IOM - Assessment on the Psychosocial Needs of Haitians Affected ...
IOM - Assessment on the Psychosocial Needs of Haitians Affected ...
IOM - Assessment on the Psychosocial Needs of Haitians Affected ...
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Annex IV: Study Questi<strong>on</strong>naire<br />
A. Questi<strong>on</strong>naire for Households<br />
IDENTIFICATION PLACE OF ORIGIN<br />
Department<br />
Neighborhood/site<br />
Commune<br />
Place (village/ town)<br />
Name <strong>of</strong> <strong>the</strong> camp<br />
Name <strong>of</strong> interviewee<br />
Organizati<strong>on</strong><br />
Interviewer status<br />
Date:<br />
Time start:<br />
Time finish:<br />
households<br />
LIVIN<br />
LIVING CONDITIONS<br />
1. What kind <strong>of</strong> housing do you have?<br />
2. Are you sharing your housing with o<strong>the</strong>rs?<br />
3. Does <strong>the</strong> family face a threat <strong>of</strong> evicti<strong>on</strong> at any moment?<br />
4. Does <strong>the</strong> family have any restricti<strong>on</strong> <strong>on</strong> <strong>the</strong> freedom <strong>of</strong> movement in your current residence?<br />
5. How much do you pay for <strong>the</strong> rent per m<strong>on</strong>th?<br />
6. How many rooms <strong>the</strong>re are in <strong>the</strong> dwelling?<br />
7. How many <strong>of</strong> <strong>the</strong>se are bedrooms?(<strong>on</strong>ly if applicable)<br />
8. Do you think children have a safe place to play?<br />
9. Age and gender<br />
HOUSEHOLD LIST<br />
10. The date <strong>of</strong> arrival to <strong>the</strong> current place <strong>of</strong> habitati<strong>on</strong><br />
11. What is <strong>the</strong> resp<strong>on</strong>dent’s relati<strong>on</strong>ship with <strong>the</strong> head <strong>of</strong> <strong>the</strong> house<br />
12. Have you lost any member <strong>of</strong> your family due to <strong>the</strong> earthquake?<br />
13. Which educati<strong>on</strong>al level have you accomplished?<br />
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