NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2001
HOUSEHOLD QUESTIONNAIRE
NAME AND CODE OF DISTRICT ______________
NAME AND CODE OF VILLAGE MUNICIPALITY __________________
WARD NUMBER _______
CLUSTER NUMBER _________
CITY/TOWN/COUNTRYSIDE
TOWN 2
COUNTRYSIDE 3
NAME OF HOUSEHOLD HEAD _______________
NAME OF RESPONDENT ______________
IS HOUSEHOLD SELECTED FOR MAN'S SURVEY
NO 2
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
MONTH __
YEAR ____
INTERVIEWER'S NAME __________
INT. CODE __
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ____________ 9
TOTAL PERSONS IN HOUSEHOLD __
TOTAL WOMEN ELIGIBLE __
TOTAL ELIGIBLE MEN __
LINE NO. OF RESP. TO HOUSEHOLD QUEST.
SUPERVISOR
DATE _______
FIELD EDITOR
DATE ________
OFFICE EDITOR __
KEYED BY __
Now we would like some information about the people who usually live in your household or who are staying with you now.
1. LINE NO.
2. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.
3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?*
01 HEAD
02 WIFE OF HUSBAND
03 SON OR DAUGHTER
04 SON-IN-LAW OR DAUGHTER-IN-LAW
05 GRANDCHILD
06 PARENT
07 PARENT-IN-LAW
08 BROTHER OR SISTER
09 BROTHER-IN-LAW
10 NEPHEW/NIECE
11 CO-WIFE
12 OTHER RELATIVE
13 ADOPTED/FOSTER/STEPCHILD
14 NOT RELATED
98 DON'T KNOW
4. SEX: Is (NAME) male or female?
F 2
5. RESIDENCE: Does (NAME) usually live here?
NO 2
6. Did (NAME) stay here last night?
NO 2
8. MARITAL STATUS: AGE 10 AND OVER: Has (NAME) ever been married?
NO 2
9. IF YES, Has (NAME) started living with his/her spouse?
NO 2
10. ELIGIBILITY: CIRCLE LINE NO. OF ALL WOMEN AGE 15-49 WITH YES IN COL.8 AND COL.9
11. CIRCLE LINE NO. OF MEN AGE 15-59 WITH YES IN COL.8 AND COL.9
12. CIRCLE LINE NUMBER OF ALL CHILDREN UNDER AGE 6
13. IF AGE 5 YEARS OR OLDER: Has (NAME) ever attended school?
NO 2 (NEXT LINE)
14. What is the highest grade of school (NAME) has completed?**
00 LESS THAN GRADE 1
01 GRADE 1
02 GRADE 2
03 GRADE 3
04 GRADE 4
05 GRADE 5
06 GRADE 6
07 GRADE 7
08 GRADE 8
09 GRADE 9
10 COMPLETED SLC
11 INTERMEDIATE 1ST YEAR/ 10+1
12 INTERMEDIATE COMPLETE/ 10+2
13 BACHELOR'S NOT COMPLETE
14 BACHELOR'S COMPLETE/HIGHER
95 NON-FORMAL EDUCATION
98 DON'T KNOW
15. IF AGE 5-24 YEARS: Is (NAME) currently attending school?
NO 2
16. During the current school year, did (NAME) attend school at any time?
NO 2 (GO TO 18)
17. During the current school year, what grade is/was (NAME) attending?**
00 LESS THAN GRADE 1
01 GRADE 1
02 GRADE 2
03 GRADE 3
04 GRADE 4
05 GRADE 5
06 GRADE 6
07 GRADE 7
08 GRADE 8
09 GRADE 9
10 COMPLETED SLC
11 INTERMEDIATE 1ST YEAR/ 10+1
12 INTERMEDIATE COMPLETE/ 10+2
13 BACHELOR'S NOT COMPLETE
14 BACHELOR'S COMPLETE/HIGHER
95 NON-FORMAL EDUCATION
98 DON'T KNOW
18. During the previous school year, did (NAME) attend school at any time?
NO 2 (NEXT LINE)
19. During that school year, what grade did (NAME) attend?**
00 LESS THAN GRADE 1
01 GRADE 1
02 GRADE 2
03 GRADE 3
04 GRADE 4
05 GRADE 5
06 GRADE 6
07 GRADE 7
08 GRADE 8
09 GRADE 9
10 COMPLETED SLC
11 INTERMEDIATE 1ST YEAR/ 10+1
12 INTERMEDIATE COMPLETE/ 10+2
13 BACHELOR'S NOT COMPLETE
14 BACHELOR'S COMPLETE/HIGHER
95 NON-FORMAL EDUCATION
98 DON'T KNOW
TICK HERE IF CONTINUATION SHEET USED __
Just to make sure that I have a complete listing:
1) Are there any other persons such as small children or infants that we have not listed.
NO
2) In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends who usually live here?
NO
3) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed?
NO
20. What is the main source of drinking water for members of your household?
PUBLIC/NEIGHBORS TAP 12
PUBLIC/NEIGHBORS WELL 22
PUBLIC/NEIGHBORS TUBEWELL 32
RIVER/STREAM/POND/LAKE 42
STONE TAP/DHARA 43
21. How long does it take you to go there, get water, and come back?
ON PREMISES 996
22. What kind of toilet facilities does your household have?
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT LATRINE 22
NO FACILITY/BUSH/FIELD 31 (GO TO 24)
OTHER (SPECIFY) 96
23. Do you share this facility with other households?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
25. What type of fuel does your household mainly use for cooking?
IF RESPONDENT MENTIONS FIREWOOD/CHARCOAL/DUNG, PROBE FOR THE TYPE OF CHULO (FIREPLACE).
IF RESPONDENT MENTIONS IMPROVED SMOKELESS CHULO, CIRCLE 02, IF NOT CIRCLE 01
IMPROVED SMOKELESS CHULO 02
BIOGAS 03
LPG GAS 04
ELECTRCITY 05
KEROSENE 06
OTHER (SPECIFY) _________ 96
26. What is the religion of the head of the household?
BUDDHIST 2
MUSLIM 3
CHRISTIAN 4
OTHER (SPECIFY) ____________ 6
27. What is the caste of the head of the household?
WRITE CASTE ON LINE PROVIDED, LEAVE BOX BLANK. CODE WILL BE FILLED BY FIELD EDITOR.
28. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.
WOOD PLANKS 21
LINOLEUM/CARPET 31
CERAMIC TILES, MARBLE CHIPS 32
CEMENT 33
OTHER (SPECIFY) _________ 96
CHECK COLUMNS (10) AND (12): RECORD LINE NUMBER, NAME AND AGE OF EVER-MARRIED WOMEN AGE 15-49 AND ALL CHILDREN UNDER AGE 6.
29. WOMEN 15-49: LINE NO. FROM COL. 10
WEIGHT AND HEIGHT MEASUREMENT OF WOMEN 15-49:
33. WEIGHT (KILOGRAMS)
NO/DK 2
2 NOT PRESENT
3 REFUSED
6 OTHER
___
29. CHILDREN UNDER AGE 6: LINE NO. FROM COL. 12
32. What is (NAME)'s date of birth?
MONTH __
YEAR ____
WEIGHT AND HEIGHT OF CHILDREN BORN SINCE BAISAKH 1, 2052:
33. WEIGHT (KILOGRAMS)
35. MEASURED LYING DOWN OR STANDING UP
STANDING 2
36. RESULT
2 NOT PRESENT
3 REFUSED
6 OTHER
___
TICK HERE IF CONTINUATION SHEET USED __