Seventh General Population and Housing Census 2004 Questionnaire
Household no.:
District _ _
Resort _ _
Counting block _ _ _ _
Tracking no. _ _ _
Household number _ _ of _ _
Street name
Address ____
House no. _ _ _
Letter _ _ _ _
Name of institution _____
Apartment no. _ _ _ _
Enumerator
_ _ Month
_ _ Year
_ _ _ _ Code
Reviewer:
_ _ Month
_ _ Year
_ _ _ _ Code
Coder:
_ _ Month
_ _ Year
_ _ _ Code
Keyer 1:
_ _ Month
_ _ Year
_ _ _ Code
Keyer 2:
_ _ Month
_ _ Year
_ _ _ Code
[] 2 No
Confidentiality guaranteed under the 1949 Census Law Government Bulletin 1949, no. 110 and under the 2002 Statistics Law Bulletin of Acts and Decrees of 2002, no. 97 and under the Seventh General Census Law, Bulletin of Acts and Decrees of 2004, no. 95
1. What kind of living quarter is it:
[] 2 Upstairs living quarter
[] 3 Downstairs living quarter
[] 4 Single-room living quarter
[] 5 Part of multiple living quarters
[] 6 Other, namely ____
[] 9 No response
2. What is the right of use of the living quarter?
[] 2 Rent
[] 3 Sublet
[] 4 Hire-purchase
[] 5 Service/business living quarter
[] 6 Other, namely ____
[] 9 No response
[] 1 Suriname dollars
[] 2 United States dollars
[] Euros
3. How many rooms does this living quarter comprise?
_ _ Number of rooms
_ _ of which are bedrooms
[] 99 No response
4. What is the condition of the living quarter according to the respondent?
[] 2 Average
[] 3 Poor
[] 7 Don't know
[] 9 No response
5. What is the main type of water supply for this living quarter?
[] 1 Mains: indoor
[] 2 Mains: outdoor (less than or equal to 200 m)
[] 3 Mains: outdoor (greater than 200 m)
[] 4 Rainwater in containers, cisterns, barrels
[] 5 Well (Less than or equal to 200 m from living quarter)
[] 6 Well (greater than 200 m from living quarter)
[] 7 Creek or river
[] 8 Other
[] 9 No response
[] 1 SWM
[] 2 Min. Natural Resources
[] 3 Other
[] 7 Don't know
[] 1 Yes
[] 2 No
[] 2 Other, namely ____
6. What is the main type of electricity supply?
[] 1 Direct connection to EBS
[] 2 Direct connection through Nat Res and Centr Gov
[] 3 Electricity through neighbors
[] 4 Own generator (genset)
[] 5 Other, namely ____
[] 6 No electricity supply
[] 7 Don't know
[] 9 No response
1a. What is the most commonly used language in this household?
[] 1 Dutch
[] 2 Sranang Tongo
[] 3 Sarnami
[] 4 Javanese
[] 5 Arawak
[] 6 Carib
[] 7 Saramaccan
[] 8 Aukan
[] 9 Paramaccan
[] 10 Chinese
[] 11 Portuguese
[] 12 English
[] 13 French
[] 14 Other, namely ____
[] 97 Don't know
[] 99 No response
1b. What is the second language used in this household?
