Literal question
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ____
INTERVIEWER'S NAME ____
RESULT*
*RESULT CODES
COMPLETED 1
HOUSEHOLD PRESENT BUT NO COMPETENT RESPONDENT AT HOME 2
HOUSEHOLD ABSENT 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _____ 9
NEXT VISIT:
DATE ___
TIME ____
FINAL VISIT:
DAY _____
MONTH _____
YEAR _____
NAME _____
RESULT ____