PHC-1b: Page

REPUBLIC OF GHANA Quest. ID - - GHANA STATISTICAL SERVICE

PHC-1b: Page

PHC 1B

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(NON-HOUSEHOLD POPULATION)

2010 POPULATION & HOUSING CENSUS

A02 District NameA01 Region Name A03 District Type

A06a Detailed Address of House/ Compound

PLEASE PRINT CAREFULLY AND AVOID CONTACT WITH THE EDGES AS SHOWN:

  -1 2 3 4 A B C D

A06d Contact Phone Number 2

A06c Contact Phone Number 1

A05 Locality Name A06b NHIS/ECG/VRA/Other NumberA04 Sub-District

A10 Structure number of group quarters

A11 Household number within house/compound

A07 Enumeration Area Code

District TypeDistrictRegionEA

Number

A08EA

TypeA09

Locality Code / / 2 0 1 0A14 Date Completed

/ / 2 0 1 0A13 Date Started

A20

ofA15a Total number of visits

YYYYMMDD YYYYMMDD

A15b Form

Sub District

GEOGRAPHICAL INFORMATION & HOUSEHOLD INTERVIEW DATES AND NUMBER OF VISITS

SUMMARY: TOTAL PERSONS ENUMERATED

STRUC. NO(A10)

HH NO(A11)

Q. NO

M F

REPUBLIC  OF GHANA

Quest. ID - -

9715407429

PHC-1b: Page

A12 Type of residence

03 Homeless household

04 Schools, college, university, seminary, monastery, convent, school hostel

05 Children's Home/SOS, Orphanage, Destitute Home, Old People's Home

06 Hospital, maternity home, divine healers or herbalist establishment, leper settlement, infirmary, prayer camp

07 Prison, Borstal institution, Police/ Immigration/Military cells, Industrial school, Remand home

08 Service training institution including police training college, military academy and army camp

09 Mining camp, road camp, farm camp, refugee camp, etc

10 Hotel, rest-house, transit quarters, hostel, bar, night club, restaurant

11 Transit post e.g. at railway station, in ship, in ferry, inside harbour, at airport, at international border stations

12 Passengers at lorry parks and other transport terminals

13 Location of outdoor sleepers (e.g. on floor near shops, in markets, lorry parks, on beaches, on verandah of houses, on pavements at office premises)

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and other locations of persons not in transit (e.g. mentally ill)

Quest. ID - -

2856407428

PHC-1b: Page

PERSONID

3 of 10

FULL NAME RELATIONSHIP REL.CODE

A16a: ROSTER

Members present on census night

01 Head02 Spouse (Wife/Husband)03 Child (Son/Daughter)04 Parent/Parent in-law05 Son/Daughter in-law06 Grandchild07 Brother/Sister08 Step child09 Foster child10 Other relative11 Non-relative12 Group Quarters/ Outdoor Sleeper

RELATIONSHIP CODES

SEX

0 1 MF

0 2 MF

0 3 MF

0 4 MF

0 5 MF

0 6 MF

0 7 MF

0 8 MF

0 9 MF

1 0 MF

Quest. ID - -

0174407429

PHC-1b: Page

PERSON

ID

FULL NAME

P00NAME of member

P01DATE OF BIRTH

What is [NAME]'s date of birth?

P02AGE

How old is[NAME], in

completed years?

P03NATIONALITY

What is [NAME]'s Nationality?

P04ETHNICITY

To which ethnic group does [NAME]belong?

ETHNIC GROUP CODE

REFER TO APPENDIX 3 FORCODE LIST

0 1 / /0 2 / /0 3 / /0 4 / /0 5 / /0 6 / /0 7 / /0 8 / /0 9 / /1 0 / /

4 of 10

DATE OF BIRTH DAY MONTH YEAR

FILL INACTUALAGE IF

00-98

IF 99 OROLDER,FILL 99

01 Ghanaian by birth02 Dual Nationality03 Ghanaian by naturalisation04 Nigerian05 Liberian06 Sierra Leonean07 Gambian08 Togolese09 Burkinabe10 Ivorian

11 Other ECOWAS National12 African, other than ECOWAS13 European14 American (North, South/ Caribbean)15 Asian16 Oceanian (incl. Australian and New Zealander)

IF 03 - 16,GO TO P06

REFER TO HISTORICALCALENDAR OF EVENTS IF

DATE OF BIRTH IS NOTKNOWN AND ESTIMATE

YEAR OF BIRTH

(SEE APPENDIX 1 OFENUMERATOR'S MANUAL)

PLEASE COPYFROM THE

ROSTER IN A16a

Quest. ID - -

1648407426

PHC-1b: Page

PERSON

ID

P05Was [NAME]

born in thisvillage/ town?

