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[Guinea 1996 Enumeration Form]


Guinea general census of population and housing, 1996

Household questionnaire

Section A: Household identification

____ Natural region

____ Administrative region

____ Prefecture

____ Sub-prefecture (rural) /community (urban) [Sous-préfecture / Commune]

____ Census track [Zone de dénombrement (ZD)]

____ District/Quarter

____ Locality / Sector

____ Dwelling unit number

____ Household number

____ Type of household

Summary Table

Residents

2. Present

____ Male
____ Female

3. Absent (RA)

____ Male
____ Female

4. Total

____ Male
____ Female

5. Visitors (VIS)

____ Male
____ Female

6. Total enumerated

____ Male
____ Female

Order number of the form in the household ____

Total number of questionnaires used for the household ____

Statistical confidentiality

The information gathered during a census or a survey which received the authorization according to Article 5 of the Statistical Law, in particular these dealing with the personal life of the persons enumerated or surveyed, are confidential. They cannot in any case be disseminated or used for any political purpose, for tax purposes, for economic repressive purpose, or for legal action, according to Article 7 of Law L/95/047/CTRN from August 29, 1995.

The present document was printed thanks to a grant from the USAID

RGPH-95/DOC.2

All population counted (present + absent + visitors) (RP+RA+VI)

P01 Person number ____

P02 First name and last name ____

P03 Relationship to the head of household

[] 1 Head of household
[] 2 Spouse
[] 3 Child (son or daughter)
[] 4 Parents (father or mother)
[] 5 Brother or sister
[] 6 Nephew / niece
[] 7 Grandchild
[] 8 Other relatives
[] 9 Not related by blood

P04 Sex

[] 1 Male
[] 2 Female

P05 Residence status

[] 1 Resident and present
[] 2 Resident and absent
[] 3 Visitors

P06 Date of birth or age

DD in days _ _
MM in months _ _
YY in years _ _
Age ____

P07 Place of birth ____

P08 Nationality (Country of citizenship) ____

Resident Population (Present and Absent)
[Questions P09 to P12 were asked of the resident population.]

P09 Religion

[] 0 No religion
[] 1 Muslim
[] 2 Christian
[] 3 Animist
[] 4 Other religions

P10 Type of major disability or handicap
[This code is a concatenated code with 2nd adding]

[] 1 Blind
[] 2 Deaf
[] 4 Mute
[] 8 Disability in lower limbs
[] 16 Disability in upper limbs
[] 32 Multiple disability
[] 64 Other
[] No disability or handicap

P11 Duration of residence

[] 0 Since birth
[] 1 Less than a year
[] 2 1 to 4 years
[] 3 5 to 9 years
[] 4 10 years or more

P12 Place of previous residence ____

Resident population aged 6 years and above
[Questions P13-P18 were asked of resident population aged 6 years and above.]

P13 Literacy
[This code is a concatenated code with 2nd adding]

[] 0 Illiterate
[] 1 National language
[] 2 French
[] 4 English
[] 8 Arabic
[] 16 Other languages _ _

P14 Level of education (Highest grade completed)

____ School Cycle
____ Last grade attended
____ Education attainment

P15 Activity status
[The French text says "Individual situation with respect to the economic activity"]

[] 1 Employed
[] 2 Unemployed
[] 3 Seeking first job
[] 4 Housewife
[] 5 Retired
[] 6 Pensioner
[] 7 Student
[] 8 Other undetermined

To be filled out only for employed and available unemployed persons
[Questions P16-P18 to be asked only for employed and available unemployed persons.]

P16 Occupation ____
[The French text says "Occupation or economic activity practiced"]

P17 Employment status

[] 1 Self-employed
[] 2 Employer
[] 3 Public administration employee
[] 4 Mixed enterprise employee
[] 5 Private sector employee
[] 6 Cooperative
[] 7 Apprentice
[] 8 Family assistant

P18 Economic activity branch ___

Resident population aged 12 years and above
[Question P19 was asked of persons aged 12 years and above.]

P19 Marital status

[] 0 Single (never married)
[] 1 Married, with 1 wife
[] 2 Married, with 2 wives
[] 3 Married, with 3 wives
[] 4 Married, with 4 wives
[] 5 Married, with 5 wives
[] 6 Common law union/free union
[] 7 Divorced
[] 8 Separated
[] 9 Widowed

Resident women aged 12 years or more
[Questions 20-22 were asked of women aged 12 years or more. Questions 20-22 were related to the number of live births]

P20 Total number of children ever born, by sex

_ _ Males
_ _ Females

P21 Total number of children still alive, by sex

_ _ Males
_ _ Females

P22 Number born during the past 12 months, by sex

_ _ Males
_ _ Females

Housing characteristics

H01 Mode of occupancy of the dwelling unit

[] 1 Owner
[] 2 Normal renter
[] 3 Subsidized renter
[] 4 Free housing from employer
[] 5 Paid for by parent/friend
[] 6 Other

H02 Source of water

[] 1 Faucet water in the home
[] 2 Faucet water elsewhere
[] 3 Dug well
[] 4 Drilled well
[] 5 Developed spring
[] 6 Surface water
[] 7 Other

H03 Source of lighting

[] 1 Electricity
[] 2 Gas
[] 3 Kerosene
[] 4 Wood
[] 5 Candle
[] 6 Other

H04 Energy for cooking

[] 1 Electricity
[] 2 Gas
[] 3 Petrol
[] 4 Wood
[] 5 Coal
[] 6 Other

H05 Type of toilet facility

[] 1 Flush toilet
[] 2 Latrine
[] 3 Ditch
[] 4 Nature
[] 5 Other

H06 Garbage disposal

[] 1 Public sewage service
[] 2 Private collection
[] 3 Burial
[] 4 Flowing water
[] 5 Ocean
[] 6 Dumped into nature
[] 7 Incineration

H07 Disposal of household waste water

[] 1 Backyard
[] 2 Street
[] 3 Pit / Cesspool
[] 4 Ditch/Dry well
[] 5 Nature
[] 6 Flowing water
[] 7 Ocean

H08 Disposal of toilet waste water

[] 1 Backyard
[] 2 Street
[] 3 Pit / Cesspool
[] 4 Ditch/Dry well
[] 5 Nature
[] 6 Flowing water
[] 7 Ocean

H09 Number of rooms inhabited by the household _ _

Deaths in the past 12 months

Did any resident person die within the past 12 months?

[] Yes
[] No

If yes, fill in the following table:

Order number _

Sex

[] 1 Male
[] 2 Female

Age at death _ _

Observations

___ Observations of the census enumerator:

___ Name of the census enumerator:

___ Date

___ Signature

___ Observations of the team leader

___ Name of the team leader

___ Date

___ Signature