Literal question
INTERVIEWER VISITS
DATE
DAY __
MONTH __
YEAR ____
INTERVIEWER'S NAME ______
INT. CODE __
RESULT *
*RESULT CODES
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _________________
LANGUAGE
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE OF INTERVIEW *** _______________
HOME LANGUAGE OF RESPONDENT *** ____________
*** LANGUAGE CODES
1 NEPALI
2 BHOJURI
3 MAITHILI
4 THARU
5 OTHER
WAS A TRANSLATOR USED?
YES 1
NO 2
SUPERVISOR
NAME ________
DATE _________
FIELD EDITOR
NAME __________
DATE ___________
OFFICE EDITOR __
KEYED BY __