Population survey 2014
Space to be filled out by the survey agent
Identifier
Municipality ____
Department _ _
Municipality _ _ _
District _ _ _ _
Line A _ _ _
Line L _ _ _
[ ] 2 Occasional residence
[ ] 3 Secondary residence
[ ] 4 Dwelling vacant
[ ] 2 Paired or grouped together in any way
[ ] 4 Non-residential building (community, factory, station, stadium, office building, etc.)
[ ] 5 Temporary construction, mobile home
[ ] 6 Trailer, mobile home
[Housing sheet (DOM-Overseas Departments]
Type of construction
[ ] 2 Traditional hut
[ ] 3 Wood house or building
[ ] 4 Hard-material house or building
Number of individual forms collected _ _
Start here
Name of primary occupant ________
Location of dwelling
Address 1 _ _ _ _
Address 2 ____
Street ____
Name of road ________
Residence, hamlet, building ________
Stairs ____
Floor ____
Door number or position from stairs:
Postal code _ _ _ _ _
Municipality (and district for Paris, Lyon and Marseille)
Continue to pages 2, 3, and 4
Individuals usually living in the dwelling
Record either in list A or in list B or in list C each person who usually lives in this dwelling.
Do not forget to record yourself!
Then, fill out the individual form for each person recorded or listed in list A. Do not fill out any individual forms for persons listed in list B or in list C.
Do not record the temporary dwellers who usually live elsewhere but who are here during the census (for example, people visiting or on vacation).
List A-Permanent residents of the dwelling
Fill out an individual form for each one
Record in list A:
Infants, even if they are still in the maternity ward
Subtenants and joint tenants occupying part of the dwelling
Spouses who have another place of residence for professional reasons and who come to live in this dwelling on weekends, vacations, etc.
Adults who live in this dwelling because of their studies
Persons who are present in this dwelling and who do not have a usual residence elsewhere.
Household employees or au pairs who live in this dwelling.
Do not record the individuals who are to be listed in list B or in list C
Last name (example, Dupas, nee Maurin)
First name
Relationship to the person recorded on the first line (examples: spouse, domestic partnership, son, daughter, mother, father, sub-tenant, etc.)
List B-adult children living elsewhere for their studies
Do not fill out an individual form
Record in list B:
Last name
First name
Relationship to the person recorded on the first line
Year of birth
Address where this person lives for school
Municipality (and district for Paris, Lyon, Marseille)
Department
Overseas department number
List C- Other residents in the dwelling
Do not fill out an individual form
Record in list C1:
Individuals who live in this dwelling for professional reasons and who return to their family residence on the weekend.
Individuals for whom this dwelling is their personal residence and who are housed in a retirement home or hospice, hospitalized for more than one month, center for handicapped people, boarding house for workers, military personnel housed in barracks or serving abroad, penitentiaries, etc.)
Persons living in this dwelling at the time of the survey but who live in another dwelling for the majority of the year.
Last name
First name
Relationship to the person recorded on the first line of list A (if this line is filled out)
Year of birth
Example:
Mr. and Mrs. Maurin live in Saint-Malo. They have three children:
Gregoire, age 16, is a boarder at a high school in Rennes;
Julie, age 21, is a student in Paris. She rents a room and returns to her parents during vacations.
Mrs. Maurin loges her 15 year old nephew, Thomas Galard, who is a student in Saint-Malo. His parents live in Dax.
Jean Dupas, Mrs. Maurin?s father, is staying with his daughter for four months. He lives in Jura the rest of the year.
List A: Permanent residents of the dwelling
Dupas, nee Maurin, Francoise, spouse
Maurin, Christophe, son
Maurin, Gregoire, son
C2: Dupas, Jean, Father-in-law, 1937
Characteristics and comforts of the dwelling
[ ] 2 Apartment
[ ] 3 Communal dwelling
[ ] 4 Guestroom
[ ] 5 Makeshift shelter
[ ] 6 Separate room (having a separate entrance)
2) What is the year of completion on the construction of this house or apartment building?
(If different sections are not from the same time period, note the completion year of the most lived-in section)
[ ] 2 From 1919 to 1945
[ ] 3 From 1946 to 1970
[ ] 4 From 1971 to 1990
[ ] 5 From 1991 to 2005
[ ] 6 2006 or later?if this is the answer, specify the year _ _ _ _
3) Does this dwelling have an elevator?
[ ] 2 No
4) How many livable rooms are in this dwelling?
