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FAMILY QUESTIONNAIRE / RETROSPECTIVE MORTALITY SURVEY
Team n° ....... Camp .................................. Date ......../......../...........………....
Family Composition *Familyn°Arrival date<month/year>

Total NumberChildren < 59months

Number of deaths sinceChristmas
Total

Children < 59months

Births sinceChristmas

Anthropometric Data collection sheet
Team n° .........

Familyno°

6 months – 59 months (< 5 years)
Camp: .................................. Date: ....../.......

Child No1 - 450
123
4
56789

Date ofBirthdd/mm/yyAgeyears/months

Sex
F/ M

Weightkg/g

Heightcm/mm

Oedema
Y/N

MUAC
mm

TFP
Y/NSFP
Y/N