Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697705656309.pdf (Dominica)
COMMONWEALTH OF DOMINICA 2011 POPULATION AND HOUSING CENSUS CENSUS DAY ‐ MAY 14, 2011 1) Use only 2B pencils 2) For optimum accuracy, please print carefully and avoid contact with the edges of the box.

See example at right: 7 8 5 3) IMPORTANT!!!

Place an X in the box for multiple choice options.

4) Erase cleanly and make no stray marks on this form.
PARISH AREA NUMBER ED NUMBER HOUSEHOLD NUMBER SD Coastal HDist EDist FOR OFFICE USE ONLY Address of Household Community Town/Village District/Parish INTERVIEWER SAY: I am the Census Interviewer assigned to this area and I would like to get some information about the household and its members.

Here is my identification card.
(Show card) INTERVIEWER RECORD OF VISITS Visit Number Date (DD/MM/YY) Time Started Time Ended Duration (in minutes) *Results 1 2 3 4 / / / / / / / / : : : : : : : : *Result Codes: 1 = Completed 2 = Partiallly completed, call back 3 = Dwelling closed 4 = Address vacant 5 = No contact 6 = Refusal 7 = No suitable respondent at home 8 = Other (please specify) Page 1 of 7 Page 1 of 7 45486 SAMPLE NAME DATE CODE AREA SUPERVISOR FIELD SUPERVISOR INTERVIEWER EDITOR CODER / / / / / / / / / / INTERVIEWER SAY: Please give me the names of all the persons who usually live in and share at least one daily meal with your household.
LISTING OF HOUSEHOLD MEMBERS SURNAME FIRST NAME SEX M F SURNAME FIRST NAME SEX M F 01 02 03 04 05 06 07 08 09 COMMENTS Page 2 of 7 45486 SAMPLE 1.

(a) Did any member of this household move to live abroad and is still living abroad during the last ten years?

( 2001‐2011) 2.

How many persons moved?

SECTION 1 ‐ MIGRATION 1 Yes (If YES, CONTINUE) 2 No (GO TO SECTION 2) .

4.

Year Moved o N (2001 ‐ 2011) s ' l (Write year in boxes) a u d i v i d n I .

3 01 02 03 04 05 6.
3 01 02 03 04 05 6.

Sex 7.

Age when moved 8.

Occupation when moved 9.

Name of country of migration 1 Male 2 Female Write details on dotted lines below 5.
Educational Level when moved 1 None 2 Primary 3 Secondary 4 Tertiary (non‐ university/ College) 5 University 6 Other 7 Don’t know 8 Not Stated (Name of country) 9 Don't know (Name of country) 9 Don't know (Name of country) 9 Don't know (Name of country) 9 Don't know (Name of country) 9 Don't know 45486 Page 3 of 7 SAMPLE SECTION 2 ‐ HOUSING INTERVIEWER: Ask this question only if the answer is not obvious.
Else, place 'x' in the appropriate box.

10.

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 Studio 9 Other 16.

How much mortgage are you now paying monthly?

(PRESENT FLASH CARD) 1 Not paying 2 Don't know 11.

(a) Is this dwelling insured?

17.

What about the land – is it freehold, leasehold, or some other type of occupancy?
1 Yes 2 No 3 Don't know 9 Not stated 1 Owned/Freehold 5 Sharecropping (b) Are the contents of this dwelling insured?

1 Yes 2 No 3 Don't know 9 Not stated 12.

Does this household own, rent or lease this dwelling?

1 Owned 2 Squatted 3 Rented‐Private 4 Rented‐Govt 5 Leased 6 Rent‐free 7 Other 8 Don't know/Not stated (GO TO Q.16) (GO TO Q.17) (GO TO Q.13) (GO TO Q.13) (GO TO Q.13) (GO TO Q.17) (GO TO Q.17) (GO TO Q.17) 13.

What is the rental/lease period for this dwelling?


1 Weekly 2 Fortnightly 3 Monthly 4 Quarterly 5 Half‐yearly 6 Annually 7 Other 8 Don’t know 9 Not Stated Is this dwelling rented as fully furnished, semi‐furnished or 14. unfurnished?

