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Republic of Zimbabwe
Population Census 2012

If a continuation questionnaire for this household mark here []

Enumerator number _ _ _ _ _ _
A- Identification
Province _
District _ _
Ward _ _
Sector _ _
EA _ _ _
Household _ _ _
Agriculture _

B- For all persons
[Question 1 to 7 were asked of all persons]

1. Who stayed the Friday night (17 August) here?

Write the names of all adults, children and babies. Include visitors and persons temporarily absent (on night duty, travel, etc. not counted elsewhere), returning on Saturday morning (18 August). List all persons starting with the person who was heading the household on census night.

Person number []

2. What is [the respondent] relationship to the head of household?

[] 1. Head
[] 2 Spouse
[] 3 Son/daughter
[] 4 Parent
[] 5 Grandson/daughter
[] 6 Brother/sister
[] 7 Other relative
[] 8 Non relative

3. Is [the respondent] male or female?

[] 1 Male
[] 2 Female

4. How old was [the respondent] at his or her last birthday?

Enter age in completed years ("00" for children less than one year). Example: Name is 37. [First digit in the first box and the second digit in the second box]

Age _ _

5. Does (the respondent) have a birth certificate?

[] 1 Yes
[] 2 No
[] 9 Not known

6. Where was (the respondent) born?

Enter district or country code.

Code _ _ _

7. Where does (the respondent) usually live?

Enter district or country code.

Code _ _ _

8. Where was (the respondent) living (last census year) in August 2002?

Enter district or country code.

[Question asked only of persons 10 years and above]

Code _ _ _

B- For all persons
[Questions 9 and 10 were asked of all persons]

9. What is (the respondent's) ethnic origin?

[] 1 African
[] 2 European
[] 3 Asiatic
[] 4 Mixed race
[] 5 Other

10. What is (the respondent's) citizenship?

Enter country code ("000" for Zimbabwe)

Country _ _ _

11. What is (the respondent's) marital status?

[Question was asked of persons age 15 years and above]

[] 1 Never married
[] 2 Married
[] 3 Divorced/ separated
[] 4 Widowed

For persons age 17 years and below
[Question 12 and 13 were asked of persons age 17 years and below]

12. Is (the respondent's) father by birth alive?

[] 1 Yes
[] 2 No
[] 9 Not known

13. Is (the respondent's) mother by birth alive?

[] 1 Yes
[] 2 No
[] 9 Not known

14. Does (the respondent) have any of the following disabilities?

[Question was asked of all persons.]

a. Difficulty moving
[] 1 Yes
[] 2 No

b. Totally blind
[] 1 Yes
[] 2 No

c. Difficulty seeing
[] 1 Yes
[] 2 No

d. Difficulty speaking
[] 1 Yes
[] 2 No

e. Deaf
[] 1 Yes
[] 2 No

f. Difficulty hearing
[] 1 Yes
[] 2 No

g. Difficulty learning/ mental handicap
[] 1 Yes
[] 2 No

h. Chronic fits/ Epilepsy
[] 1 Yes
[] 2 No

i. Strange behaviors/ mental illness
[] 1 Yes
[] 2 No

j. Lack of feeling- hands or feet/ leprosy
[] 1 Yes
[] 2 No

k. Albinism
[] 1 Yes
[] 2 No

C. Education - for persons age 3 years and older
[Questions 15 and 16 were asked of persons age 3 and older]

15. Has (the respondent) ever been to school?

[] 1 Yes
[] 2 No

16. What is the highest level and grade of education completed by (the respondent)?

[] Level 0
Grade
[] 1
[] 2
[] 3
[] Level 1
Grade
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] Level 2
Grade
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] Level 3
[] 1 Certificate / diploma after primary
[] 2 Certificate / diploma after secondary
[] 3 Graduate / postgraduate
[] 8 None
[] 9 Not known

C- Education for persons 3-24
[Questions 17 to 19 were asked of persons 3- 24 years]

