Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697705829765.pdf (Dominica)
5153 COMMONWEALTH OF DOMINICA Survey of Living Conditions and Household Expenditure and Income 2008/09 Household Schedule For optimum accuracy, please print carefully and avoid contact with the edges of the box.

The following will serve as an example: IMPORTANT!!!

Place an X in the box for multiple choice options BUILDING NO USE ONLY 2B PENCIL Subsample No Replicate letter - IMPORTANT!!!
Transfer these codes to the top of EACH individual questionnaire and Daily Diary Address of Household: INTERVIEWER'S NAME: SUPERVISOR'S NAME: EDITOR/CODER'S NAME: Parish ED NUMBER HOUSEHOLD NO Telephone number - Interviewer No No In Household LISTING OF HOUSEHOLD MEMBERS Confidential Surname First Name Surname First Name 01 02 03 04 05 06 07 08 09 10 5 r e d n u s i n o s r e p f i x o b n i X e c a l P r e d n u s i n o s r e p f i x o b n i X e c a l P INTERVIEWER RESULTS Interview Calls Date (DD/MM/YY) Time Started Confidential Duration *Results / / 1 2 3 4 *RESULTS CODES: 1 = Completed 2 = Partially Completed 3 = Refused 4 = No Suitable respondent at home 5 = No Contact 6= Vacant Central Statistical Office, Ministry Of Finance, Kennedy Avenue, Roseau, Dominica, Tel: 767-448-2401 ext.
3400 - 3407 Confidential Confidential 1 0 0 0 0 0 0 7 1 0 0 0 0 0 0 7 Page 1 SAMPLE SECTION 1 - HOUSING 5153 H2.

H2.1 What type of dwelling does this household occupy?

1 Undivided private house 2 Part of a private house 3 Flat, apartment, condominium 4 Townhouse 5 Double house/Duplex 6 Combined business & dwelling 7 Barracks 8 Other H3.8 In which year was this dwelling built?
1 Before 1970 2 1970 - 1979 3 1980 - 1989 4 1990 - 1995 5 1996 - 2000 6 2001 7 2002 8 2003 9 2004 10 2005 11 2006 12 2007 13 2008 14 2009 15 Don't Know H2.2 What is the construction material of the outer walls?

1 Wood/Timber 2 Concrete/Concrete Blocks 3 Wood & Concrete 4 Stone 5 Brick/Blocks 6 Plywood 8 Other/Don't Know 7 Makeshift (Specify........................................) H2.3 What is the material used for roofing?
1 Sheet metal (galvanize, galvalume) 2 Shingle (asphalt) 3 Shingle (wood) 4 Shingle (other) 5 Tile 6 Concrete 7 Makeshift/thatched 9 Don't know 8 Other (Specify..............................................) H2.4 Do you own the land on which this house is built?

1 Owned with title 4 Leases the land 2 Family Owned 5 Squatting 3 Rents the land 6 Not Owned H3.

H3.1 Does this household own, rent or lease this dwelling?
1 Owned (with mortgage) 6 Leased 2 Owned (Without mortgage) 7 Rent-free 3 Rented-Furnished 4 Rented-Unfurnished 8 Squatted 9 Other (please specify..........................) H3.2 What type of fuel does this household use MOST for cooking?

1 Coal 2 Wood 3 Gas/LPG/Cooking gas 4 Kerosene 5 Electricity 6 no cooking H3.3 What is the MAIN type of toilet facilities used by this household?
7 Other (please specify........................) 1 W.C. (flush toilet) linked to sewer system 2 W.C. (flush toilet) linked to Septic tank/Soak-away 3 Pit-latrine 4 Ventilated Pit-latrine 5 Other (please specify..............................................) 6 None H3.4 Does your household share any of the following facilities with another household?
1 Kitchen 2 Toilet / Bathroom 3 Water 4 Electricity 5 Cable TV 6 Any combination of 1, 2, 3, 4 or 5 7 None 8 Other (please specify.......................) H3.9 How many rooms does your dwelling unit contain?

(Do not count bathrooms, porches, kitchens, laundry rooms, balcony, arttic, corridor ) Number of Rooms H3.10 How many are used 1.

Solely as bedrooms?

3.

Rented or sub-letted?

2.

Used for business?

4.

Vacant?


H3.11 How do you compare the overall economic situation of the household with one year ago?

1 Much worse now 2 A Little worse now 3 Same 4 A Little better now 5 Much better now 6 Don't know H3.12 On a scale of 1 to 5, where 1 is poor and 5 is rich how would you rate your household?

1 2 3 4 5 H4.

H4.1 Indicate how many of each of the following items is owned by all household members?

(Write "0" where there is none) Number Number 1.

Telephone - Land Line 2.


Telephone - Cellular 3.

Television 4.

Video/VCR 5.

Game Player, eg Play Station 6.

Ipods/MP3 7.

DVD Player 15.

Motor Vehicle 16.

Computer (laptop, desktop) 17.

Sewing Machine 18.

Clothes Dryer 19.

