Questionnaire Text

Questionnaire form view entire document:  text  image

Part IV: Questions on personal characteristics


Physical disability


20. Visible physical disability, mental disorder or psychological defect, if any

[] 1 Yes
[] 2 No


Ask those who answer "Yes" to question 20.
[Questions 21-22 were asked of those who had physical disability, as per question 20.]


21. Nature of disability

(One eye blind, two eyes blind, one leg crippled, crippled, one ear deaf, dumb with mental disorder or psychological defect, etc.)

____

Questionnaire instructions view entire document:  text  image

Section IV: Questions regarding individual characteristics (11-42)
This section includes questions (questions 11-42) about the population's social and economic characteristics. In this section, only write the characteristics of those people present at the time and place where the census is being conducted.
Whether or not the household head is at home, be absolutely sure to begin by first writing his/her name and surname on the first line of Section IV, together with all of his/her characteristics (from question 11 to question 42). Take care that the household head's name and surname entered in this section is identical to the one written in in the first line of Section III.
After writing down all of the characteristics of the household head, whether he/she is at home or not, also write down all the characteristics of the other household members at home, beginning from the oldest and proceeding in order of age, from oldest to youngest. After the household members, write onto the dotted line in printed letters, in order of their ages, the names surnames and all the characteristics of those, who, while being present at home, are not household members. Answer questions with a box, by placing an "X" into it.


Handicap status (20-22)


Question 21: Type of handicap you have?

(Blind in one eye, blind in both eyes, lame in one foot, crippled, deaf in one ear, deaf in both ears, mentally or emotionally impaired, etc.)

The purpose is to determine the type of handicap that the person being administered the census has.

Handicapped: Those impaired in terms of discerning reality with the eye, or clearly comprehending it, and handicapped in terms of physical malfunctions, as well as from a mental or emotional standpoint. Clearly write out whatever type of handicap it is, such as being blind in one eye, blind in both eyes, lame in one foot, crippled, deaf in one ear, deaf in both ears, mentally or emotionally impaired. For those with more than one handicap, write the one that is most advanced. Some definitions having to do with handicaps are elucidated below.

[] Blind: A person is referred to as blind if, despite all corrective measures taken, the person's vision with both eyes is less than 1/10; in other words, a person unable to make use of his/her eyesight for living a normal life or in their work.

[] Deaf: A person referred to as deaf is someone, who despite all corrective measures taken has experienced a [hearing] loss of more than 90 db (decibels) in both ears; in other words, a person unable to make use of his/her hearing for living a normal life or in their work.

[] Orthopedically handicapped: A person, who despite all corrective measures taken, cannot adequately use their skeleton, nervous system, muscles and joints in order to live a normal life and in their work is referred to as orthopedically handicapped.

[] Handicapped in terms of mental characteristics: A person, who for various reasons has undergone a continuous slow-down, interruption, and retardation of their mental, psycho-motor, social, maturity, and development functions, resulting in a one-quarter or higher [level of] enduring loss of capacity and functioning, is referred to as mentally handicapped or mentally retarded.