[] 1 Dutch
[] 2 Sranang Tongo
[] 3 Sarnami
[] 4 Javanese
[] 5 Arawak
[] 6 Carib
[] 7 Saramaccan
[] 8 Aukan
[] 9 Paramaccan
[] 10 Chinese
[] 11 Portuguese
[] 12 English
[] 13 French
[] 14 Other, namely ____
[] 15 No second language
[] 97 Don't know
[] 99 No response
2. What is the main fuel used for cooking?
[] 1 Gas
[] 2 Wood/charcoal
[] 3 Kerosene
[] 4 Electricity
[] 5 Other, namely ____
[] 6 Doesn't cook
[] 7 Don't know
[] 9 No response
3. What type of telecommunication facilities does this household have?
[] 1 Landline (cable)
[] 2 Mobile
[] 3 Fixed cellular/ FRA
[] 4 Radio station
[] 5 No telecommunication facility
[] 7 Don't know
[] 9 No response
4. How do you dispose of your rubbish?
[] 1 Collected once a week
[] 2 Collected twice a week
[] 3 Collected more than twice a week
[] 4 Put it in a waste container myself
[] 5 Burn it myself
[] 6 Bury it myself
[] 7 Take it to a disposal site myself
[] 8 Throw it into a river/gutter/ditch myself
[] 9 Dump it elsewhere
[] 99 No response
5. What is the most commonly used toilet facility in the household?
[] 1 Flush toilet and septic tank
[] 2 Private toilet
[] 3 River or creek
[] 4 Open pit or hole in the ground
[] 5 No toilet facility, woods, field
[] 7 Don't know
[] 9 No response
[] 1 Yes
[] 2 No
6. What means of transport, in working condition, are available?
[] Bicycle
[] Moped
[] Scooter
[] Motorcycle
[] Passenger car
[] Bus
[] ATV (All-Terrain Vehicle)
[] Boat with outboard motor
[] Dugout canoe
[] Other, namely ____
[] No means of transport
[] No response
Seventh Population and Housing Census, August 2004
N.B.: The reference time is set at: (Monday 2 August 2004, 00.00 hours)
Persons present during census night (the night of 1 August 2004, 18.00 hours to 2 August 2004, 06.00 hours):
A. How many persons spent the night of the census at this living quarter?
Please include yourself in the count!! (Provided you were one of those present)
1. Visitors laving on 2 Aug. 2004 left
2. Persons staying temporarily and leaving by 1 Feb. 2005
3. Persons staying temporarily and leaving after 1 Feb. 2005
4. Staying here permanently
Persons absent during census night (the night of 1 August 2004, 18.00 hours to 2 August 2004, 06.00 hours)
B. How many persons permanently or temporarily staying at this living quarter did NOT spend the night of the census here?
How many of those listed under BA:
Persons returning from a trip, a detention, hunting/fishing, a party/wake, a night shift, a visit to Accident and Emergency etc. on 2 August 2004 are
5. Are staying temporarily and leave by 1 Feb. 2005
6. Are staying temporarily and will or after 1 Feb. 2005
7. Live here
How many of those listed under BB:
Persons returning after 2 August 2004 or by 1 Feb. 2005
8. Are staying temporarily and will leave by 1 Feb. 2005
9. Are staying temporarily and will leave on or after 1 Feb. 2005
10. Live here permanently
2. Please provide the personal details of those identified above by the numbers: 1, 2, 5, 8
Type of member _ _
Name ____
Address ____
Age _ _
Sex
[] 2 Female
Nationality
[] 2 Dutch
[] 3 Guyanese
[] 4 French
[] 5 Brazilian
[] 6 Haitian
[] 7 Chinese
[] 8 US
[] 9 Other
[] 97 Don't know
[] 99 No response
_ _ Female
_ _ Male + Female
3. Please provide the personal details of those identified by a P-Form reference (numbers 3, 4, 6, 7, 9, and 10) in:
Number _ _
Type of member _ _
First name and initial of middle name ____
Age _ _
Sex
[] 2 Female
Nationality
[] 2 Dutch
[] 3 Guyanese
[] 4 French
[] 5 Brazilian
[] 6 Haitian
[] 7 Chinese
[] 8 US
[] 9 Other
[] 97 Don't know
[] 99 No response
Child of
_ _ Number of mother
Number of partner _ _
Family Number _ _
P-Form completed _ _
_ _ Female
_ _ Male + Female
District _ _
Resort _ _
Counting block _ _ _ _
Serial number _ _ _
Household _ _ of Number _ _
All persons in the household
[Questions P00 to P06c were asked of all persons.]
P00. Serial no. of this person _
P01. Starting with the head of the household, please provide the family name and first names of those living in this house.
If not the head of the household, start with the most senior member of the household
Person's family name and first and middle names ____
Identity number _
P02. Which CBB office is this person registered with?