1 Fully furnished 2 Semi‐furnished 3 Unfurnished 9 Not stated 15.

How much rent are you now paying ?

(GO TO Q.18) (PRESENT FLASH CARD) 1 Don't know 9 Not stated 2 Leasehold 3 Rented 6 Squatted 7 Other 4 Permission to work land 9 Don’t know/Not stated 18.
What is the MAIN construction material of the outer walls?

(SINGLE RESPONSE) 1 Wood 5 Brick 2 Concrete/Concrete Blocks 6 Adobe 3 Wood & Concrete 7 Makeshift (specify) 4 Stone 9 Don’t know/Not stated 19.

What is the material used for roofing?

(SINGLE RESPONSE) 1 Sheet metal* 6 Concrete 2 Shingle (asphalt) 7 Makeshift/thatched 3 Shingle (wood) 8 Other (specify) 4 Shingle (other) 9 Don't know 5 Tile *zinc, aluminum, galvanize 20.

(a) In which year was this dwelling built?


1 Before 1980 2 1980‐1989 3 1990‐1999 4 2000‐2005 5 2006 6 2007 7 2008 8 2009 9 2010 10 2011 11 Don't know (b) Were any repairs made to this dwelling?

1 Yes 2 No 3 Don't know 9 Not stated (c ) If yes, were repairs to this dwelling: 1 Private 2 Government‐Assisted 4 Other (specify) 3 Part private/ Part government 5 Don't know Page 4 of 7 45486 SAMPLE SECTION 2 (cont'd) ‐ HOUSING 21.

What is the MAIN source of your water supply?


(SINGLE RESPONSE) 1 Private, piped into dwelling 2 Private catchment, not piped 3 Private catchment piped 4 Public, piped into dwelling 5 Public, piped into yard 6 Public standpipe 7 Public well or tank 8 Other (specify) 28.

Is your kitchen indoors or outdoors?

1 Indoors 2 Outdoors (private) (GO TO Q.30) 3 None 4 Other (specify) 29.

Is the kitchen shared with a/other person(s) not of this household?

1 Yes, shared 2 Not shared 22.


What is the MOST used type of toilet facilities in this household?

(SINGLE RESPONSE) 1 W.C. (flush toilet) linked to sewer 30.

How many rooms does your household occupy?

(DO NOT COUNT BATHROOMS, PORCHES, KITCHENS etc?)

2 W.C. (flush toilet) linked to cesspit or septic tank/soak‐away 3 Pit‐latrine rooms 4 Other (specify) 5 None (GO TO Q.24) 31.

How many bedrooms are there in this dwelling unit?


(Bedrooms are rooms used mainly for sleeping and exclude makeshift and temporary sleeping quarters – COUNT ALL BEDROOMS INCLUDING 23.

Are these toilet facilities shared with a/other person(s) not of this household?

SPARES NOT OCCUPIED.)

1 Yes, shared 2 Not shared bedrooms 24.

Are your bathing facilities indoors or outdoors?

1 Indoors 2 Outdoors (private) (GO TO Q.26) 3 None 4 Other (specify) 25.
Are these bathing facilities shared with a/other person(s) not of this household?

1 Yes, shared 2 Not shared 32.

(a) What is your MAIN method of garbage disposal?

(SINGLE RESPONSE) 1 Dumping land 2 Compost 3 Burning 4 Dumping river/sea/pond/valley 5 Burying 6 Garbage truck 7 Skip 9 Other (specify) 26.

What type of lighting does this household use MOST?

(SINGLE RESPONSE) (b) What THREE main environmental concerns have affected your household in the past five years?
1 Gas 2 Kerosene 3 Electricity–Public 4 Electricity–Private Generator 5 Solar 6 Other (specify) 7 None 27.

