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RURAL BANGLADESH - PreventionWeb

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Annex: Household Questionnaire<br />

Section A: Demographics<br />

List all persons residing in the household:<br />

A1 A2 A3 A4 A5 A6 A7 A8 A9<br />

Age in Marita<br />

Name of the Respondent’s Sex years l Status Employment Employmen Primary Economic Other Economic No. of<br />

household relationship<br />

Status<br />

t Stability Activity<br />

Activities income<br />

members<br />

(15 yrs and above) (15 yrs and<br />

above)<br />

sources<br />

(15 years and above (15 years and above age<br />

age group only) group only)<br />

1<br />

2<br />

3<br />

4<br />

5<br />

6<br />

7<br />

8<br />

9<br />

10<br />

…<br />

1st line is<br />

the Head of<br />

Household<br />

(Code 1) (Code<br />

2)<br />

Male ..1 If < 1,<br />

Female2 then 0<br />

(Code 3) (Code 4) (Code 5) (Code 5)<br />

If

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