National Institute of Statistics
II General of Population and Housing Census
Section A: Geographic Location of the Dwelling
District _________
Administrative Post__________
Neighborhood _______
Enumeration Area No. ____
Block No. ____
Name of City/Village _______
House No. _____
No. of dwellings in this household ____
No. of this household _____
Enumeration Area No. ____
Name of Village/Settlement _______
Name of Zone/Neighborhood _______
House No. _____
No. of dwellers in this house ____
No. of this household ____
Street: ________
No.:____ Floor:____ Apt:____
Description: ________
Section B: To be filled out after interview
No. of Female ____
Total ____
[] 1
[] 2
[] 3
[] 4
DECLARATION: I declare that the information in this Form is true and accurate.
Name (legible): ________
Signature: ________
Date: _ _ - _ _ - 1997
Controller No.: _ _
Name (legible): ________
Signature:________
Date: _ _ - _ _ - 1997
INTRODUCTION: Good morning, I am (name). I work for the census and here is my identification (show your badge/I.D). We are conducting our II General Population and Housing Census and I need to ask you some statistical data.
Enumerator:Write the first and last names on the people in the space below. This form allows space for 9 names. If there are more than 9 people in the dwelling, please fill out the continuation form.
1. _________________R V
...
9. ________________ R V
1. _________________R V
...
9. ________________ R V
Section D: Questions about the Population
Name (first and last): ________
2. What is (the person)?s relationship to the head of the household?
[] Spouse
[] Son/daughter
[] Parent
[] Son/daughter-in-law
[] Grandchild
[] Other relative
[] Non- related Person
[] 2 Female
4. What is (the person)?s age?
5. Say whether at 12:00a.m. of August 1, 1997 in this household, the person was a/an:
[] Absent resident
[] Visitor
[Questions 6 through 31 were asked of usual residents of the household.]
6. What is (the person)?s race/origin?
[] Mixed
[] White
[] Indian
[] Pakistani
[] Other
7. Where was (the person) born?
District ________ _ _
City/Village ________ _ _
Foreigner ________ _ _
8. What is (the person)?s nationality?
[] Foreigner
9. Does (the person) have any disability?
[] Mental
[] Physical
[] Mental and Physical
10. What is (the person)?s religion/belief?
11. Where was (the person) living on August 1, 1996?
Province ________
District ________
City/Village ________
Foreigner ________
12. Where was (the person) living when the war was over (October, 1992)?
District ________
City/Village ________
Foreigner ________
[] No
[] Does not know
14. Say whether the person: (in any language)
[] Can read only
[] Cannot read nor write
15. Does (the person) know how to speak Portuguese?
[] No
16. In what language did (the person) learn to speak?
17a. What language is most used at home?
17b. Besides the ones mentioned, what other language does (the person) use in communication?
[] Attended an educational establishment
[] Has never attended an educational establishment ? Go to #2
19. What level of educational does (the person) attend or has attended (even if incomplete)?
[] Primary School (1st ? 5th grade)
[] Primary School (6th ? 7th grade)
[] General Secondary School ? 1st Cycle (8th ? 10th grade)
[] General Secondary School ? 2nd Cycle (11th ? 12th grade)
[] Elementary Technical School
[] Basic Technical School
[] Upper Technical School
[] Primary Teacher Training Course
[] Higher Education
20a. Has (the person) completed the level indicated in the previous question?
[] No
20b. If not, indicate the highest level and year/grade completed.
Year/grade: _ _
FOR PEOPLE AGED 7+ ONLY.
