HEAD OF
HOUSEHOLD:.......................................................................................................
DISTRICT:.............................................................................................................................
SECTOR:..............................................................................................................................
PREPARED BY:....................................................................................................................
I. GENERAL FAMILY DATA
MEN................................................................
WOMEN..........................................................
BOYS..............................................................
GIRLS.............................................................
TOTAL MEMBERS...........................................
KNOWS HOW TO READ AND WRITE?
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Husband |
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Wife |
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II. FARMING
Property ownership
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Specify:...................................................................... |
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Area
Total area in manzanas........................................
Individually
owned................................................
Collectively owned...............................................
Distribution of farm area
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Land use |
Area |
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Farming |
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Pasture |
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Grassland |
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Forest |
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Infrastructure |
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Total area |
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Agricultural activities
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Agricultural activity |
Crop area |
Who does the work? |
Purpose of output |
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Men |
Women |
Sale |
Consumption |
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Barnyard: |
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Livestock system Labour
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Species |
Number |
Breed |
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Large livestock |
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Total |
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Milking cows |
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Bulls |
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Calves |
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Small livestock |
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Poultry |
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Pigs |
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Goats |
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Productive resources owned
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Labour
Family
Salaried workers
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Specify:.............................................. |
Other activities generating family income
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III. HOUSING
The house you live in is
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Household drinking-water comes from
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Distance from the house is..............................................
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Is there a privy/toilet/lavatory? |
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Is there electricity? |
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Tipe of stove
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Specify:............................................................................ |
Where does the fuelwood supply comes from?................................
How far away is the source of fuelwood?.........................................
IV. ORGANIZATION AND PARTICIPATION
Do you participate in a community organization?
Yes
No
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Type |
Man |
Woman |
Other member |
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Union |
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Community |
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Project |
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Religious |
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Do you receive assistance from a project?
Yes
No What kind?
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Type of assistance |
Man |
Woman |
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Credit |
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Technology |
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Basic services |
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