YES

NO

P06In what region or country was [NAME] born?

BIRTHPLACE P07LIVING IN

THISVILLAGE

/TOWN

Has [NAME]been living inthis village or

town since birth?

YES

NO

P08NUMBER OF

YEARS LIVEDIN THIS

VILLAGE/TOWN

For how long has[NAME] beenliving in this

village or town?

P09RELIGION

What is [NAME]'s religious affiliation?

1 No Religion2 Catholic3 Protestant (Anglican, Lutheran, Presbyterian, Methodist, etc)4 Pentecostal/Charismatic5 Other Christian6 Islam7 Ahmadi8 Traditionalist9 Other (Specify)

P10MARITAL STATUS

What is [NAME]'s current maritalstatus?

1 Never married2 Informal/consensual union/ living together3 Married4 Separated5 Divorced6 Widowed

CODE OTHER (SPECIFY)GO TO P08

0 1

0 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

1 0

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01 Western02 Central03 Greater Accra04 Volta05 Eastern06 Ashanti07 Brong Ahafo08 Northern09 Upper East10 Upper West11 Nigeria12 Liberia13 Sierra Leone14 Gambia

15 Togo16 Burkina Faso17 Cote d'Ivoire18 Other ECOWAS States19 Africa, Other than ECOWAS20 Europe21 Americas (North, South/ Caribbean)22 Asia23 Oceania

ANSWER FORPERSONS 12 YEARS

AND OLDER

IF YES,GO TO

P07

IF YES,GO TO

P09

Quest. ID - -

4526407424

PHC-1b: Page 6 of 10

PERSON

ID

P11

In what language can [NAME]read and write?

1 None (not literate)2 English only3 Ghanaian language only4 English and Ghanaian language5 English and French6 English, French and Ghanaian language7 Other (Specify)

P12cHIGHEST EDUCATIONALGRADE COMPLETED FOR

THOSE CURRENTLYATTENDING SCHOOL ORATTENDED IN THE PAST

What is the highest grade(form/class/level)

[NAME] has completed atthat level of schooling?

P12bWhat is the highest level of schooling [NAME] is attending

now/attended in the past?

01 Nursery02 Kindergarten03 Primary04 JSS/JHS05 Middle06 SSS/SHS07 Secondary08 Voc/technical/commercial09 Post middle/secondary certificate (teacher training/college of education, agric, nursing, etc)10 Post secondary Diploma (University diploma, HND, teacher training/college of education diploma, etc)11 Bachelor degree12 Post graduate (Cert., Diploma, Masters, PHD, etc)

P12aHas [NAME] ever attended school

or is [NAME] attending schoolnow?

PAST

NOW

NEVER

FULL TIME EDUCATION: ANSWER FOR PERSONS 3 YEARS AND OLDER

IF 0 - 8, RECORDACTUAL GRADE

IF 9 OR MORE,CODE 9

LITERACY:ANSWER FOR PERSONS 11YEARS AND OLDER

OTHER (SPECIFY)CODE

0 1

0 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

1 0

IF NEVER,GO TO P13a

Quest. ID - -

3155407421

PHC-1b: Page7 of 10

PERSON

ID

P13aDuring the 7 days before

census night, did [NAME]engage in any activity for pay

(cash or kind) or profit orfamily gain for at least one

hour?

(THIS INCLUDESHELPING IN THE

FAMILY BUSINESS/FARM, TRADING,

STREET VENDING, ETC)

YES

NO

ECONOMIC ACTIVITY--P13-P17: SHOULD BE RELATED TO THE PAST 7 DAYS PRECEDING CENSUS NIGHT(ANSWER ONLY FOR PERSONS AGED 5 YEARS OR OLDER)

P13bHow was [NAME] mainly engaged?

