Data Cart

Your data extract

0 variables
0 samples
View Cart



Statistics South Africa
Community Survey 2007
Household Questionnaire

For Statistical use only
(Under Statistics Act No. 6 of 1999)

Particulars of the household
Enumeration area number _ _ _ _ _ _ _ _
Dwelling unit number _ _ _ _
Physical identification of the dwelling unit ________
Landline telephone number of enumerated household (if any) _ _ _ - _ _ _ _ _ _ _ _
Cellphone number (if any) _ _ _ - _ _ _ _ _ _ _ _
Total number of persons in the household _ _

Number of males _ _
Number of females _ _

Number of questionnaires for this household _

Households at the selected dwelling
Household number of this household _ _
Total number of households at the selected dwelling _ _
Was this questionnaire subjected to quality control (or checks) by any Community Survey personnel other than the supervisor? Mark the appropriate box with an X.

[] 1 Yes
[] 2 No

[The rest of the materials in this section are not presented here.]
[p.2]

Flap: This Section covers particulars of each person in the household.
Read out: Please give the name and surname of every person who usually resides in this household at least four (4) nights a week and has done so over the last four (4) weeks, whether present or absent last night.
Please also give information on any other person who stayed in this household last night as a visitor. Do not forget to include babies, the bedridden and the elderly persons.
By household, I mean all persons who live together, and provide themselves jointly with food or other essentials for living, or a single person who lives alone.
A single questionnaire is completed for each identified household. If there are more than 10 persons in the household, use a second questionnaire.
Person number (assign column or person number to each person from 01 to 10; if second questionnaire, start from 11 etc.)

[Columns for up to 10 persons underneath text. Personal numbers are recorded at the top of every page from p.2, 4-18.]

P-01 Person number

_ _

F-01 First name and surname

Write down the name and surname of each member in the appropriate column.
Start with the usual members (starting with the head) who were present last night, followed by those members who were absent last night, and lastly by those who stayed in the household last night as visitors.
Always start with the head or acting head of household i.e. person no. 01. The head or acting head is the person who is the main decision-maker in the household. If two or more people are equal decision-makers, take the oldest person first. Write sideways.
______

F-02 Age

Do not ask the question. Write the age in block provided based on answer from P-03
_ _ _

F-03 Sex

Do not ask the question. Mark the appropriate box with an X based on answer from P-04
[] 1 Male
[] 2 Female

F-04 Respondent

For each person in the household, indicate the number of the person who provided or responded to most questions applicable to that person. Enter person no. in the box.
_ _

[p. 3 is not presented here.]
[p.4]

Section A: Demographics - ask of everyone listed on the flap
Start from the left (person number 01) and complete Section A for each person in the household separately.

Read out: First I am going to ask you for some basic information about each person whose name you have provided.

P-02 Date of birth
What is (the person)'s date of birth?

Date of birth is recorded as DD/MM/YYYY
DD is for day; MM is for month and YYYY is for year.
For any information that is not known, leave the box blank.
[Example omitted]
Day of birth: _ _
Month of birth: _ _
Year of birth: _ _ _ _

P-03 Age
What is (the person)'s age in completed years?

If age not known ask for an estimate of age. If no one is able to estimate, write 998.
For babies less than 1 year write 000 for age. For a person 7 years and 10 months write 007 for age.
Age (in years): _ _ _ _
Transcribe the answer to F-02 on the flap

P-04 Sex
Is (the person) male or female?

Mark the appropriate box with an X.
[] 1 Male
[] 2 Female
Transcribe the answer to F-03 on the flap.

P-05 Usually stay
Does (the person) usually live in this household for at least four nights a week and has done so over the last four weeks?

Mark the appropriate box with an X.
[] 1 Yes
[] 2 No

P-06 Last night stay
Did (the person) stay in this household last night?

Mark the appropriate box with an X.
[] 1 Yes
[] 2 No

[p.5]

P-07 Relationship
What is (the person)'s relationship to the head or acting head of the household?

