Age in years (during census taking)* The value must be in range 0 to 120

Sex*

Male Female

First name* Surname*

Head of the household*

Yes No

Marital status*

Never married Currently married or living as married Divorced or separated Widowed

Main Occupation

Unemployed Occasional/seasonal employment Employed by government Employed in private sector Self-employed Pupil / student Housewife / homemaker Working on own land Other (Specify)

Occupation, other*

Highest level of education completed*

None Primary school – fill actual grade Secondary school grade – fill actual grade Higher education fill details

Grade*

Grade must be between 1 and 12.

Education is higher, details*

Masters Diploma College University Trades Other

If other, please specify*

Is the participant a usual household member (living at least 9 month out of the year in the HH)*

Yes No

Lenth/duration residence*

<=1 yrs 1-5 yrs 5-10 yrs >10 yrs

Present at visit*

Yes No

When will the person return*

Today Not today, but late this week Not this week, later this month More than a month Unknown

Eligible partiIcpant*

Yes No

Participant physically able to attend the field site*

Yes No, need transport No, interview at home No, out of the area

Eligible partiIcpant and invited*

Yes No

Participant Number* PIN*

Consent provided by participant (assent given if 15-17 years)*

Yes No, not at home during enumeration No, refused participation

Consent provided by parent*

Yes No

Reason for no assent and other remarks*

When you are done entering the member's details, click the button below.