roster_4
Sunday, March 23, 2008, 11:18 AM
Questionnaire



QUESTIONNAIRE OPTIONS
Option Setting
Parent Namesingle item
Child Namemultiple items
Max user text length50
Min user text length0
Text ConversionNone

MAIN SECTION (Directed)
0. Roster number: Take from prompt sheet or use a new number (roster_id) - number, identifier
1. What is the name of this household member? (s1q0) - text, single item
2. What is {{s1q0}}'s relationship to the household head? (s1q2) - menu, single item
3. Please specify {{s1q0}}'s relationship to the household head. (s1q2s) - text, single item
4. What is {{s1q0}}'s gender? (s1q3) - menu, single item
5. How old is {{s1q0}}? (s1q4) - number, single item
6. What was the highest level of schooling attended by {{s1q0}}? [Interviewer: if other schooling, such as schooling for the blind, select closest equivalent to level completed.] (s1q6a) - menu, single item
7. What was the highest grade {{s1q0}} attained in that level? (Interviewer: this refers to the number of years completed within that level of schooling, for example, completed 2 years of middle school.) (s1q6b) - number, single item
8. What is the main occupation of {{s1q0}} now? (s1q7) - menu, single item
9. Please specify {{s1q0}}'s primary occupation. (s1q7s) - text, single item
10. What is the secondary occupation of {{s1q0}}? (Interviewer: if only one occupation, then select "None" here.) (s1q8 ) - menu, single item
11. Please specify {{s1q0}}'s secondary occupation. (s1q8s) - text, single item
12. Is {{s1q0}} married? (s1q9) - menu, single item
13. To which ethnic group does {{s1q0}} belong? (s1q10) - menu, single item
14. Please specify {{s1q0}}'s ethnic group: (s1q10s) - text, single item
15. Health questions - message, none
16. Health Consent - message, none
17. Does {{s1q0}} suffer from any physical disabilities? (s1q11) - menu, single item
18. What kind of physical disbability is this? (s1q12) - ticklist, single item
19. Does {{s1q0}} suffer from any long-term illnesses or disorders? (s1q13) - menu, single item
20. What kind of illness/disorders does {{s1q0}} suffer from? (Choose all that apply) (s1q14) - ticklist, single item
21. During 3 months of major crop season last year (NOVEMBER, DECEMBER, & JANUARY of 2003-2004), has {{s1q0}} suffered from any of the following conditions for a long time (at least 1 months? Choose all that apply or "Prefer not to answer". (s1q15) - ticklist, single item
22. For how many days in NOVEMBER, DECEMBER, and JANUARY of the last MAJOR GROWING SEASON (2003-2004) was {{s1q0}} too sick to carry out his or her normal daily routine? (s1q16) - number, single item
23. Which of the following best applies: From September 2003 to August 2004, {{s1q0}} has been sick... (s1q17) - menu, single item

COMMON SECTION (Directed)



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