The head or acting head is the person listed in column 1 of the first questionnaire, if more than one questionnaire has been completed for this household.
[] 01 Head/acting head
[] 02 Husband/wife/partner
[] 03 Son/daughter
[] 04 Adopted son/daughter
[] 05 Stepchild
[] 06 Brother/sister
[] 07 Parent (mother/father)
[] 08 Parent-in-law
[] 09 Grand/great grandchild
[] 10 Son/daughter-in-law
[] 11 Brother/sister-in-law
[] 12 Grandmother/father
[] 13 Other relative
[] 14 Non-related person
_ _

P-08 Marital status
What is (the person)'s present marital status?

Write only one code per person.
If both civil/religious and traditional indicate civil/religious.
[] 1 Married civil/religious
[] 2 Married traditional/customary
[] 3 Polygamous marriage
[] 4 Living together as married partners
[] 5 Never married
[] 6 Widower/widow
[] 7 Separated
[] 8 Divorced
If 5 to 8, Go to P-10
_

P-09 Spouse
Who, in this household, is (the person)'s spouse or partner?

[Question P-09 was asked of persons who are currently married, per question P-08.]
Write the person no. of the spouse or partner in the appropriate box. If the spouse does not reside in the household, write 98.
_ _

P-10 Population group
How would (the person) describe himself/herself in terms of population group?

Write code in the box.
[] 1 Black
[] 2 Coloured
[] 3 Indian or Asian
[] 4 White
_

[p.6]

Section B: Migration - ask of everyone listed on the flap

Read out: I am now going to ask you for some information on migration - i.e. movement of people from one place to another.

P-11 Province of birth
In which province in South Africa was (the person) born?

Write code in the box. If the person was not born in South Africa, the code is 10.
[] 01 Western Cape
[] 02 Eastern Cape
[] 03 Northern Cape
[] 04 Free State
[] 05 KwaZulu-Natal
[] 06 North West
[] 07 Gauteng
[] 08 Mpumalanga
[] 09 Limpopo
[] 10 Outside RSA
[] 11 Do not know
_ _

P-12 Main place of birth
In which city, town, township or tribal area was (the person) born?

Write the name of the place in capital letters. If the person was born outside South Africa, write the country of birth, and Go to P-14.
____

P-13 Sub-place of birth
In which suburb, village, informal settlement, Section or farm was (the person) born?

Write the name of the place in capital letters.
____

P-14 Main place of usual residence
In which city, town, township, or tribal area does (the person) usually live?

Write the name of the place in capital letters.
____

P-15 Sub-place of usual residence
In which suburb, village, informal settlement, Section or farm does (the person) usually live?

Write the name of the place in capital letters.
____

[p.7]

P-16 Five years ago
Was (the person) living in this dwelling in October 2001?

Mark appropriate box with an X.
If 1 "Yes" or 3 "Born after October 2001", Go to P-21.
[] 1 Yes
[] 2 No
[] 3 Born after October 2001

P-17 Period of movement
In which year and month did (the person) move to this dwelling?

[Question P-17 was asked of persons who were born before October 2001and not living in the current dwelling in October 2001, per question P-16].
[Example omitted]
Month _ _
Year _ _ _ _

P-18 Province of previous residence
In which province did (the person) live before moving to this dwelling?

[Question P-18 was asked of persons who were born before October 2001and not living in the current dwelling in October 2001, per question P-16].
Write code in the box. If the person moved from outside South Africa, write code 10.
[] 01 Western Cape
[] 02 Eastern Cape
[] 03 Northern Cape
[] 04 Free State
[] 05 KwaZulu-Natal
[] 06 North West
[] 07 Gauteng
[] 08 Mpumalanga
[] 09 Limpopo
[] 10 Outside RSA
[] 11 Do not know
_ _

P-19 Main place of previous residence
In which city, town, township or tribal area did (the person) live before moving to this dwelling?

[Question P-19 was asked of persons who were born before October 2001and not living in the current dwelling in October 2001, per question P-16].
Write the name of the place in capital letters.
If the person was living outside South Africa, write the country of previous residence, and Go to P-21.
____

P-20 Sub-place of previous residence
In which suburb, informal settlement, village, Section or farm did (the person) live before moving to this dwelling?

