Literal question
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DAY __
MONTH __
YEAR ____
INTERVIEWER'S NAME __________
INT. CODE __
RESULT **
** RESULT CODES:
1 COMPLETED
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) ____________
TOTAL PERSONS IN HOUSEHOLD __
TOTAL WOMEN ELIGIBLE __
TOTAL ELIGIBLE MEN __
LINE NO. OF RESP. TO HOUSEHOLD QUEST.
SUPERVISOR
NAME ______
DATE _______
FIELD EDITOR
NAME _______
DATE ________
OFFICE EDITOR __
KEYED BY __