Download - if respondent is not head of household
81027-PVT Private Time (1 July, 2008) Page 1 of 63
Study ID
81027-PVT
(101-108)
Resp. No.
(109-112)
Interviewer No.
(116-119)
Interview Length
(120-121)
No. Of Queries
(122-123)
Reference No.
(124-127)
Nielsen Indonesia 15/F Mayapada Tower Jl. Jenderal Sudirman Kav. 28 Jakarta 12920 Indonesia Name of Respondent : ________________________ Address : __________________________________ __________________________________ __________________________________ Phone # : __________________________________ Interviewer's Name : _________________________ Date of Interview : ______ - __________ - ________ Start : ________ Finish : ________
SCREENING
IF RESPONDENT IS NOT HEAD OF HOUSEHOLD WHO ACTS AS A BREADWINNER THEN ASK POLITELY TO THE ELIGIBLE ONE
Q1 JOB S C R E E N I N G So we are sure that we are speaking to a broad cross section of the community, do you or any one in your family or any of your close friends work in any of the following industry sectors? [MA]
Code (128)
Route
Advertising Agency 1 CLOSE
Research Agency 2 CLOSE
Public Relations 3 CLOSE
Mass media 4 CLOSE
Manufacturer/distributor of toilets (WC) 5 CLOSE
Manufacturer/distributor of craft tools 6 CLOSE
Journalist 7 CLOSE
None of the above 8
Q2 ASK ALL Have you been interviewed like this in the past 6 months? [SA]
Code (129)
Route
Yes 1 CLOSE
No 2
81027-PVT Private Time (1 July, 2008) Page 2 of 63
Q3a SHOW CARD Which of the following monthly household expenditure groups do you belong to? (That is : total daily expenditure in a month on food, tuition, electricity, water, cigarettes, servants' salaries, gasoline, etc; excluding major purchases). [SA]
Q3b How much, approximately, is the monthly income of this household from all sources in the household? [SA]
Q3c And how much is approximately your monthly personal income ? [SA]
Q3a Q3b Q3c
Household Expenditure
Household Income
Personal Income
(130) (133) (136)
Less than Rp.50.000 01 01 01
Rp. 50.001 - 75.000 02 02 02
Rp. 75.001 - 100.000 03 03 03
Rp. 100.001 - 150.000 04 04 04
Rp. 150.001 - 200.000 05 05 05
Rp. 200.001 - 250.000 06 06 06
Rp. 250.001 - 300.000 07 07 07
Rp. 300.001 - 350.000 08 08 08
Rp. 350.001 - 400.000 09 09 09
Rp. 400.001 - 450.000 10 10 10
Rp. 450.001 - 500.000 11 11 11
Rp. 500.001 - 600.000 12 12 12
Rp. 600.001 - 700.000 13 13 13
Rp. 700.001 - 800.000 14 14 14
Rp. 800.001 - 900.000 15 15 15
Rp. 900.001 - 1.000.000 16 16 16
Rp. 1.000.001 - 1.250.000 17 17 17
Rp. 1.250.001 - 1.500.000 18 18 18
Rp. 1.500.001 - 1.750.000 19 19 19
Rp. 1.750.001 - 2.000.000 20 20 20
Rp. 2.000.001 - 2.250.000 21 21 21
Rp. 2.250.001 - 2.500.000 22 22 22
Rp. 2.500.001 - 3.500.000 23 23 23
Rp. 3.500.001 - 4.000.000 24 24 24
Rp. 4.000.001 - 5.000.000 25 25 25
Rp. 5.000.001 - 10.000.000 26 26 26
Above 10.000.000 27 27 27
81027-PVT Private Time (1 July, 2008) Page 3 of 63
Q4 TRANSFER FROM Q3 SEC classification [SA]
Code (139)
Route
A1 : More than Rp 3,500,000 1 CLOSE
A2 : Rp 2,500,001 - Rp 3,500,000 2 CLOSE
B : Rp 1,750,001 - Rp 2,500,000 3 CLOSE
C1 : Rp 1,250,001 - Rp 1,750,000 4
C2 : Rp 900,001 - Rp 1,250,000 5
D : Rp 600,001 - Rp 900,000 6
E : Less than Rp 600,000 7 CLOSE
DEMOGRAPHICS
Q5 Who is the main income earner in this household? [SA]
Code (140)
Route
Husband 01
Wife 02
Daughter 03
Brother 04
Grandfather 05
Grandmother 06
Others (specify _________________________ ) 07
None 98
Don't know 99
Q6 TANYAKAN KEPADA KEPALA RUMAH TANGGA YANG MENCARI NAFKAH May I know how old you are? RECORD: Date/Month/Year ____/____/____
(R1) Exact Age (150-151)
Q7 TRANSFER FROM Q6
Code (152)
Route
55 years old or above 01
50 - 54 years old 02
45 - 49 years old 03
40 - 44 years old 04
35 - 39 years old 05
30 - 34 years old 06
25 - 29 years old 07
20 - 24 years old 08
18 - 19 years old 09
81027-PVT Private Time (1 July, 2008) Page 4 of 63
Q7 TRANSFER FROM Q6
Code (152)
Route