[Question P-20 was asked of persons who were born before October 2001and not living in the current dwelling in October 2001 but had moved in from within South Africa, per questions P-16 and P-19].
Write the name of the place in capital letters.
____

[p.8]

Section C: Disability and social grants - ask of everyone listed on the flap

Read out: I am now going to ask you for some information on the difficulties each person may have because of health problem or condition. I am also going to ask about social grants that each person may be receiving.

P-21 Disability
Does (the person) have any kind of disability?

Mark appropriate box with an X
If 2 "No" or 3 "Do not know" Go to P-24.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-22 Disability type
What type(s) of disability does (the person) have?

[Question P-22 was asked of persons who had some kind of disability, per question P-21.]
Mark any that apply with an X.
Multiple disabilities are indicated by marking more than one selection.
Read out:
[] 1 Sight (blind/severe visual limitation
[] 2 Hearing (deaf, profoundly hard of hearing)
[] 3 Communication (speech impairment)
[] 4 Physical (needs wheelchair, crutches, etc.)
[] 5 Intellectual (serious difficulties in learning)
[] 6 Emotional (behavioural, psychological)

P-23 Disability intensity
Does the disability seriously prevent (the person) from full participation in life activities (such as education, work, social life, etc.)?

[Question P-23 was asked of persons who had some kind of disability, per question P-21.]
Mark appropriate box with an X.
[] 1 Yes
[] 2 No

P-24 Social grant
Does (the person) receive any social / government grant?

Mark appropriate box with an X
If 2 "No" or 3 "Do not know" Go to P-26.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-25 Type of social grant
What type(s) of social /government grant does (the person) receive?

[Question P-25 was asked of persons who received social/government grant, per question P-24.]
Mark any that apply with an X.
[] 1 Old age pension
[] 2 Disability grant
[] 3 Child support grant (linked to a child)
[] 4 Care dependency grant
[] 5 Foster care grant
[] 6 Grant in aid
[] 7 Social relief

[p.9]

Section D: Education - ask of everyone listed on the flap

Read out: I am now going to ask you for some information on education of each person listed on the flap.

P-26 School attendance
Does (the person) presently attend an educational institution?

Read out: Attendance includes all part-time and full-time studies, whether in person or as a distance learner, as well as home schooling.
Mark appropriate box with an X.
If 2 "No" Go to P-29.
[] 1 Yes
[] 2 No

P-27 Educational institution
Which of the following educational institutions does (the person) attend?

[Question P-27 was asked of persons who presently attend an educational institution, per question P-26.]
Write code in the box.
Read out:
[] 1 Pre-school
[] 2 Primary school
[] 3 Secondary school
[] 4 College
[] 5 University/university of technology/Technikon
[] 6 Adult Basic Education and Training
[] 7 Other
_

P-28 Public or independent institution
Is the institution (the person) attends public (government) or independent (private)?

[Question P-28 was asked of persons who presently attend an educational institution, per question P-26.]
Write code in the box.
[] 1 Public
[] 2 Independent
[] 3 Do not know
_

[p.10]

P-29 Level of education
What is the highest level of education that (the person) has completed?

For a person with grade 12, probe whether he/she has a university exemption or not.
For a person with a certificate or a diploma, probe whether he/she has grade 12 (std 10) or not.
Write code in the box.
[] 00 Grade 0
[] 01 Grade 1
[] 02 Grade 2
[] 03 Grade 3/ Std 1/ ABET 1
[] 04 Grade 4/ Std 2
[] 05 Grade 5/ Std 3/ ABET 2
[] 06 Grade 6/ Std 4
[] 07 Grade 7/ Std 5/ ABET 3
[] 08 Grade 8/ Std 6
[] 09 Grade 9/ Std 7/ ABET 4
[] 10 Grade 10/Std 8/ NTCI
[] 11 Grade 11/ Std 9/ NTCII
[] 12 Attended Grade 12, but not completed Grade 12
[] 13 Grade 12 / Std 10/ NTCIII (without university exemption)
[] 14 Grade 12/ Std 10 (with university exemption)
[] 15 Certificate with [less than] Std 10/Gr.12
[] 16 Diploma with [less than] Std 10/Gr.12
[] 17 Certificate with Std 10/Gr.12
[] 18 Diploma with Std 10 /Gr.12
[] 19 Bachelors degree
[] 20 BTech
[] 21 Post graduate diploma
[] 22 Honours degree
[] 23 Higher degree (Masters/PhD)
[] 24 No schooling
[] 98 Out of scope (children under five
years of age)
_ _

[p.11]

Section E: Employment and economic activities - ask of all persons 15 years and older listed on the flap
[Questions P-30 to P-39 were asked of persons age 15 and older.]

