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Royal Government of Cambodia
General Population Census of Cambodia, 2008

Form A: house list Identification particulars

____ Khet/krong
____ Srok/khand
____ Khum/sangkat
____ Phum/mondol
Enumeration area number _ _ _ _ _ _ _ _

Building/structure and household particulars[Questions 1-13]
1. Line number _ _
2. Building/structure number _ _ _ _

Predominant construction material of building/structure
[Questions 3-5]

3. Wall

[] 1 Bamboo/thatch/grass/reeds
[] 2 Earth
[] 3 Wood/plywood
[] 4 Concrete/brick/stone
[] 5 Galvanized iron/aluminum/other metal sheets
[] 6 Asbestos cement sheets
[] 7 Salvaged/improvised materials
[] 8 Other (specify) ____

4. Roof

[] 1 Bamboo/thatch/grass
[] 2 Tiles
[] 3 Wood/plywood
[] 4 Concrete/brick/stone
[] 5 Galvanized iron/aluminum/other metal sheets
[] 6 Asbestos cement sheets
[] 7 Plastic/synthetic materials sheets
[] 8 Other (specify) ____

5. Floor

[] 1 Earth/clay
[] 2 Wood/bamboo planks
[] 3 Concrete/brick/stone
[] 4 Polished stone
[] 5 Parquet/polished wood
[] 6 Mosaic/ceramic tiles
[] 7 Other (specify) ____

6. Purpose of building/structure

[] 1 Residence
[] 2 Residence and shop
[] 3 Residence and workshop
[] 4 Residence and any other establishment (specify) ____

7. Household number _ _ _ _

Particulars of the head of household
[Questions 8-9]

8. Name ____

9. Sex

[] 1 Male
[] 2 Female

Number of persons usually living in the household

_ _ 10 Males
_ _ 11 Females
_ _ 12 Persons

13. Remarks ________

Form B: household questionnaire - part 1
Type of household/population

(Give appropriate code in the box below)

[] 1 Normal or regular household
[] 2 Institutional household
[] 3 Homeless household
[] 4 Boat population
[] 5 Transient population (specify location) ____

Population particulars

Statement 1.1: Usual members present on census night
1. Serial number _ _ _ _

2. Full name ____

3. Relationship to household head (write in words) ____

4. Sex

[] 1 Male
[] 2 Female

Statement 1.2: Visitors present on census night
1. Serial number _ _ _ _

2. Full name ____

3. Relationship to household head (write in words) ____

4. Sex

[] 1 Male
[] 2 Female

Usual residence

5. Within Cambodia
Give the name of the district, and write the name of the province within brackets ________

6. Outside Cambodia
Give the name of the country ____

Statement 1.3: Usual members absent on census night

1. Serial number _ _ _ _

2. Full name ____

3. Relationship to household head (write in words) ____

4. Sex

[] 1 Male
[] 2 Female

5. Age _ _

Location on census nights

6. Within Cambodia
Give name of district and write name of province within brackets ________

7. Outside Cambodia
Give name of country ____

8. How long absent (in completed months)

Write 0 for less than 1 month.

_ _
_ _ Total number of persons in statement 1.1
_ _ Total number of persons in statement 1.2
_ _ Total number of persons in statements 1.1 and 1.2
Form B: household questionnaire - part 2: individual particulars
[Questions 1-22 were asked of all persons]
1. Serial number _ _ _ _
2. Full name of the person ____

Names of usual members present and visitors
(Please refer to statements 1.1 and 1.2 in Part 1)
3. Relationship to household head

[] 1 Head
[] 2 Wife/husband
[] 3 Son/daughter
[] 4 Father/mother
[] 5 Grand child
[] 6 Other relative
[] 7 Non-relative

4. Sex

[] 1 Male
[] 2 Female

5. Age

Age in completed years

_ _

6. Marital status

[] 1 Never married
[] 2 Currently married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated

7. Mother tongue

[] 1 Khmer
[] 2 Vietnamese
[] 3 Chinese
[] 4 Lao
[] 5 Thai
[] 6 French
[] 7 English
[] 8 Other (specify) ____

8. Religion

[] 1 Buddhism
[] 2 Islam
[] 3 Christianity
[] 4 Other (specify) ____

9. Birthplace

Place of birth of the person _ _
If in this village, enter code 1.

If in another village, give the name of the district of that village and write the name of the province within brackets.

If outside Cambodia, write the name of the country.

____

10. Previous residence: where have you been living before?

If always lived in this village, enter code 1 and skip to column 13.

If in another village, give the name of the district of that village and write the name of the province within brackets.

If outside Cambodia, write the name of the country.

____

11. Duration of stay: how long have you lived in this village?

[Question 11 is asked of persons who ever lived outside the village where they are currently residing, as per question 10.]

(Enter code from list below)

[] 00 Less than 1 year
[] 01 Between 1 and 2 years
[] 02 Between 2 and 3 years
.
.
[] 10 Between 10 and 11 years
.
[] 20 Between 20 and 21 years
.
[] 97 Between 97 and 98 years
[] 98 98 years and over

12. Reason for migration

[Question 12 is asked of persons who ever lived outside the village where they are currently residing, as per question 10]

Give the reason for the change of residence, if the present residence is different from the previous residence.

