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Baseline Survey | IRC/Lofa County CDD Program

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Baseline Survey | IRC/Lofa County CDD Program Survey ID _________________________ Baseline Survey | IRC/Lofa County CDD Program Section I Survey Identifier Information Q 1. Household ID: Lofa Voinjama | Zorzor [circle one] PA#: COUNTY DISTRICT TOWN NAME HH # Q 2. Date/Time of Interview: A. (DD/MM/YY) |__|__|/|__|__|/|__|__| B. (24 hr clock) |__|__| : |__|__| Q 3. Enumerator Name and ID: Q 4. Enumerator ID First Name Last Name First Respondent Information Q 5. Name of First respondent (normally head of household) First Name Last Name Q 6. Is first respondent the Head of Household? Q 7. Relation with head of Househod: No Yes If not: (Code P) 0 1 Q 8. Was this person the head of his/her own household in 1989? No Yes 0 1 Can you tell us the name of one friend or family member who will know where you are or how to contact you? Q 9. Name of contact person Q 10 First Name Last Name Relationship [Use Code P] Q 11. Contact Information County Code Q _____ _____ District Code Q ____ ____ ____ ____ Town Name ______________________________ Second Respondent Information (Enter once you begin 2nd interview) Q 12. Name of 2nd Respondent for (Section IV to end): Q 13 Roster Number: First Name Last Name Q 14. How was the second respondent selected? Randomly selected from all HH members Randomly selected from all available aged 18 and over HH members aged 18 and over 0 1 Q 15. Was this person the head of his own household in 1989? No Yes 0 1 1 Survey ID _________________________ II Pre War and Post War Household Roster I want you to think about your household today. Your household includes everyone who is currently living here (for at least 1 month) and that eats from the same pot. First, list the name of each member of the household. For each person, I will ask a series of questions. Now think back to your household in 1989. List the names of other people who lived with you then, but may not live with you now because they have moved away or died. ENUMERATOR: Skip Q 34 [Is [name] still alive?] for all present members of the household; for all members form the 1989 household that have died or left, enumerate only up to Q 34. Q 16 Q 17 Q 18 Q 19 Q 20 Q 21 Q 22 Q 24 Q 25 Q 26 Q 27 Q 28 Q 29 Age? Q 23 If aged over Relation to Relation to Sex Marital If born in or If born in or Education in 13 current pre-war Status in 1989 SELECTION before 1989 before 1997 Religion Ethnic Group 1989 Head of Head of If DK See of 2nd (aged over 17) (aged over 9) HH 1 Marr In 1989: Household Household Table in Respondent Member Name? 2 Div/Sep ID (2006 ) (1989 ) Manual and Type 3 Widowed use approx Location before Location in 1989 4 Never Mar war, December electoral period 0 Fem age NOW ENTER “X” Profession Use Code Use Code 5. Living 1989 July 1997 Use Code B Use Code L Use Code N 1 Male (N) or AT P P together DEATH Use Code E Use Code Q Use Code Q 01 Post | Pre | Both 02 Post | Pre | Both 03 Post | Pre | Both 04 Post | Pre | Both 05 Post | Pre | Both 06 Post | Pre | Both 07 Post | Pre | Both 08 Post | Pre | Both 09 Post | Pre | Both 10 Post | Pre | Both 11 Post | Pre | Both 12 Post | Pre | Both 13 Post | Pre | Both 14 Post | Pre | Both [Note: If more than 14 rows required, please use extra roster sheet and mark the household ID on top] 2 Survey ID _________________________ Q 30 Q 31 Q 32 Q 33 Q 34 [For pre-war only household members only] Was [name] displaced at any stage Was [name] displaced at any Did [name] join one of the Is [name] still alive? Was [name] injured or maimed as during the stage during the fighting groups? If not, what was the cause and date of death a result of the wars? first Liberian war? [1989-1997] second Liberian war? [1998-2003] (Whether Voluntarily or Not) [skip Q 35- end of roster] 0 No 1 Illness [Use code C] Name? Who do you Location in 2 Old Age ID Location think was Which First which most Most recent 1 Yes 3 Accident or non-war injury Date of Date of from 0 No responsible for group? 0 No displacement time was displacement Date Volunteer Date Return Return which 1 Yes this injury / 1 Yes 4 War-related death: Killed by Date of Death date spent during date mm yyyy fighter mm yyyy mm yyyy mm yyyy [name] maiming? Use [Use code J] mm yyyy this period mm yyyy returned Codes J 2 Yes Use Codes J 5 Other (Specify with note) Abducted 01 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ XX XXXXXXXXXXXXX XX 02 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 03 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 04 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 05 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 06 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 07 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 08 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 09 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 10 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 11 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 12 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 13 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 14 __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ __ |__ ____ __ __ ___ if 1 or 4: by ____ __ __ |__ ____ _ 3 Survey ID _________________________ Q 35 Q 36 Q 37 Q 38 Q 39 Q 40 Highest level of Is [name] in school …If not in school, and If aged Did [name] suffer from any sickness or injury that Current Marital Name? education now? If so, what aged under 20, why > 13 prevented him/her from working or going to school in the ID Status achieved type? not? now past 1 month 0. No 1 Marr 1. Government Profession Now 2 Div/Sep (Current) 2. Church What sickness? What kind of health 3 Widowed 3.Private Use Codes F 0 No 1 Yes provider did [name] see? Use Codes E 4 Never Married Use Codes N 4. Community Use Codes C Use Codes D 5 Living Together 5. Quranic 6. Other 01 02 03 04 05 06 07 08 09 10 11 12 13 14 Now I would like to ask you some questions about How many were there How many were How many were constructed How many were How many are How many of those (newly built the public amenities available in this town.
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