What type of fuel does this household use MOST for cooking?
(SINGLE RESPONSE) 1 Charcoal 2 Wood 3 Liquid Propane Gas/Cooking Gas 4 Kerosene 5 Electricity 6 Other (specify) 1 Waste disposal 2 Water contamination 3 Air pollution (specify) 4 Drainage 5 Landslide 6 Use of pesticides 7 Deforestation 8 Soil erosion 9 Squatting 10 Flooding 11 Rodents 12 Insects 13 Cell phone tower 14 Noise (specify) 15 No major concern Page 5 of 7 45486 SAMPLE SECTION 2 (cont'd) ‐ HOUSING 33.

Which of these appliances/household equipment does your household have?
(READ CATEGORIES) 1 = Yes 2 = No 9= No response to question 1.

Water heater 2.

TV 3.

Cable TV/Satellite 4.

VCR/DVD 5.

Radio/Stereo 6.

Refrigerator 7.

Freezer 8.

Microwave oven 9.

Dishwasher 10.

Stove 11.

Cellular telephone 12.

Fixed telephone 13.

Washing machine 14.

Laundry dryer 15.

Water pump 16.

Computer 34.

(a) Does this household have access to internet?


1 Yes 2 No 3 Don't know 9 Not stated (b) Does this household have an Internet connection?

1 Yes 2 No 3 Don't know 9 Not stated (c) What type of internet connection does this household use?

1 Dial‐up 4 Broad–band link 2 Digital Subscriber Line (DSL) 5 Don’t know 3 Wireless 9 Not stated 35.

How many motor vehicles (motor cars, station wagons, jeeps, and vans) are kept at home for private use by this household?
1 None 2 One 3 Two 4 Three 5 Four or more 9 Not stated SECTION 3 ‐ CRIME 36.

(a) Has any member of your household been a victim of crime (whether against person or property) in the last six years (2006‐2011)?

1 Yes (GO TO b) 9 Not stated (GO TO SECTION 4) 2 No (GO TO SECTION 4) (b) Tick appropriate box(es) 1 2006 3 2008 2 2007 4 2009 5 2010 6 2011 ASK THE FOLLOWING QUESTION (Q.

37 – Q.

39) ONLY OF HOUSEHOLDS REPORTING CRIME .

37.


1 Crime against person (1a) Please state number Male Female Both (1b) What was/were the crime(s)?

2 Crime against property (2a) What was/were the crime(s)?

3 Other (specify) (a) (b) (c) (a) (b) (c) (a) (b) (c) Page 6 of 7 45486 SAMPLE SECTION 3 (cont'd) ‐ CRIME 38.

Was the crime reported to the police?

39.

Why was the crime not reported to the police?

(MULTIPLE 1.
(MULTIPLE 1.

Crime against person 1 Yes (GO TO SECTION 4) 3 NA (GO TO SECTION 4) 2 No 9 Not stated (GO TO SECTION 4) 2.

Crime against property 1 Yes (GO TO SECTION 4) 3 NA (GO TO SECTION 4) RESPONSE) 1.

Crime against person 2.

Crime against property 3.

Other 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 9 9 9 2 No 3.
Other 9 Not stated (GO TO SECTION 4) 1 Yes (GO TO SECTION 4) 3 NA (GO TO SECTION 4) 2 No 9 Not stated (GO TO SECTION 4) Note: 1 = No confidence in the administration of justice 2 = Afraid of perpetrator 3 = Perpetrator household member/relative 4 = Not serious enough 5 = Other 6 = Not applicable 9 = Not stated End of Household Questionnaire.

Go to Person Questionnaire.

Page 7 of 7 45486 SAMPLE IMPORTANT!!!


Transfer Parish, ED and Household Numbers to the top of EACH Individual Questionnaire from Household Questionnaire PARISH NUMBER ED NUMBER HOUSEHOLD NUMBER INTERVIEWER: Whenever a dotted line (…) appears in a question, call the name of the person to whom the information relates, if it is not the respondent himself/herself.

Else say “You”/”Your.” Complete the appropriate box.

Please do not write over the responses.


SECTION 4 ‐ CHARACTERISTICS (FOR ALL PERSONS) SECTION 5 ‐ DISABILITY (FOR ALL PERSONS) 40.

