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Temperature - European Investment Bank

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WEST AFRICAN POWER POOL (WAPP) PÖYRY ENERGY LTD.<br />

Mount Coffee HPP ESIA and RAP Date 2012-09-18<br />

ESIA Report Page 276<br />

A13.3: Household Questionnaire<br />

Data of Interview: ___________ Interviewer: ________________<br />

Socio-economic Profiles of Communities Affected<br />

Within the Project Impact Zone (PIZ)<br />

District:_______________ Village/Town:____________ Household No.:______<br />

Instruction: Please clearly print the appropriate answer(s) by filling in the blank(s) or by checking the corresponding box or numbers to the best<br />

of the respondent’s knowledge. Please be sure not to skip any box or blank.<br />

1. Personal Data<br />

a.<br />

i.<br />

ii.<br />

iii.<br />

iv.<br />

v.<br />

vi.<br />

vii.<br />

Use additional sheet if necessary.<br />

Name of Household Members<br />

Are there any vulnerable people in your HH?<br />

Vulnerable Group: This includes:<br />

Age<br />

Female<br />

Sex<br />

Male<br />

Non-formal<br />

Education<br />

Elem<br />

(Grades 1-6)<br />

Female HH Head, widows, the very sick, handicapped, elderly (80 years old +), blind, etc.<br />

Educational Attainment<br />

(Check � one)<br />

Junior Hi<br />

(Grades 7-9)<br />

Senior High<br />

(Grades 10-12)<br />

Tertiary Educ<br />

& Higher<br />

Relationship<br />

to the<br />

Respondent<br />

Occupation<br />

Marital Status<br />

(Check � one)<br />

Single<br />

Married<br />

Widow/Widower<br />

Divorced<br />

Christian<br />

Religion Vulnerable<br />

Gr.<br />

Muslin<br />

Others (specify)<br />

Specify

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