21. What activity has (the person) performed in the past week?
[] Did not work, but has a job- Go to #23
[] Helped a relative- Go to #23
[] Looked for a new job- Go to #23
[] Domestic- Go to #22
[] Looked for a job for the first time- Go to #27
[] Served the FADM- Go to #27
[] Studied only- Go to #27
[] Retired/ reserve- Go to #27
[] Was unable to work- Go to #27
[] Other- Go to #27
22. If domestic, say whether in the past week (the person):
[] Has produced or sold goods
[] Has looked after the house/children only- Go to #27
23. What was (the person)?s main occupation/duty in the past week or the last time he/she worked?
24. What kind of activity is executed in the place where (the person) currently works at?
25. Say whether (the person) is a (worker of):
[] the Private Sector
[] a Government-owned Corporation
[] the Cooperative sector
[] Self-employed worker
[] Family worker with no pay
[] Member of a Cooperative
[] Boss/ Employer
26. How many hours a day did (the person) work in the past week?
FOR PEOPLE AGED 12+ ONLY.
27. What is (the person)?s marital status?
[] Married
[] Living together as married partners
[] Divorced/Separated
[] Widowed
28. How many children born alive has (the person) had?
____ Female
29. How many of (the person)?s children are alive?
____ Female
30. How many children born alive has (the person) had in the past 12 months?
____ Female
31. From those children born alive in the past 12 months, how many are alive?
____ Female
Enumerator: Please turn to the following page and carry on interviewing the next person in the dwelling/ living quarter. If this is the last person, go to Section E- Housing.
Section E: Characteristics and Condition of the Dwelling
Enumerator: Fill in the next question about the dwelling unit. If there is more than one household in the dwelling unit, fill in questions 1-10 for the first household only.
[] Flat/apartment
[] Hut
[] Precarious Dwelling (shack, tin, cardboard)
[] Wooden and Zinc house
[] Other: ________
[] Hotel/ boarding house
[] Barracks/ military camp
[] Convent/ seminary
[] School/ boarding school/ student residence
Other: ________
[] Homeless people
[Questions 2 and 4 were asked of private households.]
[] Owned
[] Borrowed
[] Other
[] Vacant
[Questions 2 and 3 were asked of private households.]
3. The walls of the house are made of:
[] Bricks
[] Wood/ zinc
[] Adobe blocks
[] Reed/ sticks/ bamboo/ palm tree
[] Weaved sticks (mud and wattle)
[] Tin/ cardboard/ paper/ canvas/ bark
[] Other materials
4. The house is roofed with:
[] Tiles
[] Asbestos plates
[] Zinc plates
[] Grass/ culms/ palm tree leaves
[] Other materials
[Questions 5 through 10 were asked of private households in occupied dwellings.]
5. The house floor is made of: (excluding kitchen and bathrooms)
[] Marble/ granite
[] Cement
[] Mosaic/ ceramic
[] Adobe
[] Nothing (dirt floor)
[] Others
6a. How many rooms is the house divided into? (Excluding kitchen and bathrooms)
6b. From those, how many are used for persons to sleep?
7. What is the main source of water used to drink in this household?
[] Piped water outside the dwelling
[] Water from fountain
[] Water from well
[] Water from borehole
[] River/ lake water
[] Other
8. The house has:
[] Toilet without flush
[] Latrine
[] No toilet/ latrine
9. Does the house have electricity?
[] No
10. Does the household have a radio?
[] No
Section F: Agricultural Activity
[Note: The word machamba refers to small plots of land used for the agricultural practices].
1. Does this household have a machamba?
[] No ? go to #5
2. How many machambas does this household have?
3. How many machambas were sowed in the last agricultural campaign (1996/1997)?
4. How many members of the household have a machamba?
5. Does this household have cashew trees?
[] No
6. How many animals do all members of the household have?
[] 2 Goats
[] 3 Pigs
[] 4 Birds
Section G: Mortality
Enumerator: Get information about the deceased in the household. Do not forget about the children.
1. Has anybody passed away in this household in the past 12 months?
[] No - Finish the interview and turn to the last page of this form.
2. Please specify the sex and age of those who passed away.
2. Age (in years) _____
Enumerator: Finish the interview and turn to the last page of the Enumeration Form.
The names of all the members of the household have been Witten in Section C, on the first page of the Enumeration Form
You have collected most part of the information about the household and the Dwelling.
The information is clear and legible
You have signed the Enumeration Form
You have issued the census cards and stuck a tag on it.
You thank the people surveyed for their cooperation and go on to the next household.