Read out: I am now going to ask you for information on employment of each person 15 years and older.

P-30 Employment status

P-30a In the last 7 days, did (the person) run or do any kind of business, big or small, for himself/herself or with one or more partners even for only one hour?
Examples: Selling things, making things for sale, repairing things, guarding cars, brewing beer, hairdressing, creche business, taxi or other transport business, having a legal or medical practice, etc.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-30b In the last 7 days, did (the person) do any work for a wage, salary, commission or payment in kind (excluding domestic worker) even for only one hour?
Examples: a regular job, contract, casual or piece work for pay, work in exchange for food or housing.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-30c In the last 7 days, did (the person) do any work as a domestic worker for a wage, salary or payment in kind even for only one hour?
[] 1 Yes
[] 2 No
[] 3 Do not know

P-30d In the last 7 days, did (the person) help unpaid in a household business of any kind even for only one hour?
Examples: Help to sell things, make things for sale or exchange, doing the accounts, cleaning up for the business, etc. Do not count normal housework
[] 1 Yes
[] 2 No
[] 3 Do not know

P-30e In the last 7 days, did (the person) do any work on his/her own or the household's plot, farm, food garden, cattle post or kraal, or help in growing farm produce or in looking after animals for the household even for only one hour?
Examples: Ploughing, harvesting, looking after livestock.
[] 1 Yes
[] 2 No
[] 3 Do not know

[p.12]

P-30f In the last 7 days, did (the person) do any construction or major repair work on his/her own home, plot, cattle post or business even for only one hour?
[] 1 Yes
[] 2 No
[] 3 Do not know

P-30g In the last 7 days, did (the person) catch any fish, prawns, shell fish, wild animals either as food for sale or for household use, even for only one hour?
If 1 "Yes" to any of P-30a to P-30g, Go to P-36.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-31 Temporary absence from work
Even though (the person) did not do any of these activities in the last seven days, does he/she have a job, business, or other economic or farming activity that he/she will definitely return to?

[Question P-31 was asked of persons who were not working in the last seven days, per questions P-30a to P-30g.]
For agricultural activities, the off season in agriculture is not a temporary absence.
If 1 "Yes" Go to P-36.
[] 1 Yes
[] 2 No
[] 3 Do not know

[p.13]

P-32 Reasons for not working
Why did (the person) not work during the past seven days?

[Question P-32 was asked of persons who were not working in the last seven days, per questions P-30a to P-30g.]
[] 01 Has found a job, but is only starting at a definite date in the future
[] 02 Scholar/student and prefers not to work
[] 03 Housewife/homemaker and prefers not to work
[] 04 Retired and prefers not to seek formal work
[] 05 Invalid, ill, disabled or unable to work (handicapped)
[] 06 Too young or too old to work
[] 07 Seasonal worker, e.g. fruit picker, wool-shearer
[] 08 Lack of skills or qualifications for available jobs
[] 09 Cannot find work
[] 10 Cannot find suitable work (salary, location of work or conditions not satisfactory)
[] 11 Contract worker, e.g. mine worker resting according to contract
[] 12 Retrenched
[] 13 Other reason
Write code in the box.
_ _

P-33 Availability for work
If a suitable job is offered, how soon can (the person) start work?

[Question P-33 was asked of persons who were not working in the last seven days, per questions P-30a to P-30g.]
[] 1 Within a week
[] 2 Within two weeks
[] 3 Within four weeks
[] 4 More than four weeks from now
[] 5 Not interested
[] 6 Not able (health or disability)
[] 7 Do not know
Write code in the box.
_

P-34 Active steps seeking work
During the past four weeks, has (the person) taken any action to look for any kind of work?

