2011 Census Form

Household indicative information
Province _ _
District _ _
LLD_ _
Urban area or rural ward _ _
Census unit _ _ _
Workload No. _ _
Household No. _ _ _
House type _ _
Response code _ _

Office use only
Total persons in this household _ _ _

Collection: The information asked for is collected under the authority of the Statistical Services Act (1981).
Authority: Your co-operation in completing this form is important to the success of the census.
Privacy: The law protects your privacy. No one outside of this office can see your form or link your answers with your name and address.
Coverage: All persons present on the Census Night must be counted whether they are family members or not. Check whether persons who spent Census night but have since gone away are included.

For all persons

1. What is the name of each person including visitors who slept here on the night of Sunday 10th July 2011?

Start with head of household.
Name ____

2. What is the person's relationship to the head of household?

[] 1. Head of household
[] 2. Husband/ Wife
[] 3. Own son/daughter
[] 4. Step/ adopted child
[] 5. Other relative
[] 6. Non-relative

3. Is the person male or female?

[] 1. Male
[] 2. Female

4. What is the person's date of birth or age in years?

Write date of birth in six boxes provided. If not know, write age in completed years.

Day/month/year _ _ _ _ _ _
Age in years _ _

5. What is the person's present marital status?

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

6. What church or religion does the person belong to?

Religion ____

7. Is the person's own father still alive?

[] 1. Yes
[] 2. No

8. Is the person's own mother still alive?

If "yes" and mother in this house, write mother's person number in the boxes. Enter "00" if mother not in this house.

[] 1. Yes
[] 2. No

Mother's person number _ _

9. Where was the person born?

If not PNG, write country name

____Province/ country
____District

10. What is the person's place of usual residence now?

If not PNG, write country name.

____Province/ country
____ District

11. What was the person's place of usual residence one year ago?

If not PNG, write country name.

____Province/ country
____ District

12. What is the person's citizenship?

____Citizenship

Continue only for persons aged 5 years or more.
[Questions 13 and 14 were asked of persons age 5+]

13. Is the person attending any formal schooling now?

[] 1. Yes
[] 2. No - Attended in the past
[] 3. No - Never attended

14. What is the highest formal educational grade completed by the persons?

If code 3 "Never attended in Q.13, enter "00"

_ _ Grade

Continue only for persons aged 10 years or more
[Questions 15 to 21 were asked of persons age 10+]

15. Has the person completed a certificate, diploma, or a university degree, or any other educational qualification since leaving school?

If "yes", specify level and subject of qualification in the space provided.

[] 1. Yes, specify____
[] 2. No

16. Which languages can the person read and write with understanding?

English

[] 1. Yes
[] 2. No

Pidgin

[] 1. Yes
[] 2. No

Motu

[] 1. Yes
[] 2. No

Tokples

[] 1. Yes
[] 2. No

17. In the last seven days, has the person done any of the following?

(If more than one answer is given record main activity.)

If code 7 "none" go to Q.20.

[] 1 Gardening/fishing for money
[] 2 Gardening/fishing for own use only
[] 3 Business (any type) with paid help
[] 4 Business (any type) without paid help
[] 5 Helping in family business without pay
[] 6 Wage job (including temporary absence)
[] 7 None (go to Q.20)

18 (a). What kind of work did the respondent do in the last seven days?

Describe kind of work or occupation, e.g. plumber, street seller, kaukau farmer, car mechanic.

Type of work ________

18 (b). What are the main tasks/ duties done in that work?

Describe kind of tasks or duties done in the work stated in Q. 18 (a). e.g. mending tap, selling betel nut, weeding garden, fixing engines.

Tasks of duties ________

19. What kind of business is done at the place where the person works?

Describe business activity. E.g. house building, air transport, selling betel nut.

Kind of business ________

Go to Q.22

20. Has the person actively sought any kind of wok in the last four weeks?

[] 1. Yes
[] 2. No

21. What was the person doing mostly in the last seven days?

If "other", describe in the space provided.

[] 1. Housework
[] 2. Studying
[] 3. Waiting to start a new job
[] 4. Looking for work

Not working because

[] 5. Too young
[] 6. Too old/ retired
[] 7. Sick
[] 8. Permanently disabled
[] 9. Other, describe ____

Continue only for all citizen women aged 15 years or more
[Questions 22 to 26 were asked of citizen women age 15+]

For Q. 22 to 26, write answer in boys or girls columns.

22. How many children have you given birth to?

_ _ Boys
_ _ Girls

23. How many of your own children are living in this house?

_ _ Boys
_ _ Girls

24. How many of your own children are living elsewhere?

_ _ Boys
_ _ Girls

25. How many of your own children are dead?

_ _ Boys
_ _ Girls

26. How many children have you given birth to in the last 12 months?

_ _ Boys
_ _ Girls

For the household, ask the following questions

27. Deaths in the household in the last 12 months: Total number of deaths

Enter the total number of deaths and record the following information for each deceased person. If no deaths, enter "00" and Go to Q.28

Name____

(Write the name of the deceased member of the household)

Sex

[] 1. Male
[] 2. Female

Age _ _

In complete years

For females aged 15-45 years: was the cause of death related to

[] 1. Pregnancy
[] 2. Delivery
[] 3. Within 6 weeks of the end of pregnancy or childbirth
[] 4. Not pregnancy related

28. Does this household grow/raise any of the following for:

1. Cocoa