Please fill in this person’s assigned number.

(from page 2) LONG STANDING DISABILITY 41.

What is…..’s relationship to the head of household?

1 Head 2 Spouse 3 Partner 4 Child 5 Son/daughter‐in‐law 6 Grandchild 7 Parent/parent‐in‐law 8 Other relative 9 Non‐relative 10 Other (specify) INTERVIEWER: Complete the appropriate box.

FOR PERSONS NOT 42.
FOR PERSONS NOT 42.

SEEN ASK: Is…..male or female?

1 Male 2 Female 43.

What is ………’s date of birth?

/ / DD MM YYYY If not known, ask: How old was …………on his/her last birthday?

46.

Does…… live with any long‐standing disability or infirmity?

1 Yes 2 No (GO TO Q.53) 47.

What is the origin of the disability?

1 Illness 2 From birth 3 Accident 4 Other (specify) 48.

At what age was disability acquired?

years TYPE OF DISABILITY 49.

What type of disability or impairment does…have?


(MULTIPLE RESPONSE) 1 Sight ( even with glasses if worn) 2 Hearing (even with hearing aid if used) years 3 Speech (speaking, communicating) 4 Mobility (walking, standing, climbing stairs) 44.

To what ethnic, racial or national group do you think………belongs?
5 Body movements (reaching, crouching, kneeling) 1 African/Negro/Black 2 Amerindian/Carib/Kalinago 3 East Indian 4 Chinese 5 Portuguese 6 Syrian/Lebanese 7 Caucasian/White 8 Mixed 9 Other (specify) 10 Don't know/Not stated 6 Gripping 7 Learning 8 Behavioral 9 Other (specify) 10 Not stated 50.

Was…….. disability/major impairment ever diagnosed by a medical doctor?

1 Yes 2 No 9 Not stated 45.

What is……..’s religion/denomination?


1 Anglican 2 Baptist 3 Bahai 4 Brethren 5 Christian Union Mission/Church 6 Church of God 7 Gospel Mission 8 Hindu 9 Jehovah Witness 10 Methodist 11 Muslim 12 Other Evangelical 13 Pentecostal 14 Presbyterian 15 Rastafarian 16 Roman Catholic 17 Seventh Day Adventist 18 Other (specify) 19 None 20 Not stated Page 1 of 8 Page 1 of 8 3560 SAMPLE SECTION 5 (cont'd) ‐ DISABILITY (FOR ALL PERSONS) 51.
Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities: Yes No a.

Learning, remembering, or concentrating?

b. Dressing, bathing, or getting around inside the home?

c. Going outside the home alone to shop or visit a doctor’s office d. (Answer if person is 15 YEARS OLD OR OVER.)

Working at a job or business?

e. Using customary language?

f. Other self‐care?

52.


Are you required to use any of the following aids?

(MULTIPLE 55.

What MAIN medical facility has……utilised in the PAST MONTH?

1 Public Hospital 2 Family Planning Clinic 3 Public Health Centre/ Medical Visiting Stations 4 Private Clinic/Hospital 5 Private Doctor’s Office 6 Pharmacy 7 Other (specify) 9 Not stated Is …..covered by an Insurance (health, life etc.)

and/or Employee 56.

Medical Plan?

1 Yes 2 No (GO TO Q.58) 9 Not stated (GO TO Q.58) 57.
What type of Insurance does……………have?

(MULTIPLE RESPONSE) 1 NIS 2 Group Health Ins 3 Individual Health 4 Life with Health 5 Endowment with Health 6 Life 7 Other (specify) 7 Cane 8 Prosthesis/artificial body part SECTION 7 ‐ BIRTHPLACE AND RESIDENCE (FOR ALL PERSONS) RESPONSE) 1 Hearing Aid 2 Wheelchair 3 Walker 4 Crutches 5 Braille 6 Adapted car 9 Orthopedic Shoes 10 Other (specify) 11 None SECTION 6 ‐ HEALTH (FOR ALL PERSONS) CHRONIC ILLNESS 53.