Dish washer 20.

Weed Eater /Lawn Mower 21.

Air Conditioner 22.

Solar Water Heater 23.

Electric Water Heater H3.5 What is the main source of your water supply?

8.
8.

Electric/Gas Stove 1 Public, piped into dwelling 2 Public, piped into yard 3 Public standpipe 7 Private catchment piped 4 Public well/tank or truck 5 Private, piped into dwelling 6 Private catchment not piped 8 Other (please specify..............................................) If response is 1 or 2 to H3.5 continue, otherwise skip to H3.7 H3.6 In the past twelve months, how many days on average per week do you have water in your pipe?
Days enter 8 for "Don't Know" and 9 for "Not Stated" H3.7 What type of lighting does this household use most?

9.

Toaster/toaster oven 10.

Micro-wave 11.

Electric Iron 12.

Refrigerator/Freezer 13.

Radio/Stereo/CD Player 1 Gas 2 Kerosene 4 Electricity - Private Generator 14.
Washing Machine 5 Other (please specify.....................................) 3 Electricity - Public 6 None 1 0 0 0 0 0 0 7 Page 2 SAMPLE SECTION 2 - EXPENDITURE ON ACCOMMODATION 5153 INTERVIEWER: For each of the following questions where an answer is not applicable leave blank.

If an answer is applicable but unknown put 9's followed by 8 in the last position.

For entries not stated make an effort to obtain an answer.

If this is not possible put 9's in the boxes provided.
All entries are annual unless otherwise stated and should be rounded to the nearest $ FILTER: In the past twelve months did you own or rent your dwelling?

1 Own (Continue) 2 Both (Continue) 3 Rent (Go to PART 3) PART 1 - OWNER OCCUPIED ACCOMMODATION CODE Amount ($) 1.1 How much is due to be paid annually for the following: 1 Land and House taxes 2 Other property taxes 1.2 What is the annual rent or lease for the land on which the house is built?
1.3 How much Insurance premium is paid on this dwelling annually ?

0423103 0423102 0411201 1252101 , , , , 1.4 Is any part of this dwelling rented?
1 Yes 2 No if No, go to 1.6 1.5 What amount do you receive monthly for leasing/timeshares/rental/sub-letting: for any or all of the following purposes: 1 Furnished/Partly furnished (household accommodation) 2 Unfurnished (household accommodation) 3 Business 4 Vacation Home leasing/rental/timeshares 1.6 How much rent would you charge monthly if you were to rent this accommodation?

1.7A What is the estimated market value of the dwelling unit currently occupied by this household?
1.7B What is the estimated market value of the vacation home(s) currently owned by this household?

1800501 1800502 1800503 1800504 0421101 1900104 1900105 , , 1.8 Do you make mortgage payments for this dwelling?

2 No Check H3.1 then answer this question 1 Yes 1.9 What is the monthly mortgage payments for this dwelling?

1900105 , , , , , , , if No, go to 2.1 , PART 2 PROPERTY BOUGHT/CONSTRUCTED IN SURVEY YEAR Amount ($) 2.1 Did you purchase/construct this dwelling unit during the past 12 months?
1 Yes 2 No Yes, Continue If no, go to Q3.1 2.2 If purchased, was the dwelling unit bought new or was it previously occupied?
1 New 2 Used Please state the following: 2.3 Purchase price or construction cost 2.4 Duration of mortgage 2.5 Amount of mortgage 1900101 1900102 1900103 , , Years , , After Q2.5 go to Q3.1 PART 3 - RENTED ACCOMMODATION INTERVIEWER: If the family occupied a rented dwelling for all or part of the survey year, complete this section Ask question if household has been renting for all or part of the last twelve months 3.1 3.2 3.3 State amount paid for monthly rent Is any part of this dwelling unit sub-letted?
State monthly receipts from sub-letting or renting Furnished/Partly furnished Unfurnished Business 3.4 If rent includes meals, estimate approximately the monthly value of meals 0411100 1800801 1800802 1800803 1800901 1 Yes 2 No if No, go to 4.1 , , , , , 1 0 0 0 0 0 0 7 Page 3 SAMPLE SECTION 2 - REPAIR AND MAINTENANCE OF DWELLING 4.1 5153 During the past 12 months have you incurred any expenditure on any of the following items for the purpose of repairing and maintaining the accommodation occupied by your household?
Note: Exclude any expenditures on major additions and improvements which add to the value of the property, e.g.

built a new wall, built a retaining wall, etc.

Also, exclude expenditure on damages caused by extraordinary events, e.g.

hurricane, fire, etc.

Even if rented, probe for repair and maintenance expenses.
1 Yes (Complete Q 4.1) 2 No (Go to Q 4.2) Not applicable Leave Blank Not Known 9's ending in 8 Amount too large 9's ending in 7 Not Stated Try harder, if not use all 9's REPAIR AND MAINTENANCE Y/N CODE $ AMOUNT Materials (excluding labor) 1.

Painting e.g.

paints, varnishes, brushes and scrapers 2.

