CANAAN COMMUNITY INITIATIVE, NALYAMAGONJA GAYAZA

BASIC HOUSEHOLD SURVEY

Plot No of
HH

Name of
Househ
old
Head

District
of
Origin
of HH
Head

Ag
e

Sex
M/F

Profes
sion
of HH
Head

Spou
se
Nam
e

Ag
e

Sex
M/F

Professio
n of HH
Spouse

Religion
espouse
d by the
HH

Primary
contact
of HH
Head/
spouse

Names of
other
people
staying in
HH

Ag
e

Se
x

Relationsh
ip to HH
Head
Child,
relative,
visitor,
parent

Additional Comments if any:________________________________________

Car registration number(s) if any:

__________________________

Whatsup Numbers (maximum 2 per household)

1_____________________________
2_________________________