Does….suffer from any of the following illness?


(MULTIPLE RESPONSE) 1 Sickle Cell Anaemia 2 Arthritis 3 Asthma 4 Diabetes 5 Hypertension 6 Heart disease 7 Stroke 10 HIV 11 AIDS 12 Lupus 13 Carpal Tunnel Syndrome 14 Mental Illness 15 Other (specify) 58.

Where was ………….. born?

1 In this country 2 Abroad (GO TO Q.61) 3 Not stated 9 Don't know (GO TO Q.60) (GO TO Q.60) 59.

In what part of the country is that?

Community District/Parish 60.

Have you/has……ever lived in another country?


1 Yes (GO TO Q.62) 3 Don't know (GO TO Q.65) 2 No (GO TO Q.65) 8 Kidney Disease 16 None 9 Cancer 17 Not stated/Don't know 61.

In what country was that?

9 Don't know UTILIZATION OF MEDICAL FACILITY 54.

Has ….utilised a medical facility in the PAST MONTH?

1 Yes 2 No (GO TO Q.56) 9 Not stated (GO TO Q.56) 62.

In what country did…..last live?


9 Don't know Page 2 of 8 3560 SAMPLE SECTION 7 (cont'd) ‐ BIRTHPLACE AND RESIDENCE (FOR ALL PERSONS) SECTION 8 ‐ EDUCATION (FOR ALL PERSONS) 63.

In what year did…..last come to live in this country?

9 Don't know 64.

Why did you return/come to….

(insert name of country below)?

Is……attending any school or educational institution now, whether 69. full‐time or part‐time?

1 Yes, full time 2 Yes, part‐time 3 No 4 Don't know (GO TO Q.73) (GO TO Q.73) 70.
What type of school or institution are you/is he/is she attending?

1 Regard it as home 5 Homesick 2 Family reasons 6 To start a business 3 Deported 4 Retired 7 Other (specify) 65.

In what town, village or district did……………...he/she last live in this country?

1 Never moved (GO TO Q.69) 9 Don't know Community District/Parish 1 Daycare/Nursery 2 Pre‐school 3 Infant/Kindergarten 4 Special education 5 Primary 6 Senior Primary/Junior Secondary/Post Primary 7 Secondary 8 Post‐ Secondary(e.g.
BTC) 9 State College(Sixth Form, Advanced(A)level,CDCC) 10 Technical/Vocational School 11 University 12 Adult Education 13 Other (specify) 14 Don't know 99 Not stated In what year did….you come last to live in this town, village or 66. district?

71.

Please give the name and address of the school or institution.

9 Don't know 67.

Where does……usually live?

Name Address 1 At this address (GO TO Q.69) 3 Abroad (GO TO Q.69) 2 Elsewhere in the country 4 Don't know (GO TO Q.69) 68.
In what part of the country is that?

9 Don't know Community District/Parish 72.

What is your/his/her MAIN mode of travel to the school or institution?

(SINGLE RESPONSE) 1 Walk 2 Bicycle 5 Public transport ( minibus) 6 Hired transport (taxi) 3 Private car or vehicle 9 Don’t know/Not Stated 4 Government School Bus Page 3 of 8 3560 SAMPLE SECTION 8 (cont'd) ‐ EDUCATION (FOR ALL PERSONS) SECTION 9 ‐ PROFESSIONAL, TECHNICAL & VOCATIONAL TRAINING (FOR PERSONS 15 YEARS AND OVER) 75.
INTERVIEWER: Mark the appropriate square (SEE Q.

43) 1 Under 15 (GO TO Q.112) 2 15 years and over 76.

(a) Were you ever trained/are you being trained for any occupation or profession?

(Training can be formal or non‐formal) 1 Yes 2 No (GO TO Q.79) 9 Not stated (GO TO Q.79) (b) For which occupation(s)/profession(s) (state the most recent one first)?

