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.]


22. Cause of disability

[] 1 Congenital
[] 2 Traffic accident
[] 3 Work accident
[] 4 Illness
[] 5 Other

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 22: The cause of your handicap?

Being sought is the reason for the genesis of the disability of the person being administered the census. If according to the response obtained, the reason for the handicap is congenital, put an "X" into the 1 "Congenital" box, if a traffic accident, into the 2 "Traffic accident" box, if due to a work accident, into the 3 "Work accident" box, if from an illness, into the 4 "Illness" box, if other, into the 5 "Other" box. If there is more than one handicap, write the one for the handicap identified in question 21.