Name of the CBB office____
P03. Where was this person born?
[] 2 Wanica
[] 3 Nickerie
[] 4 Coronie
[] 5 Saramacca
[] 6 Commewijne
[] 7 Marowijne
[] 8 Para
[] 9 Brokopondo
[] 10 Sipaliwini
[] 11 Abroad
[] 12 Distr. Suriname
[] 13 Other
[] 2 Female
P05. What age was this person on 2 Aug. 2004?
If answer is don't know, provide estimated age
_ _ Age
_ _ Estimated age
P06. When was this person born?
P06b. Month _ _
P06c. Year _ _ _
[] 7 Don't know
All persons in the household
[Questions P07 to P12 were asked of all persons in the household.]
P07. What is the family relationship of this person with the head of the household?
If there is no head of the household ask for family relationship with most senior person in the household.
[] 2 Spouse/Partner
[] 3 Child/Adopted child
[] 4 Stepchild/Foster child
[] 5 Grandchild
[] 6 Parent/Parent-in-law/Foster parent
[] 7 Grandparent/Grandparent-in-law
[] 8 Son-in-law/Daughter-in-law
[] 9 Other family member
[] 10 No family member
P08. Where did this person live 1 year ago?
[] 2 Wanica
[] 3 Nickerie
[] 4 Coronie
[] 5 Saramacca
[] 6 Commewijne
[] 7 Marowijne
[] 8 Para
[] 9 Brokopondo
[] 10 Sipaliwini
[] 11 Abroad
[] 12 not born yet
[] 97 Don't know
[] 99 No response
P09. What nationality is this person?
[] 2 Dutch
[] 3 Guyanese
[] 4 French
[] 5 Brazilian
[] 6 Haitian
[] 7 Chinese
[] 8 US
[] 9 Other
[] 97 Don't know
[] 99 No response
P10. What religion/faith is this person?
[] 2 Hindu
[] 3 Islamic
[] 4 Traditional religion
[] 5 Other
[] 6 No religion
[] 7 Don't know
[] 9 No response
P11. What ethnic group does this person say they are?
[] 2 Maroons
[] 3 Creole
[] 4 Hindustani
[] 5 Javanese
[] 6 Chinese
[] 7 Caucasian/White
[] 8 Mixed
[] 9 Other
[] 97 Don't know
[] 99 No response
[If answer 1 or 2, go to question P12. Elsewise, go to P13.]
P12. To what tribe does this person belong?
[] 2 Caribbean
[] 3 Wajana
[] 4 Trio
[] 5 Akurio
[] 6 Saramaka
[] 7 Aukan/Ndyuka
[] 8 Matuari
[] 9 Paramaccan
[] 10 Bonis/Alukus
[] 11 Kwinti
[] 12 Other tribe
[] 13 Mixed
[] 14 None
[] 97 Don't know
[] 99 No response
P13. How are healthcare costs of this person mainly paid for?
[] 1 SZF (government)
[] 2 SZF (voluntary insurance)
[] 3 Medical Consignment
[] 4 SoZaVo (insolvent)
[] 5 SoZaVo (impecunious)
[] 6 Business
[] 7 Insurance Company
[] 8 From own resources
[] 9 Other
[] 97 Don't know
[] 99 No response
P14. Is this person able to write letters/messages to their family/friends?
Instruction: Language used for writing e.g. Chinese, Arabic or Hindi is irrelevant
[] 1 Yes
[] 2 No
[] 7 Don't know
[] 9 No response
5 years and above
[Question P15 was asked of persons 5 years and over.]
P15. What is the highest formal education this person received up to and including the 2002/2003 school year?
