Questionnaire Text

Questionnaire form view entire document:  text  image
IV. Deaths in past 12 months
[Questions D1-D4.]

These questions are to be asked to the head of household, or to his/her representative.


[Questions D1-D4 were asked only if there was a death in the household in the last 12 months]


D1. ____ Names

Write down the last names and the first names of all deceased persons during the past 12 months.


D2. Sex
Circle the number corresponding to the sex of the deceased person.

[] 1. Male
[] 2. Female


D3. _ _/ 200_ Date of death (month and year)
Specify in the first two boxes the month of the death, and in the last box the year of the death.


D4. _ _ _ Age at death
Write down in the empty boxes the age of the deceased person at time of his/her death.

Questionnaire instructions view entire document:  text  image

7.3.1.5: How to fill-in section 5: deaths over the past 12 months (D0-D5)

In this section, the census enumerator will be careful and discrete for obvious reasons. He will ask the head of household or his representative, in full privacy, whether there were deaths which occurred in the household over the past 12 months.
If there was no death, the interview for this topic stops here.
If there were deaths, the census enumerator will write them down in order, and will ask their sex, day, month of death, or their age at death. For each person who died, he/she will ask: the name, the sex, the date of death (month and year) and the age at death.

Remark:
The census enumerator must comply with the instructions written on the census questionnaire.

[p.52]

The issue concerning the 12-months time period, where it begins and where it ends, will require a lot of attention.

The census enumerator will do his/her best so that months included in the 12 months period are well understood by the interviewed person.
Sometimes, it will be necessary to count them one by one. He will do with the same expertise as that used for filling questions P27 to P30.

The space made to write down the month has two boxes that the census enumerator has to fill in.

The space made to write down the year has four boxes, of which three are already filled in, and are in grey ; the census enumerator is asked to fill in only the remaining box with numbers 1 or 2 (2001 or 2002).