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Glue Area Fieldworker ID No STATISTICS ACT NO. 6 OF 1999 (CONFIDENTIALITY) 17(1) Despite any other law, no return or other information collected by Statistics South Africa 18(1e) Any officer of Statistics South Africa who willfully discloses any data or for the purposes of official or other statistics that relates to an individual or a household 18(1g) information obtained in the course of such employment to a person not authorised may be disclosed to any person. to receive that information is guilty of an offence and liable on conviction to a fine 17(3b) Any person who is involved in the collection of, or who may use, that information or data, not exceeding R10 000, or to imprisonment for a period not exceeding 6 months or must first take an oath of confidentiality. to both. ENUMERATION AREA NUMBER Province ........................................................................................... Local municipality............................................................................................ Main place ....................................................................................... Sub-place ........................................................................................................ Physical identification of the dwelling unit ....................................................................................................................................................................... ......................................................................................................................................................................................................................................... Postal code Landline/Cell phone of enumerated household ...................................................................................... PARTICULARS OF THE HOUSEHOLD Dwelling unit number Total number of persons Males Females Total in the household Household number Total number of households at this dwelling Questionnaire of completed for this household Map reference number Listing record number If more than one questionnaire is used in the household, write the barcode of the 1st questionnaire below METHOD OF QUESTIONNAIRE COMPLETION - Mark the appropriate circle with an X A fieldworker through an interview A household member through self-completion FIELD STAFF Glue area Fieldworker ID No. Supervisor ID No. Signature ..................................................................................... Signature ......................................................................................... RESPONSE DETAILS RESULT RESPONSE Interview Next Visit (Planned) CODE DETAILS Visit No. Date (actual) Start Time End Time Result Code Date Time 1 Completed 2 Partly completed 1 3 Non-contact 2 4 Refusal 3 5 Unoccupied dwelling 6 Vacant dwelling 4 7 New dwelling under construction 8 Demolished dwelling Comments and full details of all non-response / unusual circumstances 9 Status change ......................................................................................................................................... FINAL RESULT CODE ......................................................................................................................................... ......................................................................................................................................... SHOULD YOU ENCOUNTER ANY DIFFICULTIES IN THE COMPLETION OF THE QUESTIONNAIRE, PLEASE CONTACT: ................................................................................ ON .............................................................................................................................................. OR PHONE THE CENSUS HOTLINE, TOLL FREE, ON .............................................................................................................................................. Census 2011 - A© Statistics South Africa, July 2010 FLAP: PARTICULARS OF ALL INDIVIDUALS Please write the name and surname of the household head and first names of every person who was present in this household on the night between 9 - 10 October. One name on each row. Start with head or acting head of household. The head or acting head is the person who is the main decision-maker in the household. If people are equally decision-makers, take the oldest person. For babies with no name, write BABY. Have you included babies, small children, old people and visitors who were present in this household on the night between 9 - 10 October? F-00 F-01 PERSON NAME F-02 AGE IN F-03 SEX PERSON COMPLETED 1 = Male NUMBER YEARS 2 = Female Example Example Example JOH N M A L X 1 Male 0 3 1 ULEKE 2 Female Mark the