Confidential
Form 2
(Enumeration form)
Sheet number ____ of ____ sheets for this household
Part I Identification of household
a. Address
_ _ Province
_ _ District
_ _ Sub district
Institution household
[] 3 Jail
[] 4 Welfare Lodging
[] 5 Hospital
[] 6 Boarding School/dormitory
[] 7 Military
[] 9 Boarding house and others
h. Number of persons in a household
Male persons _ _
Female persons _ _
L0. Language usually spoken in this household _ _
For Every Person
[Questions L1- L7 were asked of every person.]
Head
Spouse
Unmarried children
Grandchildren
Parents
Other relatives
Non-relatives
L3. Relationship to head of household
[] 2 Spouse
[] 3 Unmarried children
[] 4 Grand children
[] 5 Parents
[] 6 Other relatives
[] 7 Non-relatives
Year ____
[] 2 Temporarily away from home
[] 3 Temporarily abroad
[] 2 Female
L8. Highest grade of school completed (as of January 1980) ____
For Persons born before and in 1968
[Questions L9-12 were asked of persons 12 and older.]
[] 2 Widowed
[] 3 Divorced
[] 4 Separated
[] 5 Priest
L10. Occupation last year (April 1979 to March 1980): What were you doing most of the time last year? ____
If working in L10
[Questions L11-12 were asked of persons who are working, per question L10.]
L11. Industry last year (April 1979 to March 1980) ____
[] 2 Self-employed
[] 3 Government employee
[] 4 Government enterprise employee
[] 5 Private employee
[] 6 Unpaid household worker
For Every Person
[Questions L13-L15 were asked of every person.]
L13. Is [respondent's] mother living in this household? _ _
L14. What is [respondent's] religion? ____
L15. Place of birth (Enter Changwat or country if born in other country) ____
For person 5 years and older or those who were born before and in the year 1974 (tiger year)
[Questions L16-L20 were asked of persons age 5 and over.]
L16. Grade of school attended (as of January 1, 1980 for those 5-30 years old) _ _
L17. Can read and write in any language?
[] 2 No
L18. How long has [respondent] been living in this village or municipality consecutively? ____
If less than 5 years in L18
[Questions L19-L21 were asked of person who had been living in the present village or municipality for less than 5 years, per question L18.]
L19. Previous province of residence ____
L20. For those who moved within Thailand from village or municipality
[] 2 Municipality
L21. Reason for moving
[] 2 Move with spouse
[] 3 Moved with head of household
[] 4 Looking for job
[] 5 Job transfer
[] 6 Return home
[] 7 Marriage
[] 8 Enter priesthood etc.
For person 11 years and older or those who were born before and in the year 1968.
For ever-married women.
[Questions L22-L25 were asked of women age 11 and over who have ever been married.]
L22. Age at first marriage _ _
L23. Number of children who have ever been born living in this household_ _
L24. Number of children who have ever been born living elsewhere _ _
L25. Number of children who had been born who have died _ _
L26. Do you or your husband practice contraception?
[] 1 Yes
[] 2 No
L27. If yes in L26, what method is used?
[] 1 Oral pills
[] 2 IUD
[] 3 Injection
[] 4 Female sterilization
[] 5 Male sterilization
[] 6 Other methods used
L28. What job was [respondent] working in during last week?
Occupation last week (25-31 March 1980) ____
L29. Reason for not working ____
Example: looking for work, student, aged/disability, waiting for farm season, homemaker, retired official, etc.
For office use only
Line number ____
Part 3. Housing Questions (For Private Household)
[Questions H1-H18 were asked of private households.]
Number H1 and H2 by observation of house
H1. Type of structure
[] 2 Duplex
[] 3 Row house
[] 4 Apartment
[] 5 Room
[] 6 Mobile
[] 7 Other (specify) ____
H2. Type of construction materials
[] 2 Wood, cement or brick (mixed)
[] 3 Wood
[] 4 Local materials
[] 5 Reused materials
H3. Is this house also used for commercial purposes?
[] 2 No
H4. Tenure of household living quarter (excluding land)
[] 2 Buy on installment
[] 3 Rent
[] 4 Rent free for service
[] 5 Rent free others
H5. (If rent in No. H4) Advanced payment
[] 1 Yes
[] 2 No
H6. Rent per month (Baht) ____
H7. If rent or rent free in No. H4, who is owner of house?
[] 1 Government, government enterprise
[] 2 Private
[] 3 Other (specify) ____
H8. Ownership of land
[] 1 Owner of land
[] 2 Buy on installment
[] 3 Rent
[] 4 Rent free
[] 5 Other (specify) ____
H9. Owner of land
[] 1 Government, government enterprise
[] 2 Government property
[] 3 Private
[] 4 Other (specify) ____
H10. Number of rooms used for sleeping
[] 2 Other rooms used for sleeping _ _
H11. Drinking water
[] 2 Piped water, outside
[] 3 Public well
[] 4 Private well
[] 5 Rain water
[] 6 River, canal, stream, waterfall
[] 7 Other (specify) ____
H12. Water supply system
[] 2 Piped water, outside
[] 3 Public well
[] 4 Private well
[] 5 Rain water
[] 6 River, canal, stream, waterfall
[] 7 Other (specify) ____
H13. Bathroom
[] 2 Shared bathroom
[] 3 Terrace, veranda
[] 4 Well, river, canal
[] 5 Other (specify) ____
H14. Lighting
[] 2 Pressure lamp
[] 3 Oil lamp
[] 4 Other (specify) ____
H15. Toilet Facilities
[] 2 Flush toilet, shared
[] 3 Moulded bucket latrine, exclusive
[] 4 Moulded bucket latrine, shared
[] 5 Pit
[] 6 Other or none
H16. Place for cooking
[] 2 Kitchen, shared
[] 3 Terrace, veranda
[] 4 Other (specify) ____
H17. Cooking Fuel
[] 2 2nd
[] 2 2nd
[] 2 2nd
[] 2 2nd
H18. Household Appliance
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No