Population Census Commission of Ethiopia
2007 National Population and Housing Census
Long Form
Section 1: Area identification
1. Region ____
2. Zone ____
3. Wereda ____
4. Town ____
5. Sub city/Keftegna ____
6. Supervision area ____
7. Kebele ____
8. Enumeration area ____
Section 2: Type of residence and housing identification
1. Type of residence
[] 2 Hotel/hostel
[] 3 Orphanage
[] 4 Boarding school/college/university
[] 5 Correctional facility
[] 6 Other collective
[] 7 Pasturalist
[] 8 Homeless
2. Housing unit serial number _ _ _
3. Household serial number _ _ _
Section 3: Details of persons in the household
[Questions 1 through 10 were asked of all persons]
1. Serial number of household members _ _
2. Name of usual members of the household and visitors
Spouse
Children living in the household in age order
Married children who live in the household
Other relatives
Members who are not related
Visitors
____
[] Resident absent on census day
[] Visitor on census day
4. Relationship to the head of household
[] 2 Spouse
[] 3 Son/daughter of the head and/or spouse
[] 4 Mother or father of head/spouse
[] 5 Sister or brother of head/spouse
[] 6 Nephew or niece
[] 7 Grandchild of head/spouse
[] 8 Other relatives (adopted, godchild etc.)
[] 9 Non relatives
5. What is [the respondent]'s sex?
[] 2 Female
_ _
[] 2 Protestant
[] 3 Catholic
[] 4 Muslim/Islam
[] 5 Traditionalist
[] 6 Others
8. What is [the respondent]'s mother tongue?
9. What is [the respondent]'s ethnic group?
Disability status
10. Does [the respondent] have seeing, hearing, speaking, standing/walking/sitting, body movement, non-functional upper and lower limbs? Or learning difficulties, mental, problem or other mental/physical damage?
[] 1 Yes
[] 2 No
11. If yes, what is [the respondent]'s type of difficulty or problem?
[] 2 Seeing difficulty
[] 3 Deaf
[] 4 Hearing difficulty
[] 5 Unable to speak
[] 6 Speaking difficulty
[] 7 Dear and unable to speak
[] 8 No functional upper limbs
[] 9 No functional lower limbs
[] 10 Body movement problem
[] 11 Learning difficulties
[] 12 Mental problem (go to 13)
[] 13 Other
12. What was the cause of [the respondent]'s disability?
[] 2 Other accident
[] 3 Polio
[] 4 Hanson disease
[] 5 Other diseases (after delivery)
[] 6 During pregnancy (at delivery)
[] 7 War/mines
[] 8 Others (not listed in codes 1-7)
[] 9 Not known
13. What is the number of years [the respondent] has continuously lived in this town or the rural part of this Wereda?
[] 2 1 year
[] 3 2 years
[] 4 3 years
[] 5 4 years
[] 6 5-6 years
[] 7 7-9 years
[] 8 10 years and above
[] 9 Since birth
Ask only for codes 0-7 in Column 22.
[Questions 14 and 15 were only asked of persons who had lived in their current locality for less than 10 years.]
14. Was [the respondent]'s previous address urban or rural? ____
15. To which zone does this area belong?
Zone _ _
[Questions 16 and 17 were asked for household members age 0-17.]
16. Is [the respondent]'s biological mother alive?
[] 2 No
17. Is [the respondent]'s biological father alive?
[] 2 No
Age five and above
[Questions 18-20 were asked of long form respondents age 5+.]
18. Is [the respondent] literate?
[] 2 No
19. Is [the respondent] currently attending school?
If not attending, ask if attended before.
_ _
[] 97 Attended school in the past
[] 98 Never attended school (skip to question 21)
20. What is the highest grade [the respondent] completed?
Members age ten years and above
[Questions 21-25 were asked of long form respondents' age 10+.]
21. Is [the respondent] engaged in productive activity for at least 4 hours during the last 7 days?
[] 2 Have job but not worked (go to Q23)
[] 3 No
22. Is [the respondent] available to work during the coming month?
[] 1 Available
[] 2 Personal/family affair
[] 3 Student/training
[] 4 Homemaking
[] 5 Disabled
[] 6 Injury/illness
[] 7 Too young
[] 8 Old age/pensioner/remittance
[] 9 Other
23. Was [the respondent] engaged in productive activity during most of the last 12 months?
[] 1 Engaged in productive activity
[] 2 Unemployed with work experience
[] 3 Unemployed without work experience
[] 4 Student/training
[] 5 Homemaking
[] 6 Disabled
[] 7 Injury/illness
[] 8 Too young
[] 9 Old age/pensioner/remittance
[] 10 Begging
[] 11 Other
24. What was [the respondent]'s employment status in the main job?
[] 2 Employee - government parastatal
[] 3 Employee - private organization
[] 4 Employee - NGO/international org.
[] 5 Employee - Domestic
[] 6 Employee ? Others
[] 7 Self employed
[] 8 Unpaid family worker
[] 9 Apprentice
[] 10 Member of cooperative
[] 11 Employer
[] 12 Other
25. What is [the respondent]'s current marital status?
[] 2 Married
[] 3 Divorced
[] 4 Separated
[] 5 Widowed
[] 6 Cohabiting/living together
For women of age 10 and above.
