Document No. ____
A. Geographic location
1. Department ____
2. Region no. ____
3. Judicial section no. ____
4. Segment no. ____
5. Zone no. ____
[] 2 Suburban
[] 3 Rural
[] 2 No
6. Dwelling type
[] 2 Collective
7. Populated nucleus
____ Category (write down if it is a city, village, town etc.)
8. Address
____ No.
____ Floor no.
____ Apt. no.
9. Control sheet line no. ____
B. Dwelling
1. Condition of occupation of the dwelling
Unoccupied:
[] 3 Under construction
[] 4 Under repair
Other (specify) ____
2. Type of dwelling
For places meant to be a dwelling
Private dwellings:
[] 2 Apartment in an apartment building
[] 3 Apartment or room in a house
[] 4 Apartment or room in a workshop, school, etc.
[] 5 Tenement
[] 6 House made of waste material
[] 7 Shack
[] 8 Cart, wagon, boat, etc.
[] 9 Others (tent, railroad stations, etc.)
Collective dwellings:
[] 2 Parador (type of luxury hotel)
[] 3 Hospital or asylum
[] 4 Convent
[] 5 Boarding house
[] 6 Boarding school
[] 7 Barracks
[] 8 Jail
[] 9 Others
Other places used as a dwelling (garage, granary, stable, etc.) ____
3. Exterior walls: predominant materials
[] 2 Wood, sheets of zinc, fibro-cement
[] 3 Mud (lumped, terron [earth with grass], adobe, fagina [wood lathe and mud])
[] 4 Tin or waste material
[] 5 Other
4. Roof: Predominant materials
Zinc, fibro-cement, aluminum, asphalt cardboard, tiles:
[] 3 Without a flat roof
[] 5 Tin or waste material
[] 6 Other
5. Floor: Predominant materials
[] 2 Floor tile, monolithic, pastillas
[] 3 Concrete or portland cement
[] 4 Stones or bricks
[] 5 Earth or rubble (cascote)
[] 6 Other
6. Rooms and spaces
____ Other rooms (number)
Open patio or garden
[] 2 No
7. Water service
Source:
[] 2 Pump well
[] 3 Tank [aljibe]
[] 4 Catch pipes [cachimba]
[] 5 Stream, river, spring
Other (specify) ____
Location:
[] 2 Outside the dwelling, but on the property
[] 3 Outside the property
Distance of carrying [water to dwelling]:
[] 2 Between 100 to 300 meters
[] 3 More than 300 meters
8. Sanitary service
Type:
[] 2 W.C., at floor level
[] 4 Without service
Use:
[] 2 Common
Sewerage:
[] 2 Septic ditch
[] 3 Cesspool
[] 4 Hole in the ground
[] 5 On surface
[] 6 Other
9. Bathroom services
Installation:
[] 2 Bath
[] 3 Other
Use:
[] 2 Common
10. Lighting
Electric:
[] 2 Own
Non-electric:
[] 4 Lamp with wick and candle
Other (specify) ____
11. Tenancy
[] 2 Lessee or sub-lessee
[] 3 Sharecropper (mediero or medianero)
[] 4 Usufructuary
[] 5 De facto occupant
Other (specify) ____
12. State of preservation of the dwelling
Structure:
[] 2 Average
[] 3 Bad
Humidity:
[] 2 Bad
Questions for members of the private or collective dwellings.
[Information for the household head is collected in the column for the first person of the enumeration form]
General characteristics
For all persons
[Questions 1-9 were asked of all persons]
1. Name and surname: ________
Register this of all people who spent the night in this dwelling the night before the "Day of the census." Do not omit [children who were born] before 12 o'clock on the night of the same day, nor those who died after this hour.
2. Relation or relationship with the household head: ________
Write down, according to the case: spouse, child, niece/nephew, guest, pensioner, servant, etc.
3. Sex
Mark the corresponding box.
[] 2 Woman
4. Age in completed years: ____
For those younger than 1 year, write down the number of completed months, followed by the word "Months". For minors younger than 1 month, write "0 months". Example: "0 months", "3 months", etc.