[] 1 Transfer of work place
[] 2 In search of employment
[] 3 Education
[] 4 Marriage
[] 5 Family moved
[] 6 Natural calamities or insecurity
[] 7 Repatriation or return after displacement
[] 8 Visiting only
[] 9 Other (specify) ____

13. Literacy
a. Can the person read and write with understanding the Khmer language?

[] 1 Yes
[] 2 No

b. Can this person read and write with understanding in any language? If so, which language?

(Enter the code from the list below)

[] 1 No other language
[] 2 Vietnamese
[] 3 Chinese
[] 4 Lao
[] 5 Thai
[] 6 French
[] 7 English
[] 8 Other (specify) ____

14 Full-time education
a. Has the person ever attended school/ educational institution?

[] 1 Never
[] 2 Now
[] 3 In the past

b. What is the highest grade completed? (Enter the code from the list below)

For "Never", put a dash (-)
For "Now" or "Past", the codes are as follows:

[] 00 No class completed
[] 01 Class 1 completed
[] 02 Class 2 completed
.
.
[] 11 Class 11 completed
[] 12 Class 12 completed
[] 13 Lower secondary diploma holder
[] 14 Secondary school/baccalaureate holder
[] 15 Technical/vocational pre-secondary diploma certificate
[] 16 Technical/vocational post-secondary diploma/certificate
[] 17 Undergraduate
[] 18 Graduate
[] 19 Postgraduate and above
[] 17 Other (specify) ____

15. Physical/mental disability, if any:

If the person is physically/mentally disabled, give the appropriate code number from the list below. Otherwise enter a dash (-)

a. Since birth
[] 1 In seeing
[] 2 In speech
[] 3 In hearing
[] 4 In movement
[] 5 Mental

b. After birth
[] 1 In seeing
[] 2 In speech
[] 3 In hearing
[] 4 In movement
[] 5 Mental

16. Main activity:Main activity of the person during last year

For codes 3, 4, 6 and 8, put a dash (-) in columns 17 to 21, fill in column 22, and put a dash (-) in column 23.

[] 1 Employed (fill in columns 17 to 23)
[] 2 Unemployed (employed any time before: fill in columns 17 to 21 for the last employment, fill in column 22, and put a dash (-) in column 23)
[] 3 Unemployed (never employed any time before)
[] 4 Homemaker
[] 5 Student (put a dash (-) in columns 17 to 21, and fill in columns 22 and 23)
[] 6 Dependent
[] 7 Rent-receiver, retired or other income recipient
[] 8 Other (specify) ____

17. Employment period (no. of months employed in the last 12 months) _ _

[Question 17 was asked of persons who have ever worked, as per question 16.]

18. Occupation (name of occupation) ____

[Question 18 was asked of persons who have ever worked, as per question 16.]

19. Employment status

Employment status / class (enter code from the list below)

[Question 19 was asked of persons who have ever worked, as per question 16.]

[] 1 Employer
[] 2 Paid employee
[] 3 Own-account worker
[] 4 Unpaid family worker
[] 5 Other (specify) ____

20. Industry, trade or service (nature of industry, trade or service) ____

[Question 20 was asked of persons who have ever worked, as per question 16]

21. Sector of employmentSector in which [the respondent] is employed (enter code from the list below)

[Question 21 was asked of persons who have ever worked, as per question 16]

[] 1 Government
[] 2 State-owned enterprise
[] 3 Cambodian enterprise (private)
[] 4 Foreign enterprise
[] 5 Non-profit institution
[] 6 Household sector
[] 7 Embassies, international institutions and foreign aid and development agencies
[] 8 Other (specify) ____

22. Secondary economic activity [For all codes 1 through 8 in column 16]

In terms of contribution to income or subsistence, what was the second most important economic activity of this individual over the last year?

Enter code from the list below

[] 01 None

Farming (growing crops)

[] 02 Unpaid employment (self-employed or employed in family enterprise)
[] 03 Paid employment (wage laborer)

Livestock farming

[] 04 Unpaid employment (self-employed or employed in family enterprise)
[] 05 Paid employment (wage laborer)

Other activities

[] 06 Fishing
[] 07 Other household-based production or services
[] 08 Construction
[] 09 Wholesale or retail trade
[] 10 Transport
[] 11 Other paid employment (services like teaching, cooking, child care, medical, etc.)

23. Place of work or schooling

For employed persons and students only (codes 1 or 5 in column 16)

If in another district, give the name of the district and write the name of the province within brackets. If in another country, write the name of the country.

