Questionnaire Text

Questionnaire form view entire document:  text  image
All residents
[Question 21 through 25 were asked of all resident persons.]

23. Physical handicaps

[] 1 Blind (nv)
[] 2 Deaf (so)
[] 4 Mute (mu)
[] 8 Handicapped in the lower limbs (hi)
[] 16 Handicapped in the upper limbs (hs)
[] 32 Other handicaps (ah)
[] 0 No handicap (sh)
Questionnaire instructions view entire document:  text  image
Question 23: Physical disabilities
A physical disability is any disadvantage or infirmity that deprives the individual of his/her physical abilities. For example:

- disability of the lower and/or upper limbs;
- hearing and/or speech disability: deaf and/or mute;
- vision disability: blind, etc.

Ask: "Do you have a physical disability or infirmity?"

- If the answer is no, circle code 33: no disability.
- If the answer is yes, ask: "What type of physical disability or infirmity do you have?"

Circle the code that matches the correct answer(s).

[] 1 NV: blind
[] 2 SO: deaf
[] 4 MU: mute
[] 8 HI: disability of the lower limbs
[] 16 HS: disability of the upper limbs
[] 32 AH: other disabilities.
[] 33 SH: no disability

Note: For all physical disabilities and infirmities that an individual presents but that do not appear on the short list of basic physical disabilities mentioned on the questionnaire, circle code "32: Other physical disabilities."