Fsnau-Post-Gu-2012-Technical-Report

Appendices
146
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5.12.10 Urban Household survey Questionnaire
FSNAU Technical Series Report No. VI 48
Issued October 18, 2012
URBAN HOUSEHOLD FOOD SECURITY SURVEY QUESTIONNAIRE – Gu 2012
DATE OF THE INTERVIEW: I______I______I 2012
DATE / MONTH
INTERVIEWER’S NAME: _________________________________________
QUESTIONNAIRE NUMBER:
DISTRICT NAME:
HH NUMBER:
CLUSTER NUMBER:
CLUSTER NAME:
Food Security and Nutrition Analysis Unit
RESPONDENT’S MAIN TYPE OF HOUSING:
1. Tarpaulin/sticks (buul)
2. Corrugated sheets
3. Wooden
4. Stone
5. Other (specify) _____________
THE INTERVIEW SITE:
1. Town
2. IDP settlement
SEX OF THE RESPONDENT:
1. Male
2. Female
SEX OF THE HOUSEHOLD HEAD:
1. Male
2. Female
1. DEMOGRAPHICS
1.1 How long has your household been living in this town?
To the Interviewer: In case it is less than one year please indicate the number of months in Option 2.
1. Years _______________ 2. Months______________
1.2 Please specify the residence status of your household
1. Permanent resident
To the Interviewer: Please encircle the appropriate option. If it is a temporary resident please
indicate a purpose of stay.
2. Temporary resident (specify the purpose) ____________
3. IDP
1.3 Which one of these family structures does your household belong to?
To the Interviewer: Please encircle the appropriate option
1.4 What is the age of the household head?
1. Monogamous 2. Polygamous 3. Other ________________
To the Interviewer: Please explain to the respondent that ” household head is the person within the household who has the overall responsibility,
authority and decision-­‐making over access to and control of the household resources”.
Age _________
1.5 What is the age of the individual household members?
Age groups Male Female
To the Interviewer: Please indicate number of males and females in each age category. Cross check the responses 1. 0-­‐5 years
with those in Q1.4 and ensure that the total number of children < 15 and adults (> 15) match.
2. 6-­‐14 years
1.6 What is the highest level of formal education of the household head?
To the Interviewer: Please TICK the appropriate option.
3. 15-­‐24 years
4. 25-­‐49 years
5. 50-­‐59 years
6. 60 years and over
1. No formal education 2. Primary 3. Secondary 4. Tertiary
1.7 How many children of primary school-­‐going age attended school in the last three months?
1. No school age children
To the Interviewer: If no school age children are available TICK option 1 and SKIP to Qn-­‐2.1. Otherwise, indicate the number of
2. Boys __________
children of each sex category attending the primary school, where applicable.
3. Girls __________
1.8 If any of the primary school-­‐going age children did not attend
Reasons Boys Girls
1. Sickness/handicap _______ _______
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