(i) (ii) (iii) (c) Is your/his/her present job related to your/his/her most recent training?
1 Yes 2 No 9 Not applicable (d) In what year or period did you/he/she complete that training or still being trained?

1 2011 2 2010 3 2009 4 2008 999 Not applicable 5 2004‐2007 6 2000‐2003 7 1990‐1999 8 Before 1990 9 Did not complete training 10 Still being trained 99 Not stated (e) In which field was ...............’s highest level of training?

73.

What is the HIGHEST level of formal education that…..has reached?
1 Daycare/Nursery 2 Pre‐school 3 Infant 4 Primary Grade/Standard (1 – 3) 5 Primary Grade/Standard (4 – 6) 6 Secondary 7 State College(Sixth Form, Advanced(A) level, CDCC) 8 Community College/State College Technical 9 Community College/State College Non‐technical 10 Community College/State College‐ Teachers 11 Community College/State College‐ Nursing 12 University ‐ UWI 13 University – USA 14 University – CUBA 15 University ‐ Other 16 Educational Institute (specify) 17 Other (specify) 18 None 19 Don't know 99 Not stated 74.
What is the HIGHEST certificate, diploma or degree that you/he/she have earned?

1 School leaving Certificate(e.g.
Standard /Grade Six or Seven School leaving exam) 2 JSP (Junior Secondary Program) 3 GCE ‘O’ Levels or CXC Number of subjects 0 99 Not stated 8 9 or more 4 High School Diploma/Certificate 5 GCE ‘A’ Levels Number of subjects 0 1 2 3 4 or more 9 Not stated 6 Under‐graduate Diploma 7 Other Diploma/Certificate 8 Associate Degree 9 Professional Certificate 10 Bachelors Degree 11 Post Graduate Diploma (Bachelors & half content required for a Masters) 12 Higher Degree (Masters or Doctoral Degree) 13 Other (specify) 14 None 15 Don't know 99 Not stated Page 4 of 8 3560 SAMPLE SECTION 9 (cont'd) ‐ PROFESSIONAL, TECHNICAL & VOCATIONAL TRAINING (FOR PERSONS 15 YEARS AND OVER) In………..’s field of highest level of training, what was the MAIN 77. educational method/type of training used?
1 On the job 2 Apprenticeship 3 Private study/Correspondence 4 Secondary School 5 Vocational/Trade 6 Commercial/Secretarial 7 Business School 8 Computer School 9 Technical Institution (e.g.

State College) 10 Other Institutional Training 11 University (on campus) 12 University(off campus) 13 Distance Learning 14 Other (specify) 99 Not stated SECTION 10 ‐ MARITAL STATUS, UNION STATUS (FOR PERSONS 15 YEARS AND OVER) 79.

What is your/…….’s present union status?


1 Married and living with spouse (GO TO Q.81) 2 Married and not living with spouse (GO TO Q.81) 3 Common‐law union 4 Visiting partner 5 Separated but not in a union (GO TO Q.81) 6 Legally separated and not in a union (GO TO Q.81) 7 Widowed and not in union 8 Divorced and not in union (GO TO Q.81) (GO TO Q.81) 9 Not in a union 10 Other (specify) 99 Don't know/Not stated 80.

What is ……….present marital status?


1 Never married 3 Separated 2 Married 4 Legally separated 5 Divorced 6 Widowed 78.

(a) What is /was the duration of training programme for the highest level of training which ................... completed/ attempted or is undergoing?

81.

Have you/has…..ever lived together with a partner in a common law relationship?

1 Yes 2 No (GO TO Q.83) 9 Not stated 1 Under 3 months 2 3 months.
& less than 6 months 3 6 months & less than 1 year 4 1year & less than 1.5 years 5 1.5 years & less than 2 years 6 2 years & less than 3 years 7 3 years & less than 4 years 8 4 years and over 9 Not stated (b) What type of qualification/certification did ............... receive on completion of the training at the HIGHEST level?

1 Certificate of completion 2 Diploma 3 Professional Certificate 4 Bachelor’s Degree 82.

(a) How old were you/he/she at first common‐law union?
9 Don't know years old (b) How old were you/he/she when you/he/she were/was first married?