Only count the kitchen if it is bigger than 12m2
Do not count rooms like bathrooms, laundry or utility rooms, WCs, etc., or rooms with exclusively professional uses (workshops, doctor?s offices, etc.)
5) What is the size of the dwelling?
Count all rooms, including the hallway, kitchen, bathroom, WC, etc.
Do not count balconies, patios, cellars, attics, garages, and rooms with exclusively professional uses.
[ ] 2 From 30 to less than 40m2
[ ] 3 From 40 to less than 60m2
[ ] 4 From 60 to less than 80m2
[ ] 5 From 80 to less than 100m2
[ ] 6 From 100 to less than 120m2
[ ] 7 120m2 or more
[ ] 2 A renter or subtenant of dwelling, unfurnished?
[ ] 3 A renter or subtenant of the dwelling or room, furnished?
[ ] 4 Living for free, for example from parents, friends, or employer (including persons living in a dwelling that that they sold for life annuity)?
7) Does this dwelling belong to a housing project association?
[ ] 2 No
8) In what year did you move to this dwelling?
If all the current occupants of the dwelling did not arrive at the same time, give the arrival date of the first who lived here. If that person has always lived in the house, record his or her year of birth. _ _ _ _
9) What are the sanitation facilities for this dwelling?
[ ] 2 Bathtub or shower in a room not used exclusively for cleaning
[ ] 3 Bathroom (with shower or bathtub)
10) What is the main method of heating for this dwelling?
[ ] 2 Individual boiler (particular to the dwelling)
[ ] 3 Individual boiler "all electric"
[ ] 4 Wood-burner, fireplace, stove, etc.
11) What is the primary heating fuel?
[ ] 2 Gas from town or grid
[ ] 3 Heating oil (fuel oil)
[ ] 4 Electricity
[ ] 5 Bottle gas or gas in tanker
[ ] 6 Other (wood, solar, geothermic etc.)
12) How many cars do the residents of this dwelling have at their disposal?
Do not count cars or vans that are for professional use only.
[ ] 1 One
[ ] 2 Two
[ ] 3 Three or more
13) Do you have a parking space reserved for your personal use?
This location can be a garage, a lock-up in a garage, or a parking space outside or underground.
[ ] 2 No
[Housing sheet (DOM-Overseas Departments]
9) Is there a watering place with potable water inside this apartment?
[] Cold and hot water
[] No watering place
10) The sewage is disposed of by connecting:
[ ] 2 To a septic tank?
[ ] 3 To a sump?
[ ] 4 Into the ground?
11) Does this dwelling have:
Check yes or no for each line
[ ] 2 No
[ ] 2 No
[ ] 2 No
[ ] 2 No
[ ] 2 No
[ ] 2 No
[ ] 2 No
12) How many two-wheeled motor vehicles do inhabitants of this dwelling have?
Do not count those for professional use only.
[ ] 1 One
[ ] 2 Two
[ ] 3 Three or more
13) How many cars do the residents of this dwelling have at their disposal?
Do not count cars or vans that are for professional use only.
[ ] 1 One
[ ] 2 Two
[ ] 3 Three or more
14) Do you have a parking space reserved for your personal use?
This location can be a garage, a lock-up in a garage, or a parking space outside or underground.
[ ] 2 No
Population survey 2014
Address:
Space to be filled out by survey agent
Municipality _ _ _
[ ] 2 Female
2) Date and location of birth
Born on _ _ (day) _ _ (month) _ _ _ _ (year)
At ____ Municipality (district for Paris, Lyon, Marseille)
DOM (overseas department) number _
Country for those abroad, territory for DOM (overseas territory) ____
If you were born abroad, in what year did you arrive in France?
[ ] 2 You became French (for example, through naturalization, through declaration, at adulthood)
4) Are you enrolled in a learning establishment for the current school year?
Including an apprenticeship or higher education
[ ] 1 In the municipality where you live (or in the same district for Paris, Lyon, Marseille)
[ ] 2 In another municipality (or another district)
Municipality (and district for Paris, Lyon, Marseille), department, DOM (overseas department) number
5) Where were you living on January 1, 2013? [one year ago]
Children born after this date do not apply.
[ ] 2 In another dwelling in the same municipality (or in the same district for Paris, Lyon, Marseille)
[ ] 3 In another municipality (or another district for Paris, Lyon, Marseille)
Municipality (and district for Paris, Lyon, Marseille), department, DOM (overseas department) number, country for aboard, territory for TOM (overseas territories)
6) The following portion of the questionnaire is for individuals age 14 or older.
7) Do you live with a partner?
[ ] 2 No
8) What is your legal marital status?
