This census is ordered by the decree of 1970. It is required of all people residing normally in the territory of the Haiti Republic.
Questions should be directed to the head of the household or, as the case may be, all other members of the household capable of being able to answer correctly.
The answers gathered are confidential.

I. Location


1. ____ Department [département]


2. ____ District [arrondissement]


3. ____ Municipality [commune]


4. Address

5. ____ Jurisdiction ____ Number of section


6. ____ Residence (in the rural zone only)


7. ____ Order of the visit in the building


8. ____ Order of the visit of the household in the dwelling


9. ____ Total number of households in the dwelling


10. ____ Household number

II. Dwellings

A. Characteristics of the building

1. Main material of the walls

2. Main material of the roofs

B. Characteristics and installation of the dwelling

3. Type of dwelling

4. Occupation status of the dwelling

5. Composition of the dwelling

6. Main material of the floors

7. Lighting

8. Water supply

9. Toilet facilities

10. Type of tenure

11. Rent

Note: This section is only to be filled out by households without any farmland, but having livestock. In the opposite situation, fill out a form for farms.
Number of livestock

________ Name of the census taker
________ Date of the survey
________ Supervisor
________ Check date

Advice to census agents
1. The work must be carried out with the greatest care while avoiding corrections and deletions. Write legibly and preferably the last names of people in upper case letters as well as places. Write in ball-point pen.
2. Except for special orders, all questions should be asked line by line, column by column, in the order that they appear on the questionnaire. Do not skip a column.
3. Answer each question. Use a dash to indicate "nothing" or "no" or when the question has nothing to do the situation. Do not use any sign which is not specified in the instructions for the corresponding question.
4. The census taker will fill out the questionnaire:

5. The census taker will not mark in any of the boxes which will be filled out exclusively in the office of the specialized personnel.
6. Avoid vague answers. Do not be satisfied with insufficient names for a profession such as correspondent or government employee, or write market vendor, grocer, and pharmacist, and not merchant.
7. Be sure that all buildings and households in the census section (or residence) which have been assigned to you are counted. Do not forget anyone. Carefully check at the end of the interview if all the answers have been correctly recorded. Mark down the date of the interview and sign the questionnaire.

Reminder of some definitions
Household: In its most usual form, the household is a group of people, generally, but not necessarily tied to kinship, living in the same dwelling place, and usually eating meals together. A person living alone constitutes a household by himself or herself.
To simplify the counting, we have accepted a concept of the household not requiring the sharing of meals or living on a shared budget but only resting on the requirement of sharing the dwelling space. Thus, in a house, the number of apartments will be equal to the number of households, except if some apartments are not inhabited.
Usual Residence: All people who are part of a household whether they are present or absent at the time of the census are to be recorded on the housing form. Always be careful not to forget mentioning those who are absent (traveling government employee), person being hospitalized temporarily, or visiting parents, student in a boarding school. We will ask for all the same information for those absents as well as those present.
A person who has left who has no intention to return is no longer considered a member of the household.
Room: We call all space in a dwelling unit surrounded by four walls, except for the bathroom (if it includes a sanitary installation), a "room".

Advice on determining age:
Age should be indicated in years passed. If the person in question does not know his/her age exactly, using the historic calendar as indicated in the instructions.

It often happens that the head of household forgets to declare young children. When the census taker writes down the youngest child declared by the head of household, she will thus insist that the head of household answer these questions particularly:

In the same way, he will spontaneously ask the question:

III. Population

1. First and last name
Write down all members of the household in the following order:

2. Relationship to the head of household
There are six boxes. Check the box which corresponds to the relationship with the head of household.

3. Marital status
Single having never been married or been in an arranged marriage, married in legitimate civil or religious union,
[Rest of this line is illegible]

4. Sex

5. Age
For children less than 1 year old, write the age in months from 0 to 11

6. Place of birth
If the person in question was not born in Haiti, write down in capital letters the name of the foreign country.
________ Municipality [commune]

________ Foreign country

7. Length of time living in this Municipality [commune]
The length of time living is the period up to the time of the census and expressed in years passed, during which each person has lived in this county which is his usual residence.

8. Previous area of residence
Write here in capital letters the last place where the person in question resided prior to living in the location where he/she is being enumerated.
________ Municipality [commune]

________ Foreign country

9. Nationality
Note: A Haitian cannot be born abroad. A foreigner cannot be naturalized as a Haitian.

10. Religion
The answers Jewish, Muslim, Jehovah's Witness, are to be counted under "Other"

11. Children born alive in the last 12 months
[Question 11 is asked to women 15 to 49 years old]
Write down for each woman age 15 to 49 the number of children in the corresponding box as well as the sex whether or not the child is still living in the household.

[Questions 12 to 14 are asked to persons 5 years old and over]

12. Do you know how to read and write?

13. Highest level of schooling completed
Write here the level of education: None, Literacy classes, Primary school, Secondary school, Technical, University, Teacher-training school

Indicate if the education level is complete or incomplete. Choose the highest class achieved within the education level

14. School attended this year
This means the school attended during the 1970-1971 academic year.

[Questions 15 to 21 are asked to persons 5 years old and over]

15. Main activity during the last six months
By main activity we mean the activity in which the person in question spent the greatest part of his/her time.

16. Time spent working in the last six months
Indicate approximately how much the person in question worked during the last six months.

17. Profession
This means the main profession of the person in question even if he/she is temporarily unemployed. Specify as much as possible:

________ _ _ _

18. Activity of the company
Specifically write down the institution or business where the person in question works.
Example:

For agriculture, indicate:

________ _ _ _ _

19. Status in the profession
The category "Other" is reserved for those who are not able to be classified according to the situation in the profession: workers feeling that the situation is badly defined or unemployed having never worked.

20. Number of days of work last week

21. Are you a farmer?