Literal question
Interviewer visits
1 2 3
Date
Interviewer'??s name
Result*
Final visit
Day
Month
Year 201
Int. number
Result
Next visit
Date
Time
Total no. of visits
*Result codes:
1 Completed
2 Not at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other (specify)
Language of questionnaire 01
Language of interview:
Native language of respondent
Translator used (Yes=1, No=2)
Language of questionnaire: French
Language Codes:
01 French
96 Other (specify)
Old Kirundi (from Paper)
Supervisor
Name
Number