Behavioural Surveillance Surveys - The Wisdom of Whores

Form 4
Cluster Information Sheet
Sub-Population _______________________________________________________________________
Geographic Location __________________________________________________________________
Cluster Number _______________________________________________________________________
Cluster Name _________________________________________________________________________
Date and Time When Cluster is Visited _________________________________________________
1. Estimated Measure of Size for Cluster (if it was available before the survey) :
2. Actual Measure of Size for Cluster (number of people at the site on the day
of the survey) :
3. Number of People approached to be interviewed :
4. Number of People who refused to be interviewed after being approached :
5. Number of Duplicates (people interviewed previously on another day or
at another site) :
6. Number of Interviews Completed :
Note : It is highly recommended that a separate cluster information be kept for each cluster.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S APPEN DI X 4
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