Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

TIMOR-LESTE DEMOGRAPHIC AND HEALTH SURVEY (TLDHS)
HOUSEHOLD QUESTIONNAIRE
NATIONAL STATISTICS DIRECTORATE (NSD) AND MINISTRY OF HEALTH
NAME AND CODE OF DISTRICT
NEW SUCO NAME AND NUMBER
IDENTIFICATION
CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION ID NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
URBAN/RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(URBAN=1, RURAL=2)
NAME OF HOUSEHOLD HEAD
HOUSEHOLD SELECTED FOR MALE SURVEY (YES=1; NO=2) .............................................
DEGREES DECIMALS
LONGITUDE . . . . . . . . . . (E) .
ALTITUDE
METERS
LATITUDE . . . . . . . . . . (S) . NEW LOCATION
YES=1; NO=2
INTERVIEWER VISITS
DATE DAY
MONTH
INTERVIEWER'S NAME INT. NUMBER
YEAR
RESULT* RESULT
FINAL VISIT
NEXT VISIT: DATE
TIME
TOTAL NUMBER
OF VISITS
*RESULT CODES:
1 COMPLETED TOTAL PERSONS
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT
AT HOME AT TIME OF VISIT
IN HOUSEHOLD
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED TOTAL ELIGIBLE
5 REFUSED WOMEN
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND TOTAL ELIGIBLE
9 OTHER
(SPECIFY)
MEN
LINE NO. OF
LANGUAGE OF QUESTIONNAIRE RESPONDENT
TO HOUSEHOLD
LANGUAGE OF INTERVIEW QUESTIONNAIRE
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED (YES=1; NO=2)
LANGUAGE CODES: TETUM=1; BAHASA=2; PORTUGESE=3; OTHER=4
SUPERVISOR FIELD EDITOR
NAME NAME
DATE DATE
1 2 3
20 July 2009
OFFICE KEYED BY
EDITOR
Appendix E
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