Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010

COMMUNITY QUESTIONNAIRE 1. To be completed by supervisor before the interview

Questionnaire number:

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2. To be complet ed by Supervisor and Coordinator 0.12 - Questionnaire Number:

0.1 -

Supervisor name: __________________________________

0.2 -

Date: |__|__| / |__|__| / 2010 Day Month

0.3 -

Province name:

Province code:

_____________________

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0.4 -

District name:

District code:

_____________________

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0.5 -

Chief dom name:

Chief dom code:

_____________________

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Section name:

Section code:

_____________________

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Enumeration A rea (EA ) name:

Enumeration A rea (EA ) code:

0.6-

0.7-

_____________________ Village/Town name: 0.8-

|__|__| |__|__| T eam + Q ues tionnaire c ode numbering

Supervisor ID |__|__|

0.13 - Date of coordinator checking |__|__| / |__|__| / 2010 D ay M onth Coordinator name ____________________

0.14 - Coordinator Code | __| __|

|__|__|__|__| __|__| __|__| Village/Town code:

|__|__|

_____________________

0.9-

A rea:

1 = Rural

0. 10–

Livelihood zone name:

Livelihood zone code: |__|__|

0. 11–

Remarks:

_____________________ GPS Coordinates N W

|__|__|. |__|__|.

Signature of Coordinator:

2 = Urban

|__|__| :|__|__|__| |__|__| :|__|__|__|

Persons interviewed in the community: Ensure you have at least 6 persons including persons from relevant sectors (chief of the village, head of school or teacher, master farmer, trader, women trader, health worker, religious leader, extension worker, development committee member –VDC for urban areas, village development committee –VDC- member), and at least 3 women and 2 youth (between 18 and 35 years old). Name Sex Type of work/Position

3. To be complet ed by dat a entry clerk

0.15 –

First data entry

Date: |__|__| / |__|__| / 2010 Day Month Name of data entry clerk ____________________

Remarks: Signature of f irst data entry clerk(to be put after the ques tionnaire is entered):

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

0.16 –

Second data entry

Date: |__|__| / |__|__| / 2010 Day Month Name of data entry clerk ____________________ Remarks:

Signature of second data entry clerk(to be put after the ques tionnaire is entered): ____________________________

1

Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010

COMMUNITY QUESTIONNAIRE

Questionnaire number:

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SECTION 1 – DEMOGRA PHY A ND MIGRA TION 1.1 -

What is the total population in this village/community? Ask for the register of the village/community if available

1.2 -

What is the total number of household in this village / community?

1.3 -

What is the total number of female headed household in this village / community?

1.4 -

Have households moved out of this community since 1991 because of the civil war?

1.5-

1.6-

|__|__|__|__|__|__| |__|__|__|__|__| 1 Yes

|__|__|__|__|__| 2 No  Skip to 1.6

Have these households returned? 1 = All/most have returned (> 90%) 2 = More than half have returned (50% - 90%) 3 = Less than half have returned (10% - 50%) 4 = Very few/none have returned (