Masonry e.g.

Cement, sand, lime 3.

Carpentry e.g.

Wooden planks, plywood etc.

4.

Plumbing, repair and replacing e.g.

replaced water pump etc.

5.

Electrical (repair and replace) e.g.


switches, wires, fuse boxes 6.

Other materials Labor excluding materials costs 7.

Painting (outside and inside) 8.

Plastering and Masonry, e.g.

repairing walls, flooring etc.

9.

Carpentry e.g.

repairing of doors, windows, roofs and ceilings etc.

10.

Plumbing, e.g.

replaced water pump etc.

11.

Electrical repairs and replacing, eg.

replaced wiring etc.

12.

Termite Protection 13.

All other services 14.


TOTAL EXPENDITURE 0431101 0431201 0431301 0431401 0431501 0431801 0432101 0432102 0432103 0432104 0432105 0432199 Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No , , , , , , , , , , , , , , 4.2 In the past twelve months, did the physical structure of your 4.5 How were these repairs funded and at what cost dwelling suffer any damage caused by extra-ordinary events (e.g.

Hurricane, fire, etc.?


(Select all that apply)?

1 Yes 2 No (if no, go to 5.1) 4.3 Can you tell me the nature of the damage?

(select all that apply) 1 Roof 2 Walls 3 Windows or Doors 4 Floors 5 Other 4.4 How much have you paid to repair these damages?
1 Out of Pocket 2 Insurance Claim 3 Relatives and friends 4 Government Support 5 Other $ , 1 0 0 0 0 0 0 7 $ $ $ $ $ , , , , , Page 4 SAMPLE SECTION 3 - MAJOR TYPES OF HOUSEHOLD EXPENSES 5153 Not applicable Leave Blank Not Known 9's ending in 8 Amount too large 9's ending in 7 Not Stated Try harder, if not use all 9's ASK THE HOUSEHOLD REFERENCE PERSON INITIALLY AND OTHER MEMBERS IF NECESSARY PLEASE WRITE CLEARLY AND LEGIBLY HOW MUCH WAS SPENT ON THE SERVICES LISTED BELOW CODE Amount ($) 5.1 How much did you spend during the last 3 months on gas for cooking?
e.g.
propane, butane cylinders 5.2 How much were you billed for water and sewerage in the last last month (exclude balances from previous bills from DOWASCO) 5.3 How much were you billed for electricity in the last month (exclude balances from previous bills) 5.4 5.5 How much were you billed for fixed line telephone in the last month (exclude balances from previous bills and Internet charges; include phone cards, caller ID, call waiting, etc) How much was paid by you in the last twelve months for other related household expenses n.e.s (Specify) e.g.
Emptying of septic tank 0452101 0441101 0451101 0830201 0562601 , , , , , HOW MUCH WAS SPENT MONTHLY ON THE SERVICES LISTED BELOW CODE Amount ($) 5.6 Employed staff including maids, butlers, drivers, gardeners, etc 5.7 Persons engaged temporarily for baby-sitting, housework, etc.

5.8 Child care outside of the home e.g.
day nurseries, pre-schools, baby sitting and other child minding services 5.9 Care of elderly relatives inside the home 5.10 Care of elderly relatives outside the home 5.11 Care of the disabled 5.12 Gardening/lawn care services 5.13 Cable installation and/or Service 5.14 Internet Services 0562100 0562200 1240201 1240102 1240103 1240104 0562203 0830103 0830401 , , , , , , , , , HOW MUCH WAS SPENT ANNUALLY ON THE SERVICES LISTED BELOW Amount ($) 5.16 Amount spent last twelve months on other household services, moving, laundry, 4532199 , 1 0 0 0 0 0 0 7 Page 5 SAMPLE SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT 5153 ASK THE HOUSEHOLD REFERENCE PERSON INITIALLY AND OTHER MEMBERS IF NECESSARY Complete the schedule below for all items purchased or received as a gift by anyone in the household in the past 12 months.
Note: I) If any item was bought on an installment plan, you should enter the cash price of the item and not the monthly repayment.

If the cash price is not available or cannot be recalled then use the "regular price".

However, if the respondent is not able to recall either the "cash price" or the "regular price" then use the total hire purchase price.
II) If any trade-in allowance was given, the purchase price represents the amount paid plus the value of any trade-in (the full purchase price of the new item before deducting trade-in value).
III) You should record all purchases including those bought abroad, through mail order catalogues, over the Internet and purchased in Dominica IV) Include all home made furniture and equipment and indicate this by placing an X in the check box "HomeMade" next to the description of the item under the column "HAVE BOUGHT".

