Literal question
INTERVIEWER VISITS
FIRST VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE____
TIME____
SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____________
NEXT VISIT:
DATE____
TIME____
THIRD VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____________
FINAL VISIT:
DAY____
MONTH____
YEAR 2011
INT. NUMBER____
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____________
TOTAL NUMBER OF VISITS____