[] 1 Working at home
[] 2 Working or schooling in the same district
[] 3 Working or schooling another district
[] 4 Working or schooling across the border of the country

Form B: household questionnaire - part 3: fertility information of females aged 15 and over listed in column 2 of part 2[Questions 1-6 were asked of females age 15 and older]
___ 1 Serial number

___ 2 Full name of woman

___ 3 Serial number in column 1, part 2
Fertility information

Number of children born(Give number in two digits, like: 01, 02... 10, 11, etc. If none, write 00)

4. How many children have been born alive to the woman?

a. Male _ _
b. Female _ _

5. How many of them are living?

a. Male _ _
b. Female _ _

6. How many of them have died?

a. Male _ _
b. Female _ _

Particulars of birth in the last 12 months from women aged 15-49 years.[Questions 7-8 were asked of females ages 15 to 49]

7. Any child born alive to the woman during the last 12 months?

(Give actual number, like: 1, 2, ... under the appropriate column. If none, write 0)
If no child was born to the woman in the last 12 months, skip to part 4)

Male _
Female _

8. Who assisted her during the delivery:

[] 1 Doctor
[] 2 Nurse
[] 3 Midwife
[] 4 Traditional birth attendant (TBA)
[] 5 Other
[] 6 None

Form B: household questionnaire - part 4: housing conditions and facilities Part 4 need not be filled in for institutional and homeless households, and for boat and transient population.

1. On what basis does the household occupy this dwelling?

[] 1 Owner occupied
[] 2 Rent
[] 3 Not owner, but rent free
[] 4 Other (specify) ____

2. Main source of light

[] 1 City power
[] 2 Generator
[] 3 Both city power and generator
[] 4 Kerosene
[] 5 Candle
[] 6 Battery
[] 7 Other (specify) ____

3. Main cooking fuel

[] 1 Firewood
[] 2 Charcoal
[] 3 Kerosene
[] 4 Liquefied petroleum gas (LPG)
[] 5 Electricity
[] 6 None
[] 7 Other (specify) ____

4. Toilet facility within premises

[] 1 Not available

If available, give one of the codes 2 through 5:

[] 2 Connected to sewerage
[] 3 Septic tank
[] 4 Pit latrine
[] 5 Other type of toilet (specify) ____

5. Main source of drinking water supply

[] 1 Piped water
[] 2 Tube/pipe well
[] 3 Protected dug well
[] 4 Unprotected dug well
[] 5 Rain
[] 6 Spring, river, stream, lake/pond
[] 7 Bought
[] 8 Other (specify) ____

6. Location of drinking water source:

[] 1 Within the premises
[] 2 Near the premises
[] 3 Away

7. Number of rooms occupied by household (exclude kitchen, bathroom, toilet and storeroom)

[] 1 One room
[] 2 Two rooms
[] 3 Three rooms
[] 4 Four rooms
[] 5 Five rooms
[] 6 Six rooms
[] 7 Seven rooms
[] 8 Eight rooms and more

Information on ownership of some facilities by the household

(under each item, write "0" if not available or give the number, if available)

8. Radio/transistor _ _

9. Television _ _

10. Telephone (fixed) _ _

11. Cell phone _ _

12. Personal computer _ _

13. Bicycle _ _

14. Motorcycle _ _

15. Car/van _ _

16. Boat _ _

17. Tractor _ _
a. Big tractor _ _
b. Hand tractor (koyaon) _ _

State whether the household accesses the internet

18. At home
[] 1 Yes
[] 2 No

19. Outside the home
[] 1 Yes
[] 2 No

Form B: household questionnaire - part 5: death in the household

Deaths in the household in the last 12 months

Total number of deaths _ _

Particulars of the deceased
[Questions 1- 7(c)]

1. Serial number: _ _

2. Name of the deceased ____

3. Sex

[] 1 Male
[] 2 Female

4. Relationship to the head of household

[] 1 Head
[] 2 Wife/husband
[] 3 Son/daughter
[] 4 Father/mother
[] 5 Grand child
[] 6 Other relative
[] 7 Non-relative

5. Age at death

Write the age in total years completed at the time of death _ _

6. What was the cause of death?

Illness:
[] 01 Fever
[] 02 Diarrhea
[] 03 Tuberculosis
[] 04 Heart disease
[] 05 Dengue fever
[] 06 Malaria
[] 07 Tetanus
[] 08 HIV/AIDS
[] 09 Pregnancy complication
[] 10 Delivery complication
[] 11 Other illness
Accident
[] 12 Land mine
[] 13 Road accident
[] 14 Drowning
[] 15 Other accident
Not known
[] 16 Don't know

About woman aged 15-49 years who died:
[Questions 7a, b and c were asked of females, ages 15 to 49]

7a. Did the woman die while pregnant, during delivery, or within 42 days after giving birth?

[] 1 Yes
[] 2 No

7b. State where the death took place:

[Question 7b was asked of females ages 15 to 49 who died while pregnant, during delivery, or within 42 days after giving birth, as per question 7a.]

[] 1 Hospital
[] 2 Health center
[] 3 Home
[] 4 Other

7c. State who attended on her before death:

[Question 7c was asked of females ages 15 to 49 who died while pregnant, during delivery, or within 42 days after giving birth, as per question 7a.]

[] 1 Doctor
[] 2 Nurse
[] 3 Midwife
[] 4 Traditional birth attendant (TBA)
[] 5 Other (specify) ____
[] 6 None