PART 1 - During the past 12 months have you, or any member of your household purchased or received gifts, for their own use or use by any member of the household, any of the following?
PURCHASED (homemade) GIFTS FURNITURE AND FURNISHINGS CODE HAVE BOUGHT QTY BOUGHT TOTAL COST($) QTY Received TOTAL COST($) Living or recreation room 3/ 5/ 7 piece suites 0511101 Space saver/Display cabinet 0511103 Couch or sofa Coffee /side table/centre table TV / Stereo stand /entertainment center Playpens 0511104 0511107 0511108 0511111 Book case/ book shelf 0511112 Other living room furniture not specified by type 0511199 Dining room furniture 5 piece Dinette / Dining Suites 0511203 China cabinets Individual tables 0511204 0511207 Individual chairs 0511208 Other dining room furniture not specified by type 0511299 Kitchen furniture Table Chairs/Stools Trolleys Cabinets/ Cupboards (not built in) Other kitchen furniture not specified by type 0511301 0511302 0511303 0511304 0511399 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 6 SAMPLE SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT 5153 PART 1 - During the past 12 months have you, or any member of your household purchased or received gifts, for their own use or use by any member of the household, any of the following?
PURCHASED (homemade) GIFTS FURNITURE AND FURNISHINGS CODE HAVE BOUGHT QTY BOUGHT TOTAL COST($) QTY Received TOTAL COST($) Bedroom furniture Bedroom Suites Yes 0511401 HomeMade Double bed/bunk bed 0511402 HomeMade Yes King/Queen size bed 0511403 Single bed Mattress 0511404 0511406 Chest of Drawers 0511408 Wardrobe Cots, cribs 0511409 0511410 Combination wardrobe 0511412 Dressing table 0511407 Other bedroom furniture not specified by type 0511499 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes Patio and outdoor furniture Table and chair Lounge chair 0511501 HomeMade Yes 0511505 HomeMade Other outdoor furniture not specified by type Yes 0511599 HomeMade Decorative furnishings Pictures and paintings Yes 0511601 HomeMade Decorative clocks 0511605 Yes HomeMade Yes Floral Arrangements Ornaments, Vases Other decorative furniture not specified by type Lighting equipment Standard Lamps/wall lamps 0511602 HomeMade 0511603 0511699 Yes HomeMade Yes HomeMade Yes 0511705 HomeMade Kerosene Lamp 0511701 Other lighting equipment not specified by type Other furniture Computer desks 0511799 0511801 Bookcase/bookshelves Ironing boards Other furniture not specified by type 0511803 0511899 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 7 SAMPLE SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT 5153 PART 1 - During the past 12 months have you, or any member of your household purchased or received gifts, for their own use or use by any member of the household, any of the following?
PURCHASED (homemade) GIFTS FURNITURE AND FURNISHINGS CODE HAVE BOUGHT QTY BOUGHT TOTAL COST($) QTY Received TOTAL COST($) Carpets Fitted carpets Non fitted carpets /rugs Other floor covering Linoleum Ceramic tiles Vinyl tiles 0512101 0512102 Yes HomeMade Yes HomeMade Yes 0512201 HomeMade 0512202 0512203 Wooden floor covering 0512204 Other floor covering not specified by type Furnishing Material Furnishing Fabrics/ cushion fabrics Curtain material (over lace) Drape material Other furnishing material not specified by type Ready made articles Curtains- panels, kitchen sets (not plastic) Drapes 0512299 0520101 0520102 0520104 0520199 0520201 0520202 Other ready made articles not specified by type 0520299 pillows cushions 0520303 0520307 Comforters and Spreads 0520306 Other ready made beddings not specified by type 0520399 Beddings Sheets and pillow cases 0520302 HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes Towels and Table Linen Towels-Bath 0520401 HomeMade Kitchen towels 0520403 Table cloths, Table napkins 0520404 Bathroom mats Door mats 0520405 0520406 Other towels and table linen not specified by type 0520499 Other household textiles Shopping bags 0520501 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 8 SAMPLE SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT 5153 PART 1 - During the past 12 months have you, or any member of your household purchased or received gifts, for their own use or use by any member of the household, any of the following?