[] 2 Preschool
[] 3 Special-Needs Education
[] 4 GLO
[] 5 LBO
[] 6 JVO (ULO/MULO/ MULO/ LBGO)
[] 7 MBO (IMEO, NATIN, AMTO)
[] 8 Teacher Training for Primary Education
[] 9 SVO (VWO, HAVO)
[] 10 Higher Vocational Education
[] 11 University
[] 97 Don't know [Go to P16]
[] 99 No response [Go to P16]
[] 2 4 or 5-year-old child B
[] 3 1st year/group
[] 4 2nd year/group
[] 5 3rd year/group
[] 6 4th year/group
[] 7 5th year/group
[] 8 6th year/group
[] 9 Transition year
[] 10 Propedeuse
[] 11 Doctoral 1
[] 12 Doctoral 2
[] 13 Doctoral 3
[] 97 Don't know
[] 99 No response
[] 2 No
[] 7 Don't know
[] 9 No response
12 years and above
[Question P16 and P17 were asked of persons 12 years and above.]
P16. Did this person, in the period from 26 July to 1 Aug 2004, have a job, an odd job or work?
[] 1 Yes [Go to P18]
[] 2 No
[] 7 Don't know
[] 9 No response
P17. Did this person, in the period from 26 July to 1 Aug 2004, have a job or odd job/work from which they were temporarily absent?
[] 1 Yes
[] 2 No [Go to P21]
[] 7 Don't know [Go to P21]
[] 9 No response [Go to P21]
Working in main profession
[Question P18 to P20 were asked of persons working.]
P18. The job, odd job or for work was fulfilled by this person as:
[] 2 Self-employed person
[] 3 Unpaid worker in family undertaking
[] 4 Employee
[] 5 Other
[] 7 Don't know
[] 9 No response
P19. Where did this person work?
1) Name of the business ____
2) Activity of the business ____
P20. What kind of work did this person do?
N.B.!!!!!!! "Civil servant" is not a proper description.
Proceed to P23
Non-working
[Question P21 and P22 were asked of persons not working.]
P21. Has this person been looking for work in the past 4 weeks?
[] 2 No
[] 7 Don't know
[] 9 No response
P22. What is the reason why this person didn't look for work?
[] 2 Student (regardless of level of education)
[] 3 Family carer
[] 4 Incapacitated for work
[] 5 Thinks they won't find work
[] 6 Looked for work but couldn't find
[] 7 Waiting for application outcome
[] 8 Is an unpaid worker in family business
[] 9 Other
[] 97 Don't know
[] 99 No response
12 Years and above
[Question P23 to P25 were asked of persons aged 12 and above.]
P23. What is the marital status of this person?
[] 2 Married
[] 3 Divorced
[] 4 Widow(er)
[] 7 Don't know
[] 9 No response
P24. What is this person's current status of cohabitation?
[] 2 Cohabiting with partner
[] 3 Not cohabiting with partner
[] 4 None
[] 7 Don't know
[] 9 No response
P25. What is this person's main income and second most important income?
[] 1 Wages/salary
[] 2 Profit
[] 3 interest
[] 4 From property
[] 5 Pension
[] 6 Alimony
[] 7 Disability Benefit
[] 8 Other social benefit
[] 9 No income
[] 10 Other than listed
[] 97 Don't know
[] 99 Refuses to answer/doesn't answer
Main income
_ Group
_ Group
Women aged 12 to 64
[Questions P26 through P30 were asked of women aged 12 to 64.]
P26. How many sons and daughters has this woman given birth to that were born alive?
_ a. Daughters
_ b. Sons
P27. How many children of this woman are currently alive?
_ a. Daughters
_ b. Sons
P28. How many live-born children of this woman have died?
_ a. Daughters
_ b. Sons
P29. When was the first time this woman gave birth to a live-born child?
_ _ Month
_ _ Year
[] 7 Don't know
P30. When was the last time this woman gave birth to live-born child?
_ _ Month
_ _ Year
[] 7 Don't know
P31. Has this woman given birth to any live-born children in the period 2 Aug 2003 to 1 Aug 2004?
[] 7 Don't know
[] 9 No response
P32. Where did this person spend the night of the census?
[] 1 This home address
[] 2 Other home address
[] 3 Elsewhere in Suriname
[] 4 Abroad
[] 7 Don't know
[] 9 No response