Royal Government of Cambodia
General Population Census of Cambodia, 2008
Form A: house list Identification particulars
____ 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]
[] 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) ____
[] 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) ____
[] 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
[] 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]
[] 2 Female
Number of persons usually living in the household
_ _ 11 Females
_ _ 12 Persons
13. Remarks ________
Form B: household questionnaire - part 1
Type of household/population
[] 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) ____
[] 2 Female
Statement 1.2: Visitors present on census night
1. Serial number _ _ _ _
2. Full name ____
3. Relationship to household head (write in words) ____
[] 2 Female
Statement 1.3: Usual members absent on census night
3. Relationship to household head (write in words) ____
[] 2 Female
8. How long absent (in completed months)
_ _
_ _ 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
[] 2 Wife/husband
[] 3 Son/daughter
[] 4 Father/mother
[] 5 Grand child
[] 6 Other relative
[] 7 Non-relative
[] 2 Female
_ _
[] 2 Currently married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated
[] 2 Vietnamese
[] 3 Chinese
[] 4 Lao
[] 5 Thai
[] 6 French
[] 7 English
[] 8 Other (specify) ____
[] 2 Islam
[] 3 Christianity
[] 4 Other (specify) ____
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 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?
(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
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?
[] 2 No
b. Can this person read and write with understanding in any language? If so, which language?
[] 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?
[] 2 Now
[] 3 In the past
b. What is the highest grade completed? (Enter the code from the list below)
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:
[] 2 In speech
[] 3 In hearing
[] 4 In movement
[] 5 Mental
[] 2 In speech
[] 3 In hearing
[] 4 In movement
[] 5 Mental
16. Main activity:Main activity of the person during last year
[] 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) _ _
18. Occupation (name of occupation) ____
[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) ____
21. Sector of employmentSector in which [the respondent] is employed (enter code from the list below)
[] 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?
[] 01 None
Farming (growing crops)
[] 03 Paid employment (wage laborer)
Livestock farming
[] 05 Paid employment (wage laborer)
Other activities
[] 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
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?
b. Female _ _
5. How many of them are living?
b. Female _ _
6. How many of them have died?
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?
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:
[] 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?
[] 2 Rent
[] 3 Not owner, but rent free
[] 4 Other (specify) ____
[] 2 Generator
[] 3 Both city power and generator
[] 4 Kerosene
[] 5 Candle
[] 6 Battery
[] 7 Other (specify) ____
[] 2 Charcoal
[] 3 Kerosene
[] 4 Liquefied petroleum gas (LPG)
[] 5 Electricity
[] 6 None
[] 7 Other (specify) ____
4. Toilet facility within premises
If available, give one of the codes 2 through 5:
[] 3 Septic tank
[] 4 Pit latrine
[] 5 Other type of toilet (specify) ____
5. Main source of drinking water supply
[] 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:
[] 2 Near the premises
[] 3 Away
7. Number of rooms occupied by household (exclude kitchen, bathroom, toilet and storeroom)
[] 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
b. Hand tractor (koyaon) _ _
State whether the household accesses the internet
[] 2 No
[] 2 No
Form B: household questionnaire - part 5: death in the household
Deaths in the household in the last 12 months
Particulars of the deceased
[Questions 1- 7(c)]
2. Name of the deceased ____
[] 2 Female
4. Relationship to the head of household
[] 2 Wife/husband
[] 3 Son/daughter
[] 4 Father/mother
[] 5 Grand child
[] 6 Other relative
[] 7 Non-relative
6. What was the cause of death?
[] 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
[] 13 Road accident
[] 14 Drowning
[] 15 Other accident
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?
[] 2 No
7b. State where the death took place:
[] 1 Hospital
[] 2 Health center
[] 3 Home
[] 4 Other
7c. State who attended on her before death:
[] 1 Doctor
[] 2 Nurse
[] 3 Midwife
[] 4 Traditional birth attendant (TBA)
[] 5 Other (specify) ____
[] 6 None