Literal question
INTERVIEWER VISITS
DATE_____________
INTERVIEWER'S NAME______________
RESULT* _______________
1COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)
FINAL VISIT
DAY_________
MONTH___________
YEAR _________
INTERVIEWER CODE___________
RESULT___________
NEXT VISIT_________________
DATE ____________
TIME___________