PURCHASED (homemade) GIFTS FURNITURE AND FURNISHINGS CODE HAVE BOUGHT QTY BOUGHT TOTAL COST($) QTY Received TOTAL COST($) Other household textiles not specified by type 0520599 Major kitchen appliances Cooking stove (gas/electric) 0531101 Microwave Ovens 0531102 Refrigerator 0531103 Home deep freezer 0531105 Other major kitchen appliances not specified by type 0531199 Major laundry appliances Clothes washer fully automatic Clothes washer semi- automatic Clothes dryer (electric) 0531201 0531202 0531205 Other major laundry appliances not specified by type 0531299 Major cleaning appliances Vacuum cleaner 0531301 Other major cleaning appliances not specified by type 0531399 Major air and water appliances Air conditioning unit 0531401 Water heater(solar/electric) 0531404 Other major air and water appliances not specified by type 0531499 Other major household appliances Sewing machines Computers 0531501 0913101 Printers/Fax Machine/both 0531503 Other major household appliances not specified by type 0531599 Small electronic household appliances Mixer 0532001 Toaster Sandwich maker Blender Electric fan Electric Iron 0532002 0532004 0532005 0532007 0532008 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 9 SAMPLE SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT 5153 PART 1 - During the past 12 months have you, or any member of your household purchased or received gifts, for their own use or use by any member of the household, any of the following?
PURCHASED (homemade) GIFTS FURNITURE AND FURNISHINGS CODE HAVE BOUGHT QTY BOUGHT TOTAL COST($) QTY Received TOTAL COST($) Electric kettle 0532009 Yes Food processors 0532014 HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes 0532099 0820102 0820101 0911101 0911304 0911201 0911303 Small electronic household appliances not specified by type Telephone equipment Telephones Cell phones Recreation and culture Television sets Personal Stereos Radios CD/MP3/IPODS players China, Glass, Ceramic and Crystals Plates, teacups, saucers, mugs, bowls Glasses, Jug, -(Glass, ceramic) 0540101 HomeMade Yes 0540102 HomeMade Pottery, Oven ware-(glass, ceramic) 0540103 HomeMade Yes Cutlery, Flatware,Silverware Forks, Knives, Spoons 0540201 HomeMade Yes Cooking Utensils-Knives, Serving spoons, Openers, Scissors, graters Non - electric kitchen equipment Pressure cookers Saucepans, Stew pots, kettles, fryi Sterilizers/Filters Feeding bottles, Thermos flasks, Bottles Ice boxes, coolers Miscellaneous Equipment Laundry baskets, Waste Pails, Basins, Potty, Tubs, Bath Tubs Mops, brooms, brushes 0540202 0540301 0540303 0540305 0540306 0540401 0540403 0540404 Other miscellaneous equip- ment not specified by type 0540499 Gas Powered tool Lawn Mower Weed Eaters Other gas powered tools 0551202 0551203 0551299 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 10 SAMPLE SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT 5153 PART 1 - During the past 12 months have you, or any member of your household purchased or received gifts, for their own use or use by any member of the household, any of the following?
PURCHASED (homemade) GIFTS FURNITURE AND FURNISHINGS CODE HAVE BOUGHT QTY BOUGHT TOTAL COST($) QTY Received TOTAL COST($) Garden Tools (Cutlasses forks, Spades, hoes, rakes Wheelbarrows 0552201 HomeMade Yes 0552201 HomeMade Yes Ladders and steps 0552301 Small Electrical Accessories Transformers 0552501 Electric bulbs, Fluorescent lighting tubes 0552502 Flash -lights, Torches, 0552503 Yes HomeMade Yes HomeMade Yes HomeMade Yes HomeMade , , , , , , , , , , , , SECTION 4 - REPAIRS AND SERVICING OF HOUSEHOLD ARTICLES PART 2 - During the past twelve months have you or any other member of your household incurred any expenses for the repair and servicing of any of the following pieces of equipment?
1 Yes Continue 2 No Go to Section 5 REPAIRS TO APPLIANCES AND EQUIPMENT CODE AMOUNT ($) SPENT LAST YEAR Repair of furniture, furnishes and floor coverings Repair of furniture Repair of floor covering (cost of labour plus material) Repairs to major kitchen appliances Repairs to major laundry appliances e.g washing machine Repairs to major cleaning appliances e.g vacuum cleaner Repairs to other major appliances Repairs to small electric appliances e.g blender Repair of telephone and telefax equipment Repairs to audio -visual equipment (eg television set) Repairs to photographic equipment e.g cameras Repairs to information processing equipment (computers) Other repairs and servicing 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 0512301 0512303 0533001 0533002 0533003 0533004 0533005 0820201 0915101 0915102 0915103 0534101 , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 11 SAMPLE 5153 INTERVIEWER: SECTION 5 - AGRICULTURE PRODUCTS PRODUCED AND CONSUMED AT HOME Advise the household reference person that what is needed in this section is an estimate of the quantity in pounds (lbs), unless otherwise specified and the value of home grown produce consumed by his/her household LAST MONTH.
Note: Coconut trees, fruit trees, tomatoes, lettuce, sweet pepper etc grown in the backyard garden should be recorded here as home grown produce if consumed in the past month.