9 Don't know years old SECTION 11 ‐ FERTILITY (FOR PERSONS 15 YEARS AND OVER) 83.

How many live births/children has…..ever had/fathered?

(If ZERO, ENTER 00 & GO TO Q.

90) 84 (a) How old were you/he/she when you/he/she had/fathered the first live born child?
5 Post Graduate (Bachelor’s and half content required for a Master’s) 6 Higher Degree (Masters or Doctoral Degree) years old 7 Not formally certified 8 Other Specify 9 Dont know 99 Not Stated (b) How many of your/he/she/ live born children are still alive?

Page 5 of 8 3560 SAMPLE SECTION 11 (cont'd) ‐ FERTILITY (FOR PERSONS 15 YEARS AND OVER) 92.

Have you/he/she ever worked or had a job?

1 Yes (GO TO Q.94) 2 No (GO TO Q.94) 85.

How old were you/she/he at the birth of your/ her/his last live born child?
years old 93.

How many months did you/he/she work in the past 12 months?

months Q.

86 to Q.

89 APPLY TO FEMALES UNDER AGE 50.

OTHERS GO TO Q.90 86.

How many living babies/live births did you/she/ have in the last 12 months?

94.

What did….do most during the past week – for example, did you/ he/she work, look for a job, keep house or carry on some other activity?

1 None (GO TO Q.90) 2 One 3 Two separate births 5 Three or more 4 Twins 87.

What is/are the sex(es) of this child/these children?
(BORN WITHIN THE LAST 12 MONTHS) No.

of boys No.

of girls 0 0 1 1 2 2 3 3 4 4 5 5 88.

Have any of these babies died?

1 Yes 2 No (GO TO Q.90) 89.

How many died?

(a) Within the first month of life (b) After 1 month but before one year SECTION 12 ‐ ECONOMIC ACTIVITY (FOR PERSONS 15 YEARS & OVER) 90.

What did….. do most during the past 12 months‐ for example, did you/he/she work, look for a job, keep house or carry on some other activity?
1 Worked (GO TO Q.93) 2 Had a job but did not work (GO TO Q.93) 3 Looked for work 4 Wanted work and available 5 Home Duties 6 Attended School 7 Retired 8 Disabled, unable to work 9 Other (specify) 99 Not stated (GO TO Q.98) (GO TO Q.98) 1 Worked 2 Had a job but did not work 3 Looked for work 4 Wanted work and available 5 Home duties 6 Attended school 7 Retired 8 Disabled, unable to work 9 Other (specify) 99 Not stated 95.

Did you take any steps during the past two months to look for work?
1 No/Did Nothing 2 Direct Application (sent out letters) 3 Checking at work sites, factory gates etc.

4 Seeking assistance from friends (GO TO Q.97) (GO TO Q.97) (GO TO Q.97) 5 Register at public/private employment exchange (GO TO Q.97) 6 Other 9 Not stated (GO TO Q.97) (GO TO Q.97) 96.

Why did…… not seek work during the past two months?
1 Own choice, illness, disability, injury, pregnancy 2 Personal, family responsibilities 3 In school, training 4 Retirement/old age 5 Already found work to start later 6 Already made arrangements for self‐employment 7 Awaiting recall to former job 8 Awaiting replies from employers 9 Awaiting busy season 10 Believe no suitable work available 11 Could not find suitable work 12 Not yet started to seek work 13 Do not know how or where to seek work 91.

Did you/he/she do any work at all in the past 12 months?
Include work at home, for example, piece work, decorative stitching, smocking, etc.

1 Yes (GO TO Q.93) 2 No 14 Discouraged 15 Other (specify) 99 Not stated Page 6 of 8 3560 SAMPLE SECTION 12 (cont'd) ‐ ECONOMIC ACTIVITY (FOR PERSONS 15 YEARS & OVER) 104.

Did you/he/she carry on your/his /her business, work for a wage or salary or as an unpaid worker in a family business?

97.
97.

