Rwanda 1991 Enumeration Form
(Recensement Général de la Population et de l'Habitat, 16-30 août 1991)
I. Identification
[Questions 1-10]
1. Province _ _
2. Commune (Township) _ _
3. Census sector _ _
5. Census cell _ _
6. Dwelling unit number _ _ _
7. Household number _ _ _
8. Type of household:
[] 2 Institution. If applicable, specify the type of institution: ____
9. Total numbers of questionnaires filled _ _ _
10. Questionnaire number _ _ _
II. Summary table
[The following information is organized as a table]
____ Female
____ Total
Absent:
____ Female
____ Total
Total:
____ Female
____ Total
_ _ Female
_ _ Total
Date of visit: _ _ _ _ _ _ _ _
Name of census enumerator: ____
Signature: ____
Date of supervision: _ _ _ _ _ _ _ _
Name of supervisor: ____
Signature: ____
For private households
[Questions H1 - H11]
H1. Structure of the dwelling unit
[] 2 House with several households
[] 3 Building with several apartments (floors)
[] 4 Compound (inhabited by several households)
[] 5 Grouped houses / huts (inhabited by one household)
[] 6 Others
H2. Number of rooms _ _
H3. Walls
[] 1 Baked bricks
[] 2 Stone
[] 3 Cement blocks
[] 4 Adobe bricks
[] 5 Cement and adobe bricks
[] 6 Wood and cement pisé [wood and cement adobe]
[] 7 Wood and earth pisé [wood and earth adobe]
[] 8 Wood plank
[] 9 Others
H4. Roofs
[] 1 Corrugated metal sheet
[] 2 Tiles
[] 3 Concrete
[] 4 Thatch / straw
[] 5 Others
H5. Floor
[] 1 Cement
[] 2 Ceramic tiles
[] 3 Bricks / stone
[] 4 Earth / sand
[] 5 Others
H6. Type of lighting
[] 1 Electricity
[] 2 Oil lamp
[] 3 Paper oil lantern
[] 4 Candle
[] 5 Wood
[] 6 Others
H7. Source of water
[] 1 Tap inside house
[] 2 Brought from outside tap
[] 3 Street tap
[] 4 Spring / well, built
[] 5 Spring / well, natural
[] 6 River / lake
[] 7 Others
H8. Cooking fuel
[] 1 Electricity
[] 2 Gas
[] 3 Kerosene
[] 4 Coal
[] 5 Wood
[] 6 Straw
[] 7 Others
H9. Toilet facility
[] 1 Flush toilet
[] 2 Pit latrine, individual
[] 3 Pit latrine, shared
[] 4 Neighbor
[] 5 Nature / outside
[] 6 Others
H10. Ownership/renting status
[] 1 Landlord / owner
[] 2 Paid by employer
[] 3 Free housing
[] 4 Tenant
[] 5 Other
H11. Ownership of a radio
[] 1 Yes
[] 2 No
Observations from the enumerator ____
Observations from the supervisor ____
IV. Individual characteristics
[Questions P1-P33.]
For all persons
[Questions P1 to P15 were asked of all persons]
[Space is provided for responses to the following items for each person]
Head of household;
Unmarried children of the head of household whose mother is no longer a member of the household;
First wife and her unmarried children if they live in the household, starting by the youngest;
Second wife and her unmarried children if they live in the household, starting by the youngest;
Married children of the head of household, followed by their spouses and their children;
Other relatives of the head of household or of his / her spouse;
All visitors.
P3. Relationship with household head
[] 1 Household head
[] 2 Spouse
[] 3 Child
[] 4 Nephew / niece
[] 5 Parent (father / mother)
[] 6 Grandchild
[] 7 Brother / sister
[] 8 No kinship relation
P4. Residence status
[] 1 Resident, present
[] 2 Resident, absent
[] 3 Visitor
P5. Sex
[] 1 Male
[] 2 Female
P6. Date of birth ____
Write down the month and the year of birth. Separate the month and the year with a slash.
P7. Age _ _
P8. Place of birth _ _ _ _
P9. Place of residence _ _ _ _
P10. Duration of residence _ _
P11. Place of previous residence _ _ _ _
P12. Nationality / Country of citizenship _ _
P13. Religion
Circle the number matching the letters corresponding to the declared religion, following the abbreviations at the bottom of the page.
[Abbreviations are expanded here]
[] 1 Catholic
[] 2 Protestant
[] 3 Adventist
[] 4 Muslim
[] 5 Traditional religion
[] 6 Other religion
[] 7 No religion
P14. Father
Circle the number matching the letters corresponding to the answer.
[] 1 Yes
[] 2 No
[] 3 Do not know
P15. Mother
Circle the number matching the letters corresponding to the answer.
[] 1 Yes
[] 2 No
[] 3 Do not know
Population aged 6 years or older (born before August 1985).
[Questions P16-P20 were asked of persons age 6+]
P16. Literacy
Circle the number matching the letters corresponding to the answer.
[] 1 Yes
[] 2 No
[] 3 Reads only
P17. Foreign language spoken
Circle the number matching the letters corresponding to the answer.
[] 1 French
[] 2 English
[] 4 Swahili
[] 8 Other
[] 16 None
Level of education
[Question P18-P20 were asked of persons age 6+ who ever attended school]
P18. Highest grade completed _ _
P19. Type of education ____
P20. Highest diploma received _ _
Population aged 10 years or older (born before August 1981).
[Questions P21-P24 were asked of persons age 10+]
P21. Employment status
[] 1 Employed
[] 2 Unemployed
[] 3 Looking for [first] work
[] 4 Housewife
[] 5 Student
[] 6 Retired
[] 7 Other
Active Population / Employed or unemployed
[Questions P22-P24 were asked of individuals who were part of the active population, whether they were working or not]
P22. Current occupation ____
P23. Work status (Status in occupation)
Circle the number matching the letters corresponding to the answer given, following the abbreviations provided at the bottom of the page.
[] 1 Self employed
[] 2 Employer
[] 3 Employee (salaried)
[] 4 Apprentice
[] 5 Family aid / family worker
[] 6 Business partner
P24. Type of economic activity (Branch or sector of economic activity) ____
Write down in full what the company produces (or was producing) or the society in which the named person works (or was working)?
P25. Marital status
What is the marital status of [the respondent]?
Circle the number matching the letters corresponding to the answer given, following the abbreviations provided at the bottom of the page.
[] 1 Single
[] 2 Married, legally
[] 3 Married, customary
[] 4 Free union
[] 5 Polygamous, two wives
[] 6 Polygamous, three wives or more
[] 7 Widowed
[] 8 Divorced / Separated
Women aged 12 years and older (born before August 1979).
[Questions P26-P33 were asked of women age 12+]
P26. Children ever born: number of boys _ _
P27. Children ever born: number of girls _ _
P28. Children surviving: number of boys still alive _ _
P29. Children surviving: Number of girls still alive _ _
P30. Own births in past 12 months: number of boys _ _
P31. Own births in past 12 months: number of girls _ _
P32. Own children dead in past 12 months: number of boys _ _
P33. Own children dead in past 12 months: number of girls _ _