Polish People Republic
Form A
Central Statistical Office
Department of Censuses ad Demographic Research
National Census, 6 December 1988
Form A should be filled and numbered separately for every dwelling (mobile housing or provisional housing) in a census district regardless the number of households living in a dwelling and the number of forms completed.
In case of collective housing separate number of the form should be given to every form completed for enumeration of the persons living there.
____ No. of census district
____ Voivodship
____ Town/commune
____ Locality
____ Street (square)
____ No. (of real estate)
____ No. (of dwelling)
____ No. of a building in a census district
[] 2 Provisional housing or mobile housing (specify the kind)
[] Other: Collective housing (specify the name) ____
In questions 2-5 write in relevant number
In questions 6-11 encircle relevant code
Cross questions 2-11
Cross questions 2-11
Characteristics of the dwelling
1.Surname and name of the main lodger or the owner____
2. Number of rooms (with window and not smaller than 4 meters squared) ____
b) without window (so called blind kitchen) or with a window but smaller than 4 meters squared (if there are not any write in "0") ____
4. Total number of chambers (sum of 2 and 3a) ____
5. Total useful floor space of dwelling ____
Not in dwelling:
[] 0 The inhabitants can not use pipe water in the building they live in
Not in dwelling:
[] 0 The inhabitants can not use flush toilets in the building they live in
[] 0 There is not
9. Hot running water in dwelling
[] 2 Heated in dwelling
[] 0 There is not
[] 2 From bottles
[] 0 There is no gas in dwelling
[] 2 Individual central heating based on gas
[] 3 Individual central heating based on another fuel (e.g. coal, wood, petrol etc.)
[] 4 Stoves (e.g. tiled stove using wood, coal, sawdust etc.)
[] 5 Electric heating (accumulative)
Census of population (inhabitants)
____ Name
2. Is the person living permanently (and was present or not at this address at 24.00 on 6. December 1988) or living temporarily? (encircle one of the options):
[] 2 Permanently living -- absent
[] 3 Temporarily living
3-4 Questions for persons living permanently but absent or staying temporarily
3. Total duration of absence or temporary staying? (encircle one of the options)
[] B Over 2 months
4. Reason for absence or temporary staying ____
5. Relation to the person enumerated as first in household-- (write in a code together with a description) ____ _
[] Female
[] Married
[] Widower
[] Divorced
9. Date of marriage contracted in registration office
Year _ _ (write in two last digits of the year)
10. Education attainment ____ _
[]Comprehensive or specializing in building,
[] Electro mechanics,
[] Mechanics,
[] Agriculture,
[] Medicine etc.
12. School attendance at present
[] 2 Not
13. Total acreage of a farm (or agricultural field) _ _
14. Name of working establishment ____
15. Name of the locality in which the working establishment is located ____
16. Status (kind of activity) ____
17. Write in the name of the working post in the working establishment listed above. Specify performed activities and duties ____
18-19 Second (additional) employment
18. Name of working establishment ____
19. Status (kind of activity) ____
20. Input (helping) in agriculture
Months _ _
21-22 Maintenance not from work
21. Type of such maintenance ____
22. Maintenance got from previous work (encircle)
[] 2 In agriculture (individual farm)
[] 3 In agriculture other then (2)
[] 4 Non applicable
[] Maintenance from work,
[] Maintenance not from work,
____Specify the number of the person.
24. Is the person fully or seriously unable to perform the tasks typical for his/her age due to disability or chronic illness? (encircle)
[] 2Yes -- seriously
[] 0 No
25. Has the person got a medical statement concerning any disability issued by KIZ (Medical Commission on Disabilities and Employment).
[] 2Yes -- II group
[] 3Yes -- III group
[] 0 No
26. Date of settlement in the locality. Give two last digits of the year of settlement. For persons born in the locality write in "00"
27-30 Complete for persons settled in the locality after 1978, so between 1979 and 1988
27. Previous place of living ____
28. Previous place of living ____
29. Source of maintenance in a previous place of living ____
30. Was the person living with a farm user or was using the farm herself/himself? ____
1. Source of maintenance of the household
____ Additional (second row in a column row 1)
Questions 2 and 3 apply only to households living in dwelling. In case of household living in provisional housing or mobile housing the questions should be crossed.
2. Legal basis for occupancy of the dwelling ____
3. Family connections between persons enumerated in different households. In a dwelling enumerated:
[] 1Two or more households -- persons from all the enumerated households are kins
[] 2Two or more households -- persons from at least two of the enumerated households are kins
[] 3Two or more households -- persons from all the enumerated households are not kins
Fill for the building in which at least one dwelling was enumerated. Answers for questions 1-10 write in only once -- in a first enumerated dwelling. In the forms filled for other dwellings this part should be crossed.
1. Who is the administrator of the building (or owner). Write in the name of the institution or a name and surname of the owner ____
[] 2 Housing cooperative
[] 3 Other socialized institution (such as working establishment, socio-political organization etc.)
[] 4 Is privately owned but at least one flat in a building is allocated by decision of the local authority
[] 5 Is privately owned and there are no flats in a building being allocated by decision of the local authority
[] 6 Church
[] 2 Partly residential; residential -- inventoried (being a part of a agricultural farm)
[] 3 Collective housing (more than half of the building is occupied by hospital, hotel or boarding school)
[] 4 Non residential (but more than half of the building is occupied by office, shop or school)
3. Material of outer walls of the building:
[] 2 Flammable ( wood etc.)
[] 2 Metal plate
[] 3 Roof felt
[] 4 Other
____ number of floors (write in the relevant number)
6. When was the building built:
[] 02 1918 - 1944
[] 03 1945 - 1960
[] 04 1961 - 1970
[] 05 1971 - 1978
[] 06 1979 - 1980
[] 07 1981 - 1982
[] 08 1983 - 1985
[] 09 1986
[] 10 1987
[] 11 1988
[] 2 Yes -- local system
[] 3 Not in a building but within a property
[] 0 Neither in a building nor within a property
[] 2 Yes -- local system
[] 0 Not in a building
[] 2 Yes -- local system
[] 0 Not in a building
10. Number of occupied dwellings in a building -- (listed under the same number on page 1)