[Question P-34 was asked of persons who were not working in the last seven days, per questions P-30a to P-30g.]
Mark appropriate box with an X.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-35 Active steps seeking work
During the past four weeks, has (the person) taken any action to start any kind of business?

[Question P-35 was asked of persons who were not working in the last seven days, per questions P-30a to P-30g.]
If P-34 and P-35 completed Go to P-40
Mark appropriate box with an X.
[] 1 Yes
[] 2 No
[] 3 Do not know

[p.14]

P-36 Work status
How can one describe (the person)'s main activity or work status best?

If yes to any of P-30a to P-30g or P-31 [who were either working during the last seven days or had work that the persons could definitely return to.]
Write code in the box.
Read out :
[] 1 Paid employee
[] 2 Paid family worker
[] 3 Self-employed
[] 4 Employer
[] 5 Unpaid family worker
_

P-37 Business type
Is the organisation/ company / business /enterprise/branch where (the person) works in the formal or informal sector?

[Question P-37 was asked of persons who were either working during the last seven days or had work that the persons could definitely return to, person questions P-30a to P-30g and P-31.]
Formal sector employment is where the employer (institution, business) is registered (i.e. has a tax number) and informal is when it is not registered.
Mark appropriate box with an X.
[] 1 In the formal sector
[] 2 In the informal sector (including domestic work)
[] 3 Do not know

P-38 Occupation
What is the main occupation of (the person) in this workplace?

[Question P-38 was asked of persons who were either working during the last seven days or had work that the persons could definitely return to, person questions P-30a to P-30g and P-31.]
For example: street vendor, primary school teacher, domestic worker etc.
Write in capital letters.
______

[p.15]

P-39 Industry

P-39a What is the name of (the person)'s place of work or company.
[Question P-39a was asked of persons who were either working during the last seven days or had work that the persons could definitely return to, person questions P-30a to P-30g and P-31.]
______

P-39b What is the main business/function of the company that (the person) works (main economic activity) for?
[Question P-39b was asked of persons who were either working during the last seven days or had work that the persons could definitely return to, person questions P-30a to P-30g and P-31.]
For example: gold mining, road construction, supermarket, police service, healthcare, hairdressing, banking, or subsistence farming if self-employed.
Write the main industry, main economic activity, product, goods or service in capital letters.
______

[p.16]

Section F: Fertility - ask of women aged 12 to 50 years (born between and including 1957 and 1995) listed on the flap
[Questions P-40 to P-47.]

Read out: I am now going to ask each woman aged 12 to 50 years old for information on her child/children.

P-40 Has (the person) ever given birth to a live child even if the child died soon after birth?

Mark appropriate box with an X.
If 2 "No" Go to P-48.
[] 1 Yes
[] 2 No

P-41 Total children ever born

a. How many children has (the person) ever had that were born alive, even if they died soon after birth?
_ _
b. How many are boys?
_ _
c. How many are girls?
_ _
Include ALL her children, i.e. those who are still living, whether or not they live in this household, and those who are dead. Do not count stillbirths.

P-42 Total children surviving and living in this household

a. How many of (the person's) children are still alive and living with her in this household, including grown-ups?
_ _
b. How many are boys?
_ _
c. How many are girls?
_ _

P-43 Total children surviving and living elsewhere

a. How many of (the person's) children are still alive and living elsewhere, including grown-ups?
_ _
b. How many are boys?
_ _
c. How many are girls?
_ _

P-44 Total children no longer alive

a. How many of (the person's) children are no longer alive?
_ _
b. How many were boys?
_ _
c. How many were girls?
_ _

[p.17]

P-45 Last child born
If the person has ever given live birth: When was (the person's) last child born, even if the child died soon after birth?

Write the day (2 digits), month (2 digits) and year (4 digits) of the last live birth. For example, if the child was born on 5 January 1970, write 05 for the day, 01 for the month and 1970 for the year. If multiple births, indicate only last child.
Do not count still births (children born dead.)
Day _ _
Month _ _
Year _ _ _ _

P-46
Is (the person)'s last born child male or female?

Mark appropriate box with an X.
If multiple births, indicate only last child.
[] 1 Male
[] 2 Female

P-47 Last born child alive
Is (the person)'s last born child still alive?