17. Is (the respondent) currently attending school?

[] 1 Yes
[] 2 No

18. Was (the respondent) ever in attendance in school at any point during this year?

[] 1 Yes
[] 2 No

19. During this school year, what level and grade is (the respondent) attending/ was enrolled in?

Level
[] 0
[] 1
[] 2
[] 3
[] 9
Grade
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 9

D- For persons age 10 years and above
[Questions 20 to 22 were asked of persons age 10 years and above]

20. What was (the respondent's) main activity during the last 12 months?

[] 0 Paid employee
[] 1 Employer
[] 2 Own account worker
[] 3 Unpaid family worker
[] 4 Looking for work/ unemployed
[] 5 Student
[] 6 Homemaker
[] 7 Retired/ Sick/ Too old
[] 8 Other

21. What was (the respondent's) main occupation during the last 12 months?

For codes 0-3 in Question 20

Occupation _ _ _

22. What was (the respondent's) field of specialization?

For persons with level 3 in Question 16 and codes 0-4 in Question 20

Field _ _

E- For women age 15-49 years
[Question 23 to 27 were asked of women age 15 to 49 years]

23. Has (the respondent) given any live births?

[] 1 Yes
[] 2 No

If yes, how many children born to (the respondent) were with her on the census night?

Male
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
Female
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

If yes, how many children born to (the respondent) were elsewhere on the census night?

Male
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
Female
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

If yes, how many children born to (the respondent) have died?

Male
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
Female
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

24. How old was (the respondent) when she had her first live birth?

Age in complete years

Age _ _

25. When was (the respondent's) last live birth?

Enter month (MM) and year (YY)

_ _ Month
_ _ Years

26. Was it a boy or a girl?

No. of Boys
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
No. of Girls
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

27. Is the child still alive?

No. of Boys
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
No. of Girls
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

F - Living conditions

28. What is the tenure status of the household?

[] 1 Owner/ Purchaser
[] 2 Tenant
[] 3 Lodger
[] 4 Tied accommodation
[] 5 Other

29. Type of dwelling unit

[] 1 Traditional
[] 2 Mixed
[] 3 Detached
[] 4 Semi- Detached
[] 5 Flat/ Townhouse
[] 6 Shack
[] 7 Other

30. Does dwelling unit have electricity?

[] 1 Yes
[] 2 No

Water for drinking and cooking

31a. Main water source

[] 1 Piped water inside house
[] 2 Piped water outside house
[] 3 Communal tap
[] 4 Well/ Borehole Protected
[] 5 Well- Unprotected
[] 6 River/ Stream/ Dam
[] 7 Other (specify below ____)

31b. Distance to water source

[] 1 On premises
[] 2 Less than 500m
[] 3 500m to 1km
[] 4 more than 1km

32. What type of toilet facility is used most by this household?

[] 1 Flush
[] 2 Blair
[] 3 Pit
[] 4 Communal
[] 5 None

33. What is the household's main source of energy for cooking?

[] 1 Wood
[] 2 Paraffin
[] 3 Electricity
[] 4 Gas
[] 5 Coal
[] 6 Other (specify below____)

G - Deaths in the household

34. Did any deaths occur in the household in the last twelve months?

[] 1 Yes (If yes, go to question 35)
[] 2 No

35. Was the deceased male or female?

[] 1 Male
[] 2 Female

36. How old was the deceased?

Age in completed years

Age _ _

Only for women age 15- 49
[Question 37 was asked of women ages 15 to 49]

37. Did she die while pregnant, giving birth or within about one month after giving birth?

[] 1 Yes
[] 2 No

H- Total number of persons in the household

Male _ _
Female _ _
Total _ _ _

If the household continues on the next questionnaire, mark this box []

General comments

Enumerator

____ Name
____ Date
____ Signature

E.A. Supervisor

____ Name
____ Date
____ Signature

District Supervisor

____ Name
____ Date
____ Signature

Confidential when completed