Did you/he/she do any other kind of work at all last week for any length of time, including helping in a family business/farm, street vending or work at home?

1 Yes 2 No (GO TO Q.109) 98.

How many hours did you/he/she work last week?

9 Don't know hours 99.

What sort of work did you/he/she, do in your/his/her main occupation?

(Please specify in detail.)


1 Paid employee – Government (GO TO Q.107) 2 Paid employee – Private (GO TO Q.107) 3 Paid employee – Statutory Body (GO TO Q.107) 4 Paid employee‐ Non‐Gov’t Org.

(GO TO Q.107) 5 Paid Employee‐ Regional Org.

(GO TO Q.107) 6 Paid Employee‐ International Org.


(GO TO Q.107) 7 Unpaid worker/employee (GO TO Q.109) 8 Unpaid family worker (GO TO Q.109) 9 Own business with paid help 10 Own business without paid help (GO TO Q.106) 11 Apprentice 99 Don't know/Not stated (GO TO Q.107) (GO TO Q.107) 9 Never worked (GO TO Q.109) 105.

How many people work for you/him/her?

100.What type of business is/was carried on at your/he/her workplace?

(Please specify in detail.)


101.What is the name and address of your/his/her present workplace?

106.

Do you/does he/she move all your/his/her goods every night; e.g.

fruits, nuts, lottery tickets, clothing/shoes, etc.?

1 Yes (Informal trader) 2 No 107.

What was …..’s last pay/income period?

1 Weekly 5 Annually 2 Fortnightly 6 Other (specify) 3 Monthly 4 Quarterly 7 None 9 Not stated 9 No present work (GO TO Q.109) 108.
What was…..’s gross pay/income during the last pay period, that is before income tax or other deductions?

(PRESENT FLASH CARD) INTERVIEWER: For self‐employed persons obtain “NET INCOME,” i.e., receipts less business expenses.

9 Don't know Income Group 102.

How do you/does he/she travel to work?


(SINGLE RESPONSE) 1 Work at home (GO TO Q.104) 6 Public transport ( minibus) 2 Walk 3 Bicycle 7 Hired transport (taxi) 8 Other 4 Private car or vehicle 9 Don't know/Not stated 5 Company/government transportation 103.

How many minutes do you/he/she take to get to work?

Minutes Page 7 of 8 3560 SAMPLE SECTION 12 (cont'd) ‐ ECONOMIC ACTIVITY (FOR PERSONS 15 YEARS & OVER) 109.

What are your/his/her sources of livelihood?


(MULTIPLE RESPONSE) IMPORTANT INTERVIEWER: If interview conducted BEFORE CENSUS DAY, ask on return visit immediately after census day.

If interview conducted AFTER CENSUS DAY, ask as part of the full interview.

SECTION 13 ‐ WHERE SPENT CENSUS NIGHT ‐ (FOR ALL PERSONS) 112.

Where did……spend census night?

1 At this address (END INTERVIEW) 2 Elsewhere in the country 3 Abroad (END INTERVIEW) 113.

What part of the country was that?

If known, please specify.
INTERVIEWER: Write as full an address as possible 1 Pension (local) 2 Pension (overseas) 3 Investment 4 Remittance (overseas) 5 Savings/Interest on savings 6 Employment 7 Disability benefits 8 Unemployment benefits 9 Social Security Payments 10 Other Public Assistance 11 Local contributions from friends/relatives 12 Overseas contributions from friends/relatives 13 Spouse 14 Partner 15 Children 16 Parents 17 Guardians 18 Non‐monetary contribution from family and friends 19 Other Private Assistance 20 Other 99 Not stated 110.
Approximately how much money did you/he/she receive last year (2010) from family and/or friends abroad?

(PRESENT FLASH CARD) 1.

Income Group (if received) 2 None 9 Don't know 111.

On average, how many hours did……spend per week on housework?

(cleaning the house, laundry, care of children, care of elderly, etc.)

1.

No.

Hours 2 None 9 Don't know Page 8 of 8 3560 SAMPLE