wood
[] 6 Straw or similar
[] 7 Other materials

B. Exterior walls
[] 1 Cement, brick or block
[] 2 Adobe or mud wall (tapia)
[] 3 Wood
[] 4 Covered cane
[] 5 Uncovered cane
[] 6 Other materials

C. Floor
[] 1 Board
[] 2 Parquet, floor tile or vinyl
[] 3 Brick or cement
[] 4 Cane
[] 5 Earth
[] 6 Other materials

4. Tenure of the dwelling

[] 1 Owned
[] 2 Rented
[] 3 Loan-backed habitation contract
[] 4 Free
[] 5 For services
[] 6 Others

5. Water supply in the dwelling

From public system
[] 1 Inside the dwelling
[] 2 Outside the dwelling but in the building
[] 3 Outside of the building
From other sources
[] 4 Well or spring
[] 5 Cistern
[] 6 River or stream
[] 7 Delivery truck
[] 8 Others

6. Availability of toilet facilities (W.C.) in the dwelling

[] 1 Toilet for exclusive use of the dwelling
[] 2 Shared use toilet
[] 3 Latrine
[] 4 None

7. Wastewater elimination system

[] 1 By sewer
[] 2 Septic tank
[] 3 None

8. Electric service available in the dwelling

[] 1 From public system
[] 2 From private generator
[] 3 None

9. How many rooms in total does this dwelling have?

____ (Not including kitchen or bathroom)

10. Of these rooms, how many are used exclusively for sleeping?

____

11. Does the dwelling have a separate room for cooking?

[] 1 Yes
[] 2 No

12. What is the primary fuel used for cooking?

[] 1 Kerosene or gasoline
[] 2 Wood or charcoal
[] 3 Gas
[] 4 Electricity
[] 5 Other
[] 6 No cooking

13. Is part of the dwelling used for handcrafts, business or other activities?

[] 1 Only handcrafts
[] 2 Only business
[] 3 Business and handcrafts
[] 4 Other activities
[] 5 Dwelling only

Population summary

____ Number of males
____ Number of females
____ Total

Comments:

____

____ Name of enumerator
____ Date
____ Name of sector head
____ Date

III. Population

[The following is a table with space for the responses of three people. Except for question 2, the response options for all people are the same.]

A. General characteristics

For all individuals
[Applies to questions 1-8]

1. What is the name and surname of each of the people who spent the night of the 7th to 8th of June in this household? Do not forget infants and the elderly.

____

2. What is your relationship to the head of the household? Mark the appropriate box.

Person 1:
[] 0 Head
Persons 2 and 3:
[] 1 Spouse, partner
[] 2 Son/daughter
[] 3 Parents
[] 4 Grandchild
[] 5 Son-in-law
[] 6 Parents-in-law
[] 7 Other relatives
[] 8 Other non-relatives
[] 9 Domestic employee

3. Are you male or female? Mark the appropriate box.

[] 1 Male
[] 2 Female

4. How old are you? For those under one year write "00".

____ Years completed

5. Where were you born?

If born in the rural parish or city where enumerated, mark the box "Here;" otherwise write the name of the rural parish or city and province. If living [sic] abroad, write just the name of the country.

[] XX Here
____ Rural parish or city
____ Province
____ Foreign country
[] 99 Unknown

6. In what rural parish or city do you habitually live?

If the place of habitual residence is the rural parish or city where enumerated, mark the box "Here;" otherwise write the name of the rural parish or city and province. If living abroad, write just the name of the country.

[] XX Here
____ Rural parish or city
____ Province
____ Foreign country
[] 99 Unknown

7. How long have you lived in the place indicated?

Write the period of residence in the place indicated in question 6. If living there less than one year, write "00."

[] XX Always - Skip to question 9
____ Number of years
[] 99 Unknown

8. In what rural parish or city did you live before?

Write the name of the rural parish or city and province. If abroad, write just the name of the country.

____ Rural parish or city
____ Province
____ Foreign country
[] 99 Unknown

B. Educational characteristics

For all individuals 6 years of age and older [Applies to questions 9-11]

9. Do you know how to read and write?

If only able to read or only able to write mark the box "no."

[] 1 Yes
[] 2 No

10. Do you attend any institution of schooling, whether primary, secondary, post-secondary (superior), or a literacy center?

[] 1 Yes, attending
[] 2 Not attending
[] 9 Unknown

11. What is the highest grade, class or year of schooling completed in primary, secondary, post-secondary, or a literacy center? Write the number of the highest grade, course or year completed on the corresponding line.

[] 00 None
____ 1. Primary
____ 2. Secondary
____ 3. Post-secondary
____ 4. Literacy center
[] 99 Unknown

C. Economic characteristics.

For all individuals 12 years of age and older [Applies to questions 12-15.]

12. What did you do the greater part of the days between the 3rd and 7th of June? Ask the questions in the order indicated: Worked? Did not work but had a job? Etc. and upon receiving a reply, mark the respective box and go on the next appropriate question.

[] 1 Worked?
[] 2 Did not work but had a job?
[] 3 Unemployed? (Looked for work having worked before)

For responses 1-3, continue with question 13.

[] 4 Looked for work without having ever worked before?
[] 5 Studied exclusively?
[] 6 Did household tasks exclusively?
[] 7 Exclusively retired or pensioner?
[] 8 Others
[] 9 Unknown

For responses 4 - 9, women skip to 16, men skip to 19.

Questions 13 -15 only for those who responded 1, 2, or 3 in question 12.

13. What is the occupation that provided the greatest income in the days from June 3rd to 7th, or what was your last occupation if unemployed? Write with some detail the work performed.

____ [A blank box also appears in the corner of this item.]

14. What does the establishment where you engage in the occupation indicated primarily do? Write for example: Ministry of Health, primary school, textile factory, restaurant, livestock ranch, etc.

____ [A blank box also appears in the corner of this item.]

15. What was your category or position in the occupation indicated? Ask the questions in the order given and upon receiving an answer, mark the appropriate box.

[] 1 Owner or active partner? (Have employees)
[] 2 Own-account? (Do not have employees)
[] 3 Worker or salaried employee?
[] 4 Unpaid family worker?
[] 5 Others
[] 9 Unknown

D. Fertility characteristics

Only for women 15 years of age and older[Applies to questions 16,17,18]

16. How many children born alive have you had?

[] 00 None Skip to question 19
____ Number
[] 99 Unknown

[For women 15+ who ever had a child born alive.]

17. How many children are currently alive?

[] 00 None
____ Number
[] 99 Unknown

18. What was the date of the birth of your last child born alive?

Date:
____ Month
19_ _ Year

E. Marital status

For all individuals 12 years of age and older [Applies to question 19]

19. Are you in a consensual union, single, married, divorced, widowed, or separated?

[] 1 Consensual union
[] 2 Single
[] 3 Married
[] 4 Divorced
[] 5 Widowed
[] 6 Separated
[] 9 Unknown