1 Did not work but had job to go back to (GO TO P14)2 Worked before, seeking work and available for work (GO TO P14)3 Seeking work for the first time and available for work (GO TO P18)4 Did voluntary work without pay (GO TO P14)5 Did not work and not seeking work

P13cWhy did [NAME] not seek

work?

GO TO P18

1 Did home duties (household chores/ full time homemaker)2 In full time education /student3 Pensioner/Retired4 Disabled/too sick to work5 Too old/too young6 Other

P14OCCUPATION

IF YES IN P13a; ASK: What kind of work did [NAME] mainly do?

IF P13b = 1, ASK: What kind of work did [NAME] do before the break period?

IF P13b = 2 OR 4, ASK: What kind of work did [NAME] do previously?

OCCUPATIONCODEDETAILED DESCRIPTION OF OCCUPATION

0 1

0 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

1 0

IF YES, GO TO P14

Quest. ID - -

8376407421

PHC-1b: Page8 of 10

PERSON

ID

P17EMPLOYMENT

SECTOR

In what sector was[NAME] mainly working?

P16EMPLOYMENT STATUS

What was [NAME]'semployment status in thatestablishment/ industry?

1 Employee2 Self employed without employees3 Self employed with employees4 Casual worker5 Contributing family worker6 Apprentice7 Domestic employee (househelp)8 Other

1 Public (Government)2 Private Formal3 Private Informal4 Semi-Public/Parastatal5 NGO (Local and International)6 International Organisation

NAME AND LOCATION OFESTABLISHMENT MAIN PRODUCT OR SERVICE

P15NAME & PHYSICAL LOCATION

What is the name and physical locationof the establishment where [NAME]currently works/ previously worked?

P15aINDUSTRY

What is the main product or service of the establishment where [NAME]works/worked?

CODE

ECONOMIC ACTIVITY--P13-P17: SHOULD BE RELATED TO THE PAST 7 DAYS PRECEDING CENSUS NIGHT(ANSWER ONLY FOR PERSONS AGED 5 YEARS OR OLDER)

0 1

0 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

1 0

Quest. ID - -

2178407425

PHC-1b: Page

PERSON

ID

Does [NAME] have any serious disablilty that limits his/her full participation in life activities (such as mobility,work, social life, etc)?

P18: DISABILITY (ANSWER FOR ALL PERSONS)

If YES IN g (OTHER), SPECIFY

INFORMATION COMMUNICATIONTECHNOLOGY (ICT):

ANSWER FOR PERSONS AGED 12YEARS AND OLDER

P19a

Does [NAME] owna mobile phone?

P19b

Does [NAME] useinternet facility (at home,internet cafe, on phone,

other mobile device?

YES

NO

YES

NO

ASK ALL QUESTIONS

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

0 1

0 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

1 0

Sight

a:Hearing

b:Speech

c:Physical

d:Intellect

e:Emotional

f: g:Other

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Quest. ID - -

7460407424

PHC-1b: Page 10 of 10

FERTILITY: CHILDREN EVER BORN AND CHILDREN SURVIVING

(ANSWER FOR FEMALES 12 YEARS AND OLDER. IF FEMALE UNDER 12 YEARS OR MALE, GO TO NEXTMEMBER)

P20aCHILDREN EVER BORN

How many children has [NAME] ever born alive?

MALE FEMALE

PERSON

ID

P20bCHILDREN SURVIVING

How many children ever born alive to [NAME] are stillsurviving (living with you or elsewhere)?

MALE FEMALE

NUMBER OF CHILDREN BORN ALIVE IN THEPAST 12 MONTHS

(ANSWER ONLY FOR FEMALES 12-54 YEARS OLD)

P20cCHILDREN BORN IN THE PAST 12 MONTHS

How many children has [NAME] born alive in the past 12months?

BOY GIRL

0 1

0 2

0 3

0 4

0 5

0 6

0 7

0 8

0 9

1 0

Quest. ID - -

3115407427