shelter_material_survey
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typenamelabelhintconstraintrelevantappearance
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startstart_time
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endend_time
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begin groupsection1Section 1. Record this information before approaching the household
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integerhhidPlease assign a unique household ID.
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datedateWhat is today's date?
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select_one statestateWhat state are you in?
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select_one geo_list or_other
geoIs this area rural, urban, peri-urban, or other?
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textaddressPlease enter the address or description of the home location.
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geopointhhgpsPlease record the GPS coordinates of this home.
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photohhpictureIf available, you may want to take a photo of the front of the house.
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end group
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begin group section2Section 2. Household information
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notenote1Begin the interview with a short introduction about who you are, the program, and the purpose of the survey.
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notenote2Ask to interview the female in charge of the household or the oldest available female. If not available, male is ok.
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textnameWhat is your name?
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select_one hhposhhpositionWhat is your position in the household?
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integerhhsizeHow many people live in this household most of the time?
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integerhhadultsHow many of the people who live here are adults (age 18 or over)?
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integerhhboysHow many boys under age 18 live here?
Don't forget babies, visitors, and household help.
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integerhhgirlsHow many girls under age 18 live here?
Don't forget babies, visitors, and household help.
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end group
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begin groupsection3Section 3. Contact information
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notenote3Thank you for participating in this survey. Here is my contact information if you want to reach me.
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select_one yesnocontactIf you're comfortable, is there any way we can get in touch with you?
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textphoneEnter phone number or other contact.
${contact} = 'yes'
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end group
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begin groupsection4Section 4. Interviewer observations
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select_one roof or_other
hh_roofThe roof of this house is made of:
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select_one wall or_other
hh_wallThe walls of the house are made of:
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select_one floor or_other
hh_floorThe floor of the house is made of:
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select_one yesnohh_toiletDoes the house appear to have access to improved toilet facilities?
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select_one light or_other
hh_lightWhat is the main source of light in the house?
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texthh_otherOther identifying characteristics of house:
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select_one povhh_comparisonCompared to other houses in the community, how would you say this one compares?likert
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textnotesDid you see anything that should be followed up or any other notes you wish to make?
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end group
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