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SURVEYOR IDENTITY |
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| 1 |
form number |
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bnetuk |
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| 2 |
surveyor ID |
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surveyor ID |
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| 3 |
surveyor 2 ID |
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surveyor 2 ID |
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| 4 |
camera ID |
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ID kamera |
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| 5 |
GPS ID |
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ID GPS |
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| 6 |
village, subdistrict/district |
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| 7 |
interview date |
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(mm/dd/yyyy) |
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| 8 |
duration |
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(hh:mm) |
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| 9 |
notes |
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| ## |
RESPONDENT IDENTITY |
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| 10 |
name of respondent |
nama |
(first, middle, last name) |
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| 11 |
available ID |
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national ID |
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(only one; in order of preference) |
| * |
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postal ID |
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| * |
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voter’s ID |
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| * |
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driver’s license |
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| * |
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birth certificate |
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| * |
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marriage certificate |
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| * |
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others, specify |
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| 12 |
photo ID |
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(file ID) |
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Note 2: Respondent must be a member of the household. Details must be recorded in the Table on pages 4 |
| * |
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incl. camera no |
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/* This is another point that could be programatically tied together */ |
| * |
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incl. photo number |
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/* To keep track of the relationship of images to specific response questions, such a identifying a person, we could integrate a “capture” feature within specific sections for data collection. */ |
| 13 |
sex |
jenis kelamin |
male |
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** Must be recorded. Give an approximation if the actual date is unknown. ** |
| * |
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female |
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| 14 |
age |
umur |
(note years of age; estimate if unknown) |
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** Must be recorded. Give an approximation if the actual date is unknown. ** |
| 15 |
date of birth |
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(mm/dd/yy) |
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** Must be recorded. Give an approximation if the actual date is unknown. ** |
| 16 |
father’s name |
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(first, middle, last name) |
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| 17 |
mother’s name |
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(first, middle, last name) |
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| 18 |
civil status |
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belum menikah |
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| * |
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single |
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| * |
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married |
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| * |
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widowed |
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| 19 |
birthplace |
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| 20 |
inhabitant of this village since year… |
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migrant from … |
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| 21 |
residency status |
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| * |
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resident |
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| * |
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normally resident (absent) |
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| * |
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temporary resident |
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| * |
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non-resident (outside project-affected villages) |
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