What is the value of home grown vegetables, fruits, ground provisions, meat, poultry, fish or dairy products consumed by your household during the last month?
1 Yes Continue 2 No Go to Section 6 5.1 HOME GROWN PRODUCE CODE (Y/N) QUANTITY Estimate Amount ($) Consumed Last Month Orange (Number) Grapefruit (Number) Limes (Number) Other Citrus (Number) Ripe bananas (lbs.)

Mangoes (any variety) Number Watermelons (lbs.)

0116101 0116102 0116124 0116104 0116105 0116110 0116117 Other fresh fruits (pawpaw, plums, cherries, sour sop, golden apples, etc (lbs.)

0116199 Green bananas (lbs.)

Plantains (lbs.)


Breadfruit (Number) Avocadoes (Number) Dry coconuts (Number) Jelly coconuts (Number) Tomatoes (lbs.)

Pumpkins (lbs) Sweet pepper, seasoning pepper (lbs.)

Cabbage (Green) (lbs. )

Carrots (lbs.)

Spinach (lbs.)
0116128 0116129 0116126 0116125 0116401 0116132 0117101 0117102 0117131 0117103 0117105 0117132 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 12 SAMPLE SECTION 5 - AGRICULTURE PRODUCTS PRODUCED AND CONSUMED AT HOME 5153 What is the value of home grown vegetables, ground provisions, meat, poultry, fish or dairy products consumed by your household during the last month?
5.1 HOME GROWN PRODUCE CODE (Y/N) QUANTITY Estimate Amount ($) Consumed Last Month Lettuce, water cress (Head / bundles) Herbs Chive and Thyme (bundle) Other Fresh vegetables (lbs.)

Pigeon peas (lbs.)

String Beans (lbs.)

Spices, cinnamon, nutmeg, ginger (lbs.)

Yams - white (lbs.)

Tannias (lbs.)

Dasheen (lbs.)

Sweet potatoes (lbs.)

White potato Nuts (cashews, peanuts etc.)

(lbs.)

Cassava (lbs.)

Other ground provisions (lbs.)
Home Produced Meat and Poultry Beef Pork Mutton/Goat Rabbit Other Meats Chicken Other Poultry 0117106 0117122 0117199 0117115 0117117 0119223 0117503 0117508 0117505 0117506 0117509 0116130 0117699 0117699 0112107 0112207 0112303 0112402 0112499 0112701 0112999 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No , , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 13 SAMPLE SECTION 5 - AGRICULTURE PRODUCTS PRODUCED AND CONSUMED AT HOME 5153 What is the value of home grown vegetables, ground provisions, meat, poultry, fish or dairy products consumed by your household during the last month?
5.1 HOME GROWN PRODUCE CODE (Y/N) QUANTITY Estimate Amount ($) Consumed Last Month Home Produced Dairy Products and Fish: Milk (quarts) Eggs (doz) Fish caught (lbs.)

Titirie (lbs.)

Lobster Conch 0114101 0114501 0113199 0113113 0113115 0113117 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No 1 Yes 2 No , , , , , , Note: 1.

List on a separate line each motor vehicle, motor cycle, bicycle etc.

and any other vehicle owned and operated in the past 3 months SECTION 6 - TRANSPORTATION 2.
When trade-ins occur the purchase price represents cash plus amount credited towards traded vehicle, always clarify this PART 1 - Do you or any member of this household own or had owned and/or operated any vehicle during the past 3 months?
1 Yes, owned and/or operated, Continue 2 No Go to Section 7 NO TYPE Car Van 01 Motorcycle Truck Jeep/SUV Bus Other Vehicle Reg no 02 Car Van Motorcycle Truck Jeep/SUV Bus Other Vehicle Reg no 03 Car Van Motorcycle Truck Jeep/SUV Bus Other Vehicle Reg no 04 Car Van Motorcycle Truck Jeep/SUV Bus Other Vehicle Reg no 05 Car Van Motorcycle Truck Jeep/SUV Bus Other Vehicle Reg no AGE (in years from date of manufacture) PURCHASED NEW OR USED?
PURCHASE PRICE % PRIVATE 98 =100% % BUSINESS 1 New 2 Used 1 New 2 Used 1 New 2 Used 1 New 2 Used 1 New 2 Used , , , , , 1 0 0 0 0 0 0 7 Page 14 SAMPLE SECTION 6 - TRANSPORTATION 5153 PART 2 - VEHICLE MAINTENANCE AND REPAIR EXPENDITURE DURING THE PAST 3 MONTH PERIOD INTERVIEWER: if vehicle is used entirely for business do not include its expenses in the list which follows.

For each vehicle list the particular expense, then sum it up in the amount field provided.
Remember the vehicle number referred to is the number assigned to the vehicle from the previous page.
Maintenance expenditure during the past three months No:______ No:______ No:______ No:______ Vehicle 01 Vehicle 04 Vehicle 03 Vehicle 02 CODE TOTAL Amount($) Parts Tyres Oil Filters/Spark plugs Batteries Brakes Other parts Operation Costs Gasoline Diesel Oil License 0721101 0721103 0721104 0721109 0721199 0722101 0722102 0722201 0724404 Insurance (vehicle) 1254100 Driving permits/License 0724303 Parking fines /Tickets Other operating cost Repairs and Servicing (including parts and labour) General servicing, Tune-ups, electrical/motor repairs 0724701 0723199 0723110 Body work (straighten, paint) 0723108 Upholstery 0723114 Front end alignment and wheel balancing 0723104 Exhaust system repairs 0723105 Brake adjustments, repairs and service 0723103 Air Condition 0723115 Car Wash, polish etc.
0723101 Other (Specify) 0723199 , , , , , , , , , , , , , , , , , , , , , , 1 0 0 0 0 0 0 7 Page 15 SAMPLE SECTION 7 - REGULARITY OF PURCHASE AND MAIN TYPE OF OUTLET 5153 Which was the main store/outlet used in the last twelve months by your household for purchasing the following items?