Mark appropriate box with an X.
If multiple births, indicate only last child.
[] 1 Yes
[] 2 No

[p.18]

Section G: Parental survival and income - ask everyone listed on the flap

Read out: I am now going to ask you for some information on parental survival and income for each person in the household.

P-48 Mother alive
Is (the person's) own biological mother still alive?

Mark appropriate box with an X. If 2 "No" or 3 "Do not know" Go to P-50.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-49 Mother's person number
Who in this household is (the person's) biological mother?
(column no. of biological mother).

[Question P-49 was asked of persons whose own biological mother is still alive, per question P-48.]
If the mother does not live in this household, write 98.
_ _

P-50 Father alive
Is (the person)'s own biological father still alive?

Mark appropriate box with an X.
If 2 "No" or 3 "Do not know", go to P-52.
[] 1 Yes
[] 2 No
[] 3 Do not know

P-51 Father's person number
Who in this household is (the person)'s biological father?
(column no. of biological father).

[Question P-51 was asked of persons whose own biological father is still alive, per question P-50.]
If the father does not live in this household, write 98.
_ _

P-52 Income category
What is the income category that best describes the gross monthly or annual income of (the person) before deductions and including all sources of income?

Read out:
Monthly / Annual
[] 01 No income / No income
[] 02 R 1 - R 400 / R 1 - R 4 800
[] 03 R 401 - R 800 / R 4 801 - R 9 600
[] 04 R 801 - R 1 600 / R 9 601 - R 19 200
[] 05 R 1 601 - R 3 200 / R 19 201 - R 38 400
[] 06 R 3 201 - R 6 400 / R 38 401 - R 76 800
[] 07 R 6 401 - R 12 800 / R 76 801 - R 153 600
[] 08 R 12 801 - R 25 600 / R 153 601 - R 307 200
[] 09 R 25 601 - R 51 200 / R 307 201 - R 614 400
[] 10 R 51 201 - R 102 400 / R 614 401 - R 1 228 800
[] 11 R 102 401- R 204 800 / R 1 228 801- R 2 457 600
[] 12 R 204 801 or more / R 2 457 601 or more
[] 13 Response not given
Write code in the box.
_ _

[p.19]

Section H: Housing and household services

Read out: I am now going to ask you for some information about housing and household services.

Services and household information

H-01 Type of main dwelling
Which of the following types best describes the main dwelling unit that this household occupies?

If this household lives in More than one dwelling, write the code of the main dwelling that the household occupies in the box.
Read out:
[] 01 House or brick structure on a separate stand or yard
[] 02 Traditional dwelling/ hut /structure made of traditional material
[] 03 Flat in block of flats
[] 04 Town/ cluster/ semi-detached house (simplex, duplex, triplex)
[] 05 House/flat/room in backyard
[] 06 Informal dwelling/ shack in backyard
[] 07 Informal dwelling/ shack not in backyard e.g. in informal/ squatter settlement
[] 08 Room/ flatlet not in backyard but on a shared property
[] 09 Caravan or tent
[] 10 Private ship/boat
[] 11 Workers' hostel (bed/room)
[] 12 Other (specify) ______
_ _

H-02 Rooms
How many rooms, including kitchens, are there for this household?

Count all rooms in all dwellings.
Exclude bathrooms, sheds, garages, stables, etc. unless persons are living in them.
_ _

H-03 Access to water
In which way does this household obtain water for domestic use?

[] 1 Piped water inside the dwelling
[] 2 Piped water inside the yard
[] 3 Piped water from access point outside the yard
[] 4 Borehole
[] 5 Spring
[] 6 Dam/pool
[] 7 River/stream
[] 8 Water vendor
[] 9 Rain water tank
[] 0 Other
Write only one code in the box.
_

H-04 Service provider
Does the household get water from the Municipality (Regional/ Local water scheme)?

Mark appropriate box with an X.
[] 1 Yes
[] 2 No
[] 3 Do not know

H-05 Distance from water access point
What is the distance from water access point?

[] 1 Less than 200m
[] 2 Between 200m and 500m
[] 3 Between 500m and 1km
[] 4 More than 1km
Write only one code in the box.
_

H-06 Toilet facilities
What is the main type of toilet facility available for use by this household?

