Lao PDR
Census, March 1995
A. Identification
Province _ _
District _ _
Village _ _ _
EA number ____
Household number _ _ _
B. For all persons
[Questions 1-10 were asked of all persons]
1. Persons in the household: Who was a member of this household on September 26, 1994?
Enter the person who was heading the household as person number one.
Name and surname ____
If there are more than 10 members in the household, use additional questionnaire(s). When this is necessary, tick the box in the bottom right corner and change the person number (1, 2, 3 ... in column a in the questionnaire) to 11, 12, 13 ... in the second questionnaire, 21, 22, 23 ... in the third questionnaire, etc.
Regarding the routines for collective households, see the enumerator's manual.
2. What is [the respondent's] relationship to head of household?
[] 2 Spouse
[] 3 Son/daughter
[] 4 Parent
[] 5 Other relative
[] 6 Not related
3. Is [the respondent] male or female?
[] 2 Female
4. How old was [the respondent] at his/her last birthday?
Write:
Actual age for other respondents
5. Where was [the respondent] born?
6. Where was [the respondent] living at last census in March 1985?
7. What is [the respondent's] citizenship?
[] 00 Laos
[] 01 Cambodia
[] 02 China P.R.
[] 03 Myanmar
[] 04 Thailand
[] 05 Vietnam
[] 06 Other Asian Countries
[] 07 European Countries
[] 08 African Countries
[] 09 American Countries
[] 10 Australia
[] 11 Other Countries
8. If code "000" in Question 7, what is [the respondent's] ethnic origin?
Remarks: There are the codes for major ethnic groups only, in case the response is given as the name of minority tribe, refer to the classification list provided in the Enumerator's Manual. Code ''48'' is for tribe that cannot be classified elsewhere.
Enter code from code list:
[] 01 Lao
[] 02 Phutai
[] 03 Khmu
[] 04 Hmong
[] 05 Leu
[] 06 Katang
[] 07 Makong
[] 08 Kor
[] 09 Xuay
[] 10 Nhuane
[] 11 Laven
[] 12 Taoey
[] 13 Talieng
[] 14 Phounoy
[] 15 Tri
[] 16 Phong
[] 17 Yao
[] 18 Lavae
[] 19 Katu
[] 20 Lamed
[] 21 Thin
[] 22 Alack
[] 23 Pako
[] 24 Oey
[] 25 Ngae
[] 26 Musir
[] 27 Kui
[] 28 Hor
[] 29 Jeng
[] 30 Nhahem
[] 31 Yang
[] 32 Yae
[] 33 Xaek
[] 34 Samtao
[] 35 Sida
[] 36 Xingmoon
[] 37 Toum
[] 38 Mone
[] 39 Bid
[] 40 Nguane
[] 41 Lolo
[] 42 Hayi
[] 43 Sadang
[] 44 Lavy
[] 45 Kmer
[] 46 Khir
[] 47 Kree
[] 48 Others
[] 99 Not Stated
9. What is [the respondent's] marital status?
[] 2 Married
[] 3 Divorced/separated
[] 4 Widowed
10. What is [the respondent's] religion?
[] 1 Buddhist
[] 2 Animist
[] 3 Christian
[] 4 Muslim
[] 5 Others
C. For persons aged 6 years and above
[Questions 11-13 were asked of persons aged 6 years and above]
11. Can [the respondent] read and write Lao?
[] 2 No
12. Has [the respondent] ever attended school?
[] 2 At school
[] 3 Left school
13. What is [the respondent's] highest level of education completed?
[] 00 None
[] 11 Primary 1
[] 12 Primary 2
[] 13 Primary 3
[] 14 Primary 4
[] 15 Primary 5
[] 16 Primary 6
[] 21 Low Sec 1
[] 22 Low Sec 2
[] 23 Low Sec 3
[] 24 Low Sec 4
[] 31 Upper Sec 1
[] 32 Upper Sec 2
[] 33 Upper Sec 3
Vocational education
[] 41 First level
[] 42 Middle level
[] 43 High level/university
[] 44 Post graduate level
[] 45 Others
D. For persons aged 10 years and above
[Questions 14-16 were asked of persons aged 10 years and above]
14.What was [the respondent's] main activity the last 12 months?
[] 01 Paid employee (Government)
[] 02 Paid employee (Parastatal)
[] 03 Paid employee (Private)
[] 04 Paid employee (State enterprise)
[] 05 Employer
[] 06 Own account worker
[] 07 Unpaid family worker
[] 08 Looking for work/unemployed
[] 09 Student
[] 10 Household duties
[] 11 Retired/sick/too old
[] 12 Other
[Answer questions 15-16 for codes 01-07 in question 14]
15.What was [the respondent's] main occupation during the last 12 months?
16. In what industrial sector was [the respondent] mainly working during the last twelve months?
E. For women, aged 15 to 49 years
[Questions 17-18 were asked of women aged 15 to 49]
17. Have you given any live birth?
If yes: How many children born alive to you?
[] 1 Yes
____ Female
____ Female
____ Female
18. How old were you when you had your first live birth?
Write:
- ''99'' for not known
19. Did any death occur in the household in the last 12 months?
[] 2 No
If no, skip to question 20. If yes, then ask:
[] 2 Female
Did she die while pregnant, while giving birth or within 42 days after giving birth?
[] 2 No
20. What is the tenure status of the household?
[] 2 Tenant
[] 3 Lodger
[] 4 Tied accommodation
[] 5 Other
[] 2 Wooden
[] 3 Wood
[] 4 Semi permanent housing
[] 5 Other
22. Is this dwelling unit electrified?
[] 2 Yes (shared meter)
[] 3 Yes (own generator)
[] 4 Yes (car battery)
[] 5 No
23. What is the living area of the dwelling unit?
24. Water for drinking and cooking
[] 2 Well/borehole, protected
[] 3 Well/borehole, unprotected
[] 4 River/stream/dam
[] 5 Rain water from tank/jar
[] 6 Other
[] 2 Less than 500 m
[] 3 Between 500 m and 1 km
[] 4 More than 1 km
25. What type of toilet facility is mainly used by this household?
[] 2 Normal toilet
[] 3 Dry toilet
[] 4 Other
[] 5 None
26. What is the household's main source of energy for cooking?
[] 2 Paraffin
[] 3 Wood
[] 4 Coal
[] 5 Charcoal
[] 6 Sawdust
[] 7 Gas
[] 8 Other
H. Total No. of persons in the household
____ Female =
____ Total
Physical address of the household ________
Comments ________
____ Date
____ Date