ITEM CODE REGULARITY OF PURCHASE FREQ CODE NAME OF OUTLET (1) (2) (3) (4) (5) Outlet Code (See below) (6) LOCATION OF OUTLET (Community, Street, District) (7) 1.

Beef Pork/Mutton - Fresh / Frozen 0112401 2.


Fish - Fresh / Frozen 0113199 3.

Chicken - Fresh / Frozen 0112899 4.

Vegetables 0117100 5.

Ground Provisions 0117500 6.

Bread and Cakes 0111100 7.

Groceries 0119501 8.

Household Supplies 0561000 9.

Clothing Material 0311000 10.

Clothing - Women 0312300 11.

Clothing - Men 0312100 12.

Clothing - Children 0313601 13.

Furniture 0511000 14.

Footwear 0321000 REGULARITY OF PURCHASE CODES TYPE OF OUTLET-CODES 1.

DAILY 2.

WEEKLY 3.

FORTNIGHTLY 4.


MONTHLY 5.

QUARTERLY 6.

SEMI-ANNUALLY 7.

ANNUALLY 9.

OTHER 11.

CLOTHING STORE 13.

SHOE STORE 01.

SUPERMARKET 02.

MINI MART/SUPERETTE 12.

TEXTILE STORE 03.

SHOP 04.

WHOLESALE OUTLET 14.

VARIETY STORE 05.

FISH MARKET 06.

BAKERY 07.

RESTAURANT 08.

HARDWARE STORE 09.

FURNITURE & APPLIANCES STORE 10.

DEPARTMENT STORE 15.

PHARMACY 16.

HOSPITAL 17.

CLINIC (HEALTH CENTER) 26.

OTHER 18.

PRIVATE DOCTOR 19.

ABROAD-USA 20.

ABROAD-T&T 21.

ABROAD-OTHER 22.


VEGETABLE MARKET 23.

VAN 24.

SEA-FRONT 25.SPECULATOR/TRAFFICKER 1 0 0 0 0 0 0 7 Page 16 SAMPLE SECTION 7 - REGULARITY OF PURCHASE AND MAIN TYPE OF OUTLET Which was the main store/outlet used in the last twelve months by your household for purchasing the following items?

5153 ITEM CODE REGULARITY OF PURCHASE FREQ CODE NAME OF OUTLET Outlet Code (See below) (6) LOCATION OF OUTLET (Community, Street, District) (7) (1) (2) (3) (4) (5) 15.
Appliances 0531000 16.

Medical Expenses -prescriptions/Cou nter Medication 0611100 17.

Medical Expenses - Consultation 0621100 18.

Medical Expenses - Procedure 0630000 19.

Breakfast (responsible adult) 20.

Lunch (responsible adult) 21.

Dinner (responsible adult) 1111101 1111201 1111301 REGULARITY OF PURCHASE CODES TYPE OF OUTLET-CODES 1.

DAILY 2.

WEEKLY 3.

FORTNIGHTLY 4.

MONTHLY 5.

SEMI-ANNUALLY 6.

ANNUALLY 9.

OTHER 11.

CLOTHING STORE 13.

SHOE STORE 1.

SUPERMARKET 2.

MINI MART/SUPERETTE 12.


TEXTILE STORE 3.

SHOP 4.

WHOLESALE OUTLET 14.

VARIETY STORE 5.

FISH MARKET 6.

BAKERY 7.

RESTAURANT 8.

HARDWARE STORE 18.

PRIVATE DOCTOR 9.

FURNITURE & APPLIANCES STORE 10.

DEPARTMENT STORE 15.

PHARMACY 16.

HOSPITAL 17.

CLINIC (HEALTH CENTER) 26.

OTHER 19.

ABROAD-USA 20.

ABROAD-T&T 21.

ABROAD-OTHER 22.

VEGETABLE MARKET 23.

VAN 24.


SEA-FRONT 25.SPECULATOR/TRAFFICKER SECTION 8 FOR HEADS OF HOUSEHOLD ONLY 8.1 How many members were there in the household in which you grew up?

8.2 What is the highest grade completed by ....... father?
10 G1/Infants2 20 Form1 00 none 11 G2/Class1/Std1 21 Form2 01 Nursery 02 Pre-school 12 G3/Class2/Std2 22 Form3 03 GK/Infants1/Stg1 13 G4/Class3/Std3 23 Form4 04 Special Education 14 G5/Class4/Std4 24 Form5 32 CommCollege - A'Level 33 CommCollege - Tech 34 CommCollege - Nursing 35 CommCollege - Teachers 36 University-UWI 15 G6/Class5/Std5 25 Upper6 37 University-USA 16 Sen1/MPC/Class6 26 Lower6 38 University-Other 17 Sen2/MPC/Class6 30 Educational Institute - Diploma 18 Sen3/MPC/Class6 31 College - Associate Degree 39 Other 40 Don't know 8.3 What is the highest grade completed by ........ mother?
10 G1/Infants2 20 Form1 00 none 11 G2/Class1/Std1 21 Form2 01 Nursery 02 Pre-school 12 G3/Class2/Std2 22 Form3 03 GK/Infants1/Stg1 13 G4/Class3/Std3 23 Form4 04 Special Education 14 G5/Class4/Std4 24 Form5 32 CommCollege - A'Level 33 CommCollege - Tech 34 CommCollege - Nursing 35 CommCollege - Teachers 36 University-UWI 15 G6/Class5/Std5 25 Upper6 37 University-USA 16 Sen1/MPC/Class6 26 Lower6 38 University-Other 17 Sen2/MPC/Class6 30 Educational Institute - Diploma 18 Sen3/MPC/Class6 31 College - Associate Degree 39 Other 40 Don't know 8.4 Do(es) ...... perceive yourself/himself/herself as being better off than........ parents?
1 Yes 2 No 3 Somewhat 4 Same 5 Don't Know 8.5 How much did you spend (or recieve as gifts) on Food in the past week?