[ ] 2 Married (or separated but not divorced)
[ ] 3 Widower, Widow
[ ] 4 Divorced
[ ] 02 No diploma, but educated until primary or middle school
[ ] 03 No diploma but educated past middle school
[ ] 11 CEP (Primary education certificate)
[ ] 12 BEPC, France, general certificate of secondary education
[ ] 13 CAP, vocational training qualification
[ ] 14 BEP
[ ] 15 General baccalaureate
[ ] 16 Technical or professional baccalaureate, Professional or technical certificate, BEA, BEC, BEI, BEH, basic legal qualification
[ ] 17 1st cycle university diploma, BTS, DUT, social or health professions diploma, nursing
[ ] 18 2nd or 3rd cycle university diploma (including medical, pharmacy, dental), engineering diploma, grande école, doctorate, etc.
10) What is your primary occupation?
Only tick one space
[ ] 4 Unemployed (whether registered or not at the unemployment center)
[ ] 5 Retired or pre-retired (formerly employed or formerly independent)
[ ] 6 Homemaker
[ ] 7 Other circumstances
11) Are you currently working?
If you have a job where you work from time to time, or if you are temporarily employed, or if you are in an apprenticeship or a paid internship, tick "yes".
If you are on medical or maternity leave, tick "yes".
[ ] 2 No, tick then skip to 12
Continue to next page, and don't forget to sign
12) If you are not currently working, answer questions 13-16.
[ ] 2 No, tick then skip to question 16
[ ] 2 Independent or self-employed?
[ ] 3 Helping a person in his or her work without getting paid?
15) What was your main profession?
16) Are you looking for a job?
[ ] 2 Yes, for a year or more
[ ] 3 No
17) The rest of the questionnaire is for individuals who are currently working.
If you have several jobs, describe your main job in questions 18 to 30.
18) What is the name of the establishment which employs you or of which you are in charge?
If you are a temporary worker, specify the name of the establishment where you work. If you are self-employed, record the name of the company or your name.
19) In what business sector is this establishment?
Be very specific (for example: "auto repair"). If it is a farm, specify the type of products (vineyard, poultry farming, etc.).
20) What is the address of your place of work?
Record the place where you usually start your work (example, 18 Pasteur Boulevard).
If this place is not fixed, record "variable".
If you work from home, record "from home".
If you work at a private individual?s, record "private".
[ ] 1 Yes
[ ] 2 No
If no, record the municipality where you work
Municipality (or district if Paris, Lyon, Marseille) ________
Department _ _
DOM (overseas department) number _
Country for aboard ____
21) What is the method of transportation you usually use to go to work?
[ ] 2 On foot
[ ] 3 Two-wheeled vehicle
[ ] 4 Car, truck, or small van
[ ] 5 Public transportation
[ ] 2 Part time
[ ] 2 Salaried company head, CEO, manager, minority of a limited liability company?
[ ] 3 Salaried, tick then skip to 26
[ ] 4 You help an individual in his/her work without pay
24) If you are self-employed or if you are a company head, how many employees do you employ?
[ ] 2 1 to 9
[ ] 3 10 or more
25) If you are not salaried, what is your profession?
Be specific. For example "florist" (and not "shopkeeper")
26) The next part of this questionnaire is for salaried employees.
27) What is your type of contract or employment?
[ ] 2 Apprenticeship and professionalism contract
[ ] 3 Placed by a temp agency
[ ] 4 Paid internship in a business
[ ] 5 Helped employment (single inclusion contract, employment initiative, support for employment, the future, etc.)
[ ] 6 Other limited length employment, CDD (fixed-length contract), short contract, seasonal, replacement worker
[ ] 2 A skilled or highly skilled laborer, a skilled workshop specialist?
[ ] 3 A technician (non-executive)?
[ ] 4 A category B public official?
[ ] 5 A middle management official, administrative or commercial official, a sales representative?
[ ] 6 A category A public official?
[ ] 7 An engineer, business executive?
[ ] 8 A category C or D public official?
[ ] 9 An employee (for example, in an office, in commerce, in the restaurant industry, in a home)?
29) What is your main profession?
Be precise. For example: "Cashier" (not "employee"),
"Head of client services" (not "manager").
If you are a public State official, of regional authority or for hospitality, record your level (professional, category, etc.)
30) What is your main duty in your work?
[ ] 2 Installations, repairs, maintenance
[ ] 3 Management, accounting
[ ] 4 Learning, research
[ ] 5 Other: sales, secretarial, logistics
Thank you for your participation