Questionnaire Text

Questionnaire form view entire document:  text  image
For enumerator's use only
____Enumerator's name:

____Physical address of this dwelling:
____Suburb/village/settlement:
____City/town/farm/tribal authority:


____Magisterial district (name):
_ _ _Magisterial district No:

_ _ _ _Enumerator area No:
_ _ _Visiting point No:
_ _Household No:
_ _ _Return No:
_ How many questionnaires were completed for this household?
____ If more than one questionnaire, what is the number of this questionnaire? (e.g. first, second, third)
Section A:

To be completed for each person in the household in a separate column. Remember to include babies. Please include yourself.


11.1. Is this dwelling (e.g. house, room, shack, flat) the place where (the person) usually lives, i.e. where (the person) spends at least four nights per week?

[] 1 = Yes
[] 2 = No

11.2. (If "No") Where does (this person) usually live?
____ Name of suburb/village/settlement
____ Name of city/town/farm/tribal authority
____ Name of magisterial district
____ If not South Africa, please state name of country
[] 3 = If no usual address, circle "3"