Purchased Food: Food Recieved as Gift $ , $ , 8.6 How much did you spend (or recieve as gifts) on Food in the past month?

Purchased Food: Food Recieved as Gifts: $ , $ , 1 0 0 0 0 0 0 7 Page 17 SAMPLE 5153 SECTION 9: MIGRATION 9.1 Have any persons left this household to live abroad in the past five years?

1 Yes (Continue) 2 No (Go to Section 10, if applicable) 9.2 How many persons?
List Individuals below: .
O N T N A R G I M 01 02 03 04 05 06 07 08 09 10 YEAR MOVED COUNTRY MOVED TO Antigua...............1 Guadeloupe........2 Martinique...........3 St Martin.............4 BVI.....................5 Other Caribbean.6 USA....................7 UK......................8 Other..................9 Don't know.........10 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 4 2007 5 2008 6 Don't Know 10 9 10 9 10 9 10 9 10 9 10 9 10 9 10 9 10 9 10 1 0 0 0 0 0 0 7 Page 18 of 20 SAMPLE SECTION 10 - FOR CHILDREN UNDER THE AGE OF FIVE YEARS Child No.
1 Child No.

2 Child No.

3 Child No.

4 Child 5 5153 1A.

Individual Number 1B.

Mother's Number 2.

Date of Birth (dd/mm/yy) Age (in months) 3.

Where was child delivered?

4. Who delivered the child?

5.

In the past two weeks, has ...... had running belly (diarrhea) i.e.

three or more loose stools per day?

6.

During this last episode of diarrhea, did ..... drink:(prompt and insert X for all items mentioned) 1.

Breast Milk 2.

Cereal-based gruel or gruel made from roots or soup 3.
Other locally-defined acceptable home fluids 4.

ORS (oral rehydration solution) packet solution 5.

Water with feeding during some part of the day 6.

Water alone 7.

Other milk or infant formula 8.

Defined "unacceptable" fluids 9.

Don't know 7.

During ……'s diarrhea, did he/she drink much less, about the same, or more than usual?

1.

Much less 2.

About the same (or somewhat less) 3.

More 4.

Don't know 8.

Has .... ever been breast fed?

1.

Yes 2.

No (If no, go to Q10) 9A.


For how many months after birth did you feed ...... on Breast milk ONLY?

9B.

Is he/she still being breast fed?

1.

Yes 2.

No 10.

Since this time yesterday, did he/she receive any of the following?

(Prompt and insert X code for all items mentioned.)?

1.

Vitamins, mineral supplements or medicine 2.

Plain water (Hot or cold).................................... 3.

Sweetened, flavoured water or fruit juice or tea or infusion 4.

Oral re-hydration solution (ORS) 5.


Tinned, powdered or fresh milk or infant formula 6.

Solid or semi-solid (mushy) food........................ 7.

Other................................................................ 8.

Received ONLY breastmilk............................... 9.

Don't know........................................................ 11.

Was …… immunized against 1.

Polio..................................................................... 2.
Diphtheria............................................................. 3.

BCG..................................................................... 4.

HIB...................................................................... 5.

Measles............................................................... 6.
Hepatitis-B........................................................... 7.. MMR1.................................................................. Hospital clinic/centre At home Other Doctor Nurse, midwife Other/self 1 2 3 4 1 2 3 Hospital clinic/centre At home Other Doctor Nurse, midwife Other/self 1 2 3 4 1 2 3 Hospital clinic/centre At home Other Doctor Nurse, midwife Other/self 1 2 3 4 1 2 3 Hospital clinic/centre At home Other Doctor Nurse, midwife Other/self 1 2 3 4 1 2 3 1 2 3 4 1 2 3 1 Yes 1 Yes 1 Yes 1 Yes 1 Yes 2 No (Go to Q8) 2 No (Go to Q8) 2 No (Go to Q8) 2 No (Go to Q8) 2 No Page 19 of 20 SAMPLE 5153 COMMENTS Spender(s)/Representative of Household 1 0 0 0 0 0 0 7 Page 20 of 20 SAMPLE