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Department of Planning
Haitian Institute of Statistics and Information Science
Republic of Haiti
Pilot Census of Population and Dwellings
General Census 1982

Questionnaire number _ _ _
This census was prescribed by the Government of Haiti. It is obligatory for all persons residing permanently in the Republic of Haiti.
The questions should be asked of the head of household or, in the absence of the head of household, of any other member of the household who is able to answer the questions accurately.
The responses are confidential.

I) Locality
[Questions 1-6.]

1. Department ____

2. Urban district [arrondissement] ____

3. Municipality [commune] ____

4. Address:

____ City
____ Street
_ _ Number
Or
____ Rural area
____ District [quartier]

5. Supervision district and census section _ _ _ _

6. Plantation or village [habitation] (in rural areas only) ____

II) Building
[Questions 7-11.]
[To be completed only for the first household in the building.]

7. Order in which building was visited _ _ _ _

8. Type of building

[] 1 Mud hut or mud-floored hut
[] 2 Hut
[] 3 Traditional circular dwelling (Joupa)
[] 4 Sheet metal hut
[] 5 Walled house (sheet-metal roof)
[] 6 Old house (Colonial gingerbread style)
[] 7 House in cement block
[] 8 Villa/detached house
[] 9 Duplex/Triplex apartments
[] 10 Hotel boarding house
[] 11 Others (not for habitation)

9. Building occupation

[] 1 Inhabited
[] 2 Uninhabited (go to the next building)

10. How building is inhabited

[] 1 With a single household
[] 2 With several households
[] 3 Mixed (business and one household)
[] 4 Mixed (business and several households)
[] 5 Institution
[] 9 All other

11. Number of household within the entire building _ _

III) Household
[Questions 12-19.]
[For each household in the building.]

12. Order in which household was visited _ _ _ _ _

13. Occupation status of dwelling

[] 1 Occupied
[] 2 Empty

14. Household composition

_ _ Number of rooms
_ _ Number of people

15. Mode of occupation

[] 1 Owner
[] 2 Staying for free
[] 3 Renter
[] 4 Farmer
[] 9 Other (please specify) ____

16. Renter or tenant farmer
[This question is asked of tenants and farmers only.]

Tenant: Monthly rent (in Haitian gourdes) _ _ _ _
Farmer:
a) Sum in Haitian gourdes _ _ _ _
b) Time period (number of months) _ _

17. Lighting

[] 1 Electric
[] 2 Kerosene
[] 9 Other (please specify) ____

18. Water supply

[] 1 Running water in dwelling
[] 2 Running water in courtyard/yard
[] 3 Well in courtyard/yard
[] 4 Public fountain
[] 5 Spring or river
[] 6 Buys water
[] 9 Other (please specify) ____

19. Latrine/ Toilet type

[] 1 Hydraulic WC
[] 2 Ordinary latrine in the yard
[] 3 Ordinary latrine outside the yard
[] 9 None

IV) Person questions

A. General characteristics
For all persons in the household.
[Questions 1-6 were asked of all persons]

1. First and last names: What is the person's name?

________ First name
________ Last name

2. Family relationship: What is this person's relationship to the head of household?

(Put an "x" in the correct box.)
[] 0 Head of household
[] 1 Spouse
[] 2 Father (mother)
[] 3 Son (daughter)
[] 4 Grandchild
[] 5 Father/mother-in-law
[] 6 Son/daughter-in-law
[] 7 Other relationship
[] 8 Servant

3. Sex: Is this person a man or a woman?

[] 1 Man
[] 2 Woman

4. Age: How old is this person?

(Children less than one year write 00.)
_ _

5. Marital status: Is this person single, married, cohabiting, divorced, etc.?

[] 1 Single
[] 2 Married
[] 3 Cohabiting
[] 4 Divorced
[] 5 Widow(er)
[] 9 Undeclared

6. Religion: What is this person's religion?

[] 1 Catholic
[] 2 Protestant
[] 3 Other
[] 4 None

B. Migrations
For all persons (except question 9 only concerns people aged 5 and beyond).
[Questions 7-9 were asked of all persons; question 9 was only asked of persons 5 years of age and older.]