appropriate circle with an X. 1 Male 1 2 Female 1 Male 2 2 Female 1 Male 3 2 Female 1 Male 4 2 Female 1 Male 5 2 Female 1 Male 6 2 Female 1 Male 7 2 Female 1 Male 8 2 Female 1 Male 9 2 Female 1 Male 0 2 Female Census 2011 - A© Statistics South Africa, July 2010 PROCEDURES OF ENUMERATION Who should be the respondent? How to complete the questionnaire - The head/acting head of the household. - Read every question carefully - In the absence of head/acting head, any responsible adult member left in - Make sure that all the codes are written inside the boxes. charge of the household. For example: Note: 3 3 A household is a group of persons who live together, and provide themselves Correct Incorrect jointly with food or other essentials for living, or a single person who lives alone. - For numeric values such as age, the enumerator/respondent should - Domestic workers are counted as a separate household even if they live in the write the correct answer in the box as a number (e.g. “007” ). same household as the employer. Who should be counted in this questionnaire? 0 0 7 - All persons present in the household on the reference night (midnight 9-10 - For open-ended questions, the enumerator/respondent should write October 2011) legibly in CAPITAL LETTERS in the boxes provided. - Include babies born before the reference night as well as visitors. For example Cape Town should be written as: - Members who died after the reference night must be counted as alive. - Members of the household who were absent overnight, for example working, CAPETOWN travelling or at an entertainment venue, religious gathering, if they returned to the household the next day. - Individuals in converted workers hostels, residential hotels and old age homes What to use when completing this questionnaire? (depending on arrangement). Use only a pencil. If you make a mistake, use a soft rubber to erase the mistake and write the correct answer. Census 2011 Census 2011 Census 2011 SECTION A: DEMOGRAPHICS - ASK OF EVERYONE LISTED ON THE FLAP P-01 DATE OF P-02 RELATIONSHIP P-03 MARITAL P-04 SPOUSE OR P-05 POPULATION P-06 LANGUAGE BIRTH STATUS PARTNER GROUP What is (name’s) What is (name’s) relationship to the head What is (name’s) Who in this house- How would (name) Which two languages date of birth? or acting head of the household? PRESENT hold is (name’s) describe him/herself does (name) speak most The head or acting head is the person listed marital status? spouse or partner? in terms of often in this household? in row 1 of the first questionnaire, if more 1 =Married population group? 01 = Afrikaans than one questionnaire has been completed 2 =Living Write the person 1 = Black African 02 = English for this household. together like number of the spouse 2 = Coloured 03 = IsiNdebele 01 = Head/Acting Head married or partner in the 3 = Indian or Asian 04 = IsiXhosa 02 = Husband/Wife/Partner partners 05 = IsiZulu appropriate box. 4 = White 06 = Sepedi 03 = Son/Daughter 3 =Never married If the spouse or 5 = Other 04 = Adopted Son/Daughter 07 = Sesotho 4 =Widower / partner does not 05 = Stepchild Write the appropriate 08 = Setswana widow reside in the house- code in the box. 09 = SiSwati Example 06 = Brother/Sister 5 =Separated 07 = Parent (Mother/Father) hold, write 98. 10 = Tshivenda 6 =Divorced 11 = Xitsonga 1 9 08 = Parent-in-law Note: Refer to person 12 = Other 09 = Grand/Great Grandchild on flap e.g. 02 0 4 10 = Son/Daughter-in-law Write the Write the appropriate code 11 = Brother/Sister-in-law appropriate code in the box. 1 7 9 9 12 = Grandmother/Father in the box. If no other language, write 13 = Other relative 00 in the second box. 14 = Non-related person If 3-6, Go Write the appropriate code in the box. to P-05 D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Glue area Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y D D First M M Second Y Y Y Y Census 2011 - A© Statistics South Africa, July 2010 SECTION B: MIGRATION - ASK OF EVERYONE LISTED ON THE FLAP P-07 PROVINCE P-08 COUNTRY P-08a YEAR P-09 SOUTH P-10 USUAL P-10a PROVINCE OF P-10b MUNICIPALITY/ OF BIRTH OF BIRTH MOVED TO SOUTH AFRICAN RESIDENCE USUAL MAGISTERIAL DISTRICT AFRICA CITIZENSHIP RESIDENCE OF USUAL RESIDENCE In which province was In which country In which year did Is (name) a South Does (name) In which province In which municipality or (name) born? was (name) born? (name) move to African citizen? usually live in does (name) usually magisterial district 01 = Western Cape South Africa? 1 = Yes this household live? does (name) usually 02 = Eastern Cape Use CAPITAL If moved more than 2 = No for at least four 01 = Western Cape live? 03 = Northern Cape LETTERS only once into South nights a week 02 = Eastern Cape 03 = Northern
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