1 - ESDS

Quastaonnalre Re f
—. Quest~on No
PERsoN
IDENTIFICATION
Q1
Q2
Cadang Sheet
Rafar9nc9
ID NO
H/H NO
PER
FU
Q1
Q2
SEALTE SECTION
No of
Boxms/
Characters
5
2
2
1
2
2
cod~ng Instructions/Ramarks
~ues 00001-4999 9
5 d~g~ts - r-ember lead~ng
zaros and ●nsura that the
numb-r LS the sane as
that on the front page of
the household ●chmdule.
Values 1-5
Enter household number
Qluea 01-zl
Enter par non numlxr,
confirnung that thm
LntmrvLmwer has recorded
tha proper referanc* for
rmmpondent.
Valuee 1-7
Enter number of fanmly unit
values -3-03
Cwar tha last 12 months has
health bean -
good ............. .......ok
fa~rly good .......... ...Oi
not good ................ .03’. ‘,
~
--
Longatandmg illnassaa,
d~sab~l~t~as?
2
Ye, ... ...............
No ...... .............
126
. ..01
...02
/