[Questions 26-29 were asked of long form respondents 10+.]
26. Of the children you have borne, how many sons and daughters are now living with you?
Record "0" for women who have no child at all.
_ _ Male
_ _ Female
27. Of the children you have borne, how many sons and daughters are living elsewhere?
Record "0" for women who have no child at all.
_ _ Male
_ _ Female
28. Did you have children who have died?
Record "0" if none.
Record "0" for women who have no child at all.
_ _ Male
_ _ Female
29. Did [the respondent] have any live births between 29 May 2006 and 28 May 2007?
_ _
Section 4: Deaths in the household during the last 12 months
1. Did a death occur in the household since 29 May 2006?
If no, record "0" and go to Section 5 (Housing).
_
[] 2 Female
_ _
5. Did [the respondent] die during pregnancy, childbirth, or within 2 months after childbirth?
[Question 5 was asked only if the deceased person was a woman who died between ages 12 and 49.]
[] 1 Yes
[] 2 No
Section 5: Information on housing unit
[Question 1 through 20 were asked of households that responded to the long form]
1. Enumerator: in accordance with the instruction, housing information will be:
[] 2 Skipped
2. How many years age was this housing unit built?
[] 2 5-9 years
[] 3 10-14 years
[] 4 15-19 years
[] 5 20 years or more
3. How many rooms are in the housing unit?
4. What is the main source of drinking water for the members of this housing unit?
[] 2 Tap in compound, private
[] 3 Tap in compound, shared
[] 4 Tap outside compound/from private tap, public tap, other organization (bought or free of charge)
[] 5 Protected well or spring
[] 6 Unprotected well or spring
[] 7 River/lake/pond
5. What type of toilet facility does the housing unit have?
[] 2 Flush toilet
[] 3 VIP latrine
[] 4 Pit latrine
6. Does the household share the toilet with other households?
[Question 6 was asked for households that had a toilet facility.]
[] 1 Yes
[] 2 No
7. What type of bathing facility does the housing unit have?
[] 2 Bathtub private
[] 3 Bathtub shared
[] 4 Shower private
[] 5 Shower shared
[] 6 A room prepared for bathing
8. What type of kitchen does the housing unit have?
[] 2 A room used for traditional kitchen inside the housing unit
[] 3 A room used for traditional kitchen outside the housing unit
[] 4 A room used for modern kitchen inside the housing unit
[] 5 A room used for modern kitchen outside the housing unit
9. Does the household share the kitchen with other households?
[Question 9 was asked of households that had a kitchen.]
[] 1 Yes
[] 2 No
10. Do members of the housing unit use mostly:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
11. What type of lighting does the housing unit have?
[] 2 Electricity/meter shared
[] 3 Electricity from generator (no meter)
[] 4 Solar energy
[] 5 Lantern
[] 6 Bio-gas
[] 7 Kerosene
[] 8 Candle/wax candle
[] 9 Firewood
12. Does the housing unit have:
[] 2 No
[] 2 No
[] 2 No
13. How does the housing unit dispose of solid waste?
[] 2 Collected by private establishments/individuals
[] 3 Dumped in street/open space
[] 4 Dumped in river
[] 5 Burned/buried solid waste
[] 6 Other
14. Do livestock spend the night in the room(s) where members spend the night?
[] 2 No
[] 3 No livestock
15. What is the type of tenure of the housing unit?
[] 2 Rent free
[] 3 Rented from Kebele
[] 4 Rented from agency of rented houses
[] 5 Rented from other organization
[] 6 Rented from private household
[] 7 Occupied by paying rent difference
For Questions 16-20, please mark by observation and/or asking.
16. What is the type of housing unit?
[] 2 Improvised
[] 3 Mobile
[] 4 Other
17. What is the major material used for the construction of the wall of the housing unit?
[] 2 Wood and thatch/wood only
[] 3 Stone and mud
[] 4 Stone and cement
[] 5 Plastered hollow blocks
[] 6 Unplastered hollow blocks
[] 7 Bricks
[] 8 Corrugated iron
[] 9 Reed/bamboo
[] 10 Mud bricks
[] 11 Other
18. What is the major material used for the construction of the ceiling of the housing unit?
[] 2 Fabrics
[] 3 Bamboo/reed
[] 4 Chip wood/hardboard
[] 5 Parquet or polished wood
[] 6 Wood planks
[] 7 Concrete/cement
[] 8 Polythene sheet "Madaberia"
[] 9 Other
19. What is the major material used for the construction of the major part of the roof of the housing unit?
[] 2 Concrete or cement
[] 3 Thatch
[] 4 Wood and mud
[] 5 Bamboo or reed
[] 6 Plastic/shera
[] 7 Asbestos
[] 8 Other
20. What is the major material used for the construction of the major part of the floor of the housing unit?
[] 2 Bamboo/reed
[] 3 Wood planks
[] 4 Parquet or polished wood
[] 5 Cement screed/cement screed not applied
[] 6 Plastic tiles
[] 7 Cement tile/brick tile
[] 8 Ceramic/marble tiles
[] 9 Other