Read out:
[] 1 Flush toilet (connected to sewerage system)
[] 2 Flush toilet (with septic tank)
[] 3 Dry toilet facility
[] 4 Pit toilet with ventilation (VIP)
[] 5 Pit toilet without ventilation
[] 6 Chemical toilet
[] 7 Bucket toilet system
[] 8 None
Write only one code in the box.
_

H-07 Energy/fuel for cooking
What type of energy/fuel does this household mainly use for cooking?

[] 1 Electricity
[] 2 Gas
[] 3 Paraffin
[] 4 Wood
[] 5 Coal
[] 7 Animal dung
[] 8 Solar
[] 9 Other (specify) ______
Write only one code in the box.
_

H-08 Energy / fuel for heating
What type of energy/fuel does this household mainly use for heating?

[] 1 Electricity
[] 2 Gas
[] 3 Paraffin
[] 4 Wood
[] 5 Coal
[] 7 Animal dung
[] 8 Solar
[] 9 Other (specify) ______
Write only one code in the box.
_

H-09 Energy / fuel for lighting
What type of energy/fuel does this household mainly use for lighting?

[] 1 Electricity
[] 2 Gas
[] 3 Paraffin
[] 6 Candles
[] 8 Solar
[] 9 Other (specify) ______
Write only one code in the box.
_

H-10 Household goods
Does the household have any of the following?

Mark appropriate box with an X

Refrigerator
[] 1 Yes
[] 2 No

Radio
[] 1 Yes
[] 2 No

Television
[] 1 Yes
[] 2 No

Computer
[] 1 Yes
[] 2 No

Landline telephone
[] 1 Yes
[] 2 No

Internet facilities at home
[] 1 Yes
[] 2 No

Post facilities (Mail postbox)
[] 1 Yes
[] 2 No

Cellphone
[] 1 Yes
[] 2 No

H-11 Tenure status
What is the tenure status of this household?

If the household uses several dwellings, write the code for the main dwelling in the box.
Read out:
[] 1 Owned and fully paid off
[] 2 Owned but not yet paid off
[] 3 Rented
[] 4 Occupied rent-free
[] 5 Other (specify) ____
Write only one code in the box.
_

H-12 Refuse disposal
How is the refuse or rubbish from this household mainly disposed of?

Read out:
1 Removed by local authority/ private company at least once a week
2 Removed by local authority/ private company less often
3 Communal refuse dump
4 Own refuse dump
5 No rubbish disposal
6 Other (specify) ____
Write only one code in the box.
_

[p.20]

Section I: Mortality in the last 12 months - (between February 2006 and March 2007)

Read out: I am now going to ask for information on any member of the household who has passed away in the last 12 months between February 2006 and March 2007.

M-00 Has any member of this household passed away in the last 12 months between February 2006 and March 2007?

Mark appropriate box with an X
If no, the questionnaire is completed. Thank the respondent(s).
[] Yes
[] No

M-01 How many members passed away?

_ _

Number (assign column or deceased number to each deceased person from 01 to 05)
[Label over questions M-02 to M-08]

M-02 Deceased number

_ _

M-03 Name of deceased

What was the first name of (the deceased)?
Write the name in the box provided.
_ _ _ _ _ _

M-04 Date of death
What was the month and year of (the deceased)'s death?

Write the month and year of death.
Month of death _ _
Year of death _ _ _ _

M-05 Sex of deceased
Was the (deceased) male or female?

Mark appropriate box with an X
[] 1 Male
[] 2 Female

M-06 Age of deceased
What was the (the deceased)'s age in completed years at the time of death?

For example, if 2 years of age write 002.
Mark appropriate box with an X
_ _ _

M-07 Cause of death
What caused the death of (the deceased)?

Mark appropriate box with an X
[] 1 Unnatural death
[] 2 Natural death

M-08 Pregnancy at time of death
Was (the deceased) pregnant at time of death or died within six weeks after delivery?

Only ask for women 12-50 years at time of death. Mark appropriate box with an X
[] 1 Yes
[] 2 No

The questionnaire is completed. Thank the respondent(s).

[Page 21 is not presented.]