Questionnaire Text

Questionnaire form view entire document:  text  image
41. Particulars of deaths in the households in the last 12 months.

1. Name of deceased
Sex _
Age _ _
2. Name of deceased
Sex _
Age _ _
3. Name of deceased
Sex _
Age _ _
4. Name of deceased
Sex _
Age _ _
5. Name of deceased
Sex _
Age _ _
Questionnaire instructions view entire document:  text  image
Column 41: Household Members Dead in the Last 12 Months

The household will be asked if there has been a regular member of the household who has died in the last 12 months. If there is any, then full name of the deceased by age and gender will be recorded in card columns 67 to 90. With regard to gender, "1" will be entered for male and "2" for female deceased members of the household. Also age of the deceased at the time of death will be entered in full years in the appropriate card columns.

This column is designed to accommodate data for up to five deceased household members. If the number of deceased household members exceeds five, then the additional data on death must be recorded in the blank space at the bottom.