7. Place of birth: Where was this person born?

Write the town or rural area, or the foreign country.
[] 1 Town or city of ________
[] 2 District of ________
[] 3 Rural area or municipality of ________
[] 4 Foreign country ________

8. Length of Residence: How long has this person lived in the current city (or rural area)?

[] 0 Has always lived here
[] 1 Less than 1 year
[] 2 1-4 years
[] 3 5-9 years
[] 4 10 years or more
[] 9 Can't remember

9. Residence in 1977: Place of residence in August 1977
(For person whose period of residence in current location is less than 5 years. This question is only asked of persons 5 years of age and older.)

[] 1 Town or city of ________
[] 2 District of ________
[] 3 Rural area or municipality of ________
[] 4 Foreign country ________

C. Educational characteristics
For persons 6 years and older.
[Questions 10-16 were asked of persons 6 years of age and older.]

10. Attendance at literacy center: Have the person attended literacy center?

[] 1 Yes
[] 2 No (Go to question 12)

11. Duration of attendance:
If answered yes to question 10, for how many months have the person been at the literacy center?

Number of month ____

12. School attendance: Was the person at school in the academic year 1981-1982?

[] 1 Yes
[] 2 No (Go to question 14)

13. Type of school

[] 1 Public
[] 2 Private

14. Literacy: Does this person know how to read and write?

[] 1 Yes
[] 2 No (Go to question 17)

15. Language: If yes, what language does the person read and write?

[] 1 French
[] 2 Creole
[] 3 Both languages

16. Highest level achieved: What is the last class (last year) that this person attended?

Class (or year) ____
[] 1 None
[] 2 Primary
[] 3 Secondary
[] 4 High school (Normale)
[] 5 University, higher education
[] 6 Technical or professional

D. Economic characteristics
For persons 10 years and older.
[Questions 17-21 were asked of persons 10 years of age and older.]

17. Type of job: What type of work did this person do during the 12 months preceding the census?

(Mark only one box)
[] 1 Worked.
[] 2 Has a job but did not work
[] 3 Is currently looking for employment
[] 4 Student only - does not work
[] 5 Retired, private income
[] 6 Takes care of house only
[] 7 Does not work because of illness
Person whose answer is from 3 to 6: Go to Question 22.

18. Working time: Number of months worked during the 12 months preceding the census

Number of month ____

19. Principal occupation: What type of work does this person do?

(Profession, trade, job) ________

20. Branch of work: What does this person's company make/do?

(Be as specific as possible)
________

21. Employment status: Is this person the owner, a paid employeeÂ…?

[] 1 Owner
[] 2 Paid employee
[] 3 Independent worker
[] 4 Unpaid family worker
[] 9 Undeclared

E. Fertility
For women 15 years and older.
[Questions 22-25 were asked of women 15 years of age and older.]

22. Live births: Has this woman ever given birth to a child, even if the child is no longer alive?

[] 1Yes (Go to question 23)
[] 2 No

[Question 23-25 were only asked of women who answered "Yes" to question 22.]

Name of the woman ____

23. Date of last birth: Indicate the date of last live birth, even if the child is no longer alive.

Date_ _
Month _ _
Year _ _ _ _

24. Children born alive: How many children were born alive by this woman, even if they are no longer alive now?

Number of children: ____

25. Children born alive:

1. Children still alive now:
a. In the household: ____ (number)
b. In Haiti but outside the household: ____ (number)
c. Currently abroad: ____ (number)
2. Children who have died: ____ (number)

V) Deaths in the household

1. During the 12 months preceding the Census, were there deaths in the household?

[] 1 No
[] 2 Yes (Complete the table below)

2. Deaths in the household during the 12 months preceding the Census

Number _
Name of the deceased ____
Sex
1 Male
2 Female
Age of the deceased ____
Date of death
Month _ _
Year _ _ _ _