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République du Mali / Un Peuple -- Un But -- Une Foi
Ministère du Plan / Bureau Central du Recensement
Ministère de l'Administration Territoriale et du Développement à la Base


General Census of the Population, 1-14 April 1987
Mali 1987 Enumeration Form



Section A: Geographic characteristics


1. Region [région]

_



2. Province [cercle]

_ _



3. District or township [Arrondissement or Commune] / rural or urban

_ _ _ _



4. Village or fraction

_ _ _



5. Hamlet or gathering point [Point de Regroupement / for rural or nomadic areas]

____




6. Neighborhood [for urban areas / commune]
_ _


Census district ____


7. Census tract

_ _ _




8. Compound number (Dwelling unit number)
_ _ _



9. Household number

_ _


Household form
Number

_ _



RP: Resident, Present

1. RP: Males

_ _


2. RP: Females
_ _


RA: Resident, Absent

3. RAI: Males
_ _


4. RAI: Females
_ _


5. RAE: Males
_ _


6. RAE: Females
_ _


V: Visitor

7. VI: Males
_ _


8. VI: Females
_ _


9. VE: Males
_ _


10. VE: Females
_ _


All Residents
11. RP + RA: Males

_ _

12. RP + RA: Females

_ _

All present
13. RP + V: Males

_ _

14. RP + V: Females

_ _

Total population
15. RP + RA + V: Males

_ _

16. RP + RA + V: Females

_ _


Type of household

[] Sedentary household
[] Nomadic household


Section B: Individual Characteristics

For each person/household member.
[Questions 1-13]

1. Sequential number

_ _

2. Last name and first name ____


3. Relationship to head of household

____



4. Sex (M/F)

____



5. Residence status

____



6. Date of birth (month/year)

_ _/_ _ _ _



7. Age

_ _ _



8. Place of birth (district [cercle] or country)

____



9. Duration of residence

_ _



10. Nationality

____



11. Disability / Handicap

____



12. Father alive

____



13. Mother alive

____



For individuals 6 years of age and older.
[Questions 14-22]


Cultural characteristics


14. Knows how to read and write

____



15. Last school grade attended

____



16. Mother's tongue (maternal language)

____



17. Language spoken

____



Economic activity


18. Type of economic activity

____



19. Profession

____



20. Main economic activity practiced

____



21. Principal branch of employment

____




22. Work status in main activity
____



For individuals 12 years of age and older.


23. Marital status

_



For women 12 years of age and older.
[Questions 24-25]


24. Total number of children ever born

_ _




25. Total number of children surviving
_ _


26. Observations

________

[See continuation on page No___]

Section "C": Events in past 12 months


Births in past 12 months

Sequential number
_ _

First name and last name ____

Sex
____

Mother's code number
_ _ _

Age of mother at time of birth
_ _



Deaths in past 12 months

Sequential number
_ _

First name and last name ____

Sex
____

Age at death
_ _ _



SECTION "D": HOUSING


Type of housing

[] Fixed (sedentary)
[] Mobile (nomadic)



1. Type of building

[] Compound [concession]
[] Isolated building (house)
[] Apartment building
[] Other type



2. Number of rooms occupied

_ _



3. Type of occupancy

[] Landlord
[] Rental
[] Other type



4. Wall materials

[] Hard material
[] Semi-hard
[] Adobe
[] Wood or straw
[] Other material



5. Roof material

[] Corrugated iron or tiles
[] Concrete
[] Adobe
[] Straw
[] Other type



6. Floor material

[] Cement, tiles
[] Earth
[] Other type



7. Source of water

[] Tap
[] Deep well / shallow well
[] River, stream, spring
[] Public tap / public well
[] Other type



8. Type of toilet facility

[] Flush toilet
[] Pit latrine
[] Other type



9. Type of lighting

[] Electricity
[] Gas
[] Petrol lamp
[] Other type



10. Type of fuel

[] Gas
[] Fire wood
[] Coal
[] Other type



11. Improved stove

[] Yes
[] No