5. Marital status
Mark the corresponding box.
[] 2 Married
[] 3 In free union
[] 4 Widowed
[] 5 Divorced
6. Place of birth
Write down the name of the department and the locality if a person was born in Uruguay or of the country of birth if a person was born abroad.
____ Locality
7. Legal nationality: ____
Write down the nationality that a person declares.
8. Year of migration
Write down the year in which a person came to reside in the place of enumeration. In other cases, or if a person has lived "Always" in the place or is "In transit," write it in the corresponding box.
[] 1 Always
[] 2 In transit
9. Origin of migration
Write down the name of the department and locality where a person resided before coming to the place of enumeration. If they live abroad, write down the name of the country.
____ Locality
Educational characteristics
For persons age 6 or older
[Questions 10-12 were asked of persons age 6 or older.]
10. Level of education
Write down, as a number, the last year of studies passed by a person on the dotted line corresponding to the class of instruction received (primary, secondary, etc.). For people without education, write down a zero ("0").
[] 1 Primary _
[] 2 Secondary _
[] 3 Preparatory _
[] 4 Faculty _
[] 5 Normal _
[] 6 Agrarian _
[] 7 Industrial _
[] 8 Military _
Other ____
11. School attendance
Write down, as a number, the year of studies that a person is now attending, on the dotted line corresponding to the class of instruction received (primary, secondary, etc.) For people who do not attend any type of studies, write down a zero ("0").
[] 1 Primary _
[] 2 Secondary _
[] 3 Preparatory _
[] 4 Faculty _
[] 5 Normal _
[] 6 Agrarian _
[] 7 Industrial _
[] 8 Military _
Other ____
12. Literacy
Mark the corresponding box, according to whether a person knows how to read and write or not.
[] 2 No
Occupational characteristics
For persons age 8 or older
[Questions 13-18 were asked of persons age 8 or older.]
13. Type of activity:
Mark only one of the boxes according to what it corresponds to. Employed is one who on the Census day has a job. Unemployed is one who has worked, is without work, and is looking for it. Looking for work for the first time is one who has never worked and is looking for work. Household duties or student are those who exclusively dedicate themselves to care of the home or studies. Retired or pensioned are those who receive a monthly sum from the state, for retirement or pensions. Rentier is one who lives on investments, without working. Other is one who is not included in any previous group.
[] 2 Unemployed
[] 3 Looking for work for the first time
[] 4 Household duties
[] 5 Student
[] 6 Retired or pensioned
[] 7 Rentier
[] 8 Other
14. Principal occupation: ________
Only for employed, unemployed and those looking for work for the first time.
If someone employed does more than one job, write down the one that produces the largest income. For unemployed, write down the last job. For one who is looking for work for the first time write down the profession or office if one exists or "None" in the other case. Examples: lawyer, carpenter, bricklayer, dairy worker, tractor driver, etc.
15. Industry of principal activity: ________
Only for those who are employed and unemployed.
Specify the class of establishment where the employed does the principal occupation, or if unemployed, the class of the last establishment worked. Examples: textile factory, food storage, public school, judge's chambers, farm, country house, etc.
16. Category of occupation
Only for those employed and unemployed.
Mark a single box according to what corresponds. Employer is one who runs their own company and pays one or more employees or workers. Worker for their own account is one who runs their own company without paid employees or workers. Employee is one who works predominantly in an intellectual activity for a salary for an employer. Laborer is one who works in a physical activity for a weekly salary or day wages for a predetermined employer. Family worker is one who, with or without pay, works for at least two days a week for a family member.
[] 2 Worker for their own account
[] 3 Employee
[] 4 Laborer
[] 5 Paid family worker
[] 6 Unpaid family worker
17. Secondary occupation: ________
Only for those who declared a principal occupation.
Write down the occupation that produces the second highest income. Examples: collector, runner, brick layer, private chauffer, porter (package carrier, etc.).
18. Industry of secondary activity: ________
Only for those who declared a secondary occupation.
Write down the class of establishment where the second occupation is performed. Examples: bank, high school, cigarette factory, farm, pool, etc.