15 - 17 years old 10
Q8 SHOW CARD Can you read, write, or both?[SA]
Code (153)
Route
Read fluently 1
Can read but having difficulty 2
Can not read 3
Q9a SHOWCARD What is the highest level of education you have completed ? [SA]
Q9b Among all member of this household, what is the highest education that have completed?[SA]
Q9a Q9b
Head of HH education
Highest education
among family member
(154) (155)
Doctoral (S3) 1 1
Post graduates (S2) 2 2
Bachelor (S1) 3 3
Academy/Diploma 4 4
Senior High 5 5
Junior High 6 6
Elementary 7 7
Elementary not finished 8 8
No formal education 9 9
Q10 ASK ALL What is your main occupation? [SA]
Code (156)
Route
Staff (administration, typist) 01
Skilled laborer (in the office) 02
Unskilled laborer (in the office) 03
Skilled laborer (in the factory/shop) 04
Unskilled laborer (in the factory/shop) 05
Farmer/fisherman 06
Student (college, high school) 07
Retiree 08
No job/looking for a job 09
Housewife 10
81027-PVT Private Time (1 July, 2008) Page 5 of 63
Q10 ASK ALL What is your main occupation? [SA]
Code (156)
Route
Refused to answer 11
Other specify _________ 12
_____________________ 13
_____________________ 14
Q11 Could you please tell me, how many hours you worked in the past 7 days. What we mean by working is that you received some form of payment for what you did. it can be salary or wages or you could have gained or exchanged from what you did (i.e.trading)
(R1) Total Hours (166-167)
Q12 How many people live in your house? (Including those staying at least 3 months in the past 12 months including children, adult relatives) INTERVIEWER: READ OUT EACH AGE INTERVALS & RECORD EXACT NUMBER OF PEOPLE
(R1) Number of people (168-170)
Q13a Please mention the number of male and female for each age group living in your household including you, other adults, children and infants but excluding helper or guests. INTERVIEWER: READ OUT EACH AGE INTERVALS & RECORD EXACT NUMBER OF PEOPLE a) MALE
Q13b b) FEMALE
Q13a Q13b
Male Female
(171-172) (240-241)
(R1) 0-4 _ _ _ _
(173-174) (242-243)
(R2) 5-9 _ _ _ _
(175-176) (244-245)
(R3) 10-14 _ _ _ _
(177-178) (246-247)
(R4) 15-19 _ _ _ _
(179-180) (248-249)
(R5) 20-24 _ _ _ _
(216-217) (250-251)
(R6) 25-29 _ _ _ _
81027-PVT Private Time (1 July, 2008) Page 6 of 63
Q13a Q13b
Male Female
(218-219) (252-253)
(R7) 30-34 _ _ _ _
(220-221) (254-255)
(R8) 35-39 _ _ _ _
(222-223) (256-257)
(R9) 40-44 _ _ _ _
(224-225) (258-259)
(R10) 45-49 _ _ _ _
(226-227) (260-261)
(R11) 50-54 _ _ _ _
(228-229) (262-263)
(R12) 55-59 _ _ _ _
(230-231) (264-265)
(R13) 60-64 _ _ _ _
(232-233) (266-267)
(R14) 65-69 _ _ _ _
(234-235) (268-269)
(R15) 70-74 _ _ _ _
(236-237) (270-271)
(R16) 75+ _ _ _ _
(238-239) (272-273)
(R17) Total _ _ _ _
Q14 May I know your religion?[SA]
Code (274)
Route
Moslem 1
Christian 2
Catholic 3
Buddha 4
Hindu 5
Other _____________ 6
HOUSING INFORMATION
Q15 ASK ALL Can you tell me the ownership status of the house you are living in right now?[SA]
Code (275)
Route
Rent 1
Owned, with my name on the land certificate 2
Owned, with my parents name on the land certificate 3
81027-PVT Private Time (1 July, 2008) Page 7 of 63
Q15 ASK ALL Can you tell me the ownership status of the house you are living in right now?[SA]
Code (275)
Route
Owned, with my family/ relative on the land certificate 4
Others, _____________________________ 5
Q16 ASK ALL What is the land size of the house you are living in at the moment?
(R1) Land size of house (m2) (276-279)
Q17 Does your house get some electricity supply?[SA]
Code (280)
Route
Yes 1 Q18
No 2 Q20
Q18 ASK Q18AND Q19IF CODE 1 IS CIRCLED IN Q17 SHOWCARD And from which source do you get electricity supply?[MA]
Code (316)
Route
PLN 1
Genset 2
Other household 3
Q19 SHOWCARD In past one month, which statement describe you the best about the electricity supply in your house?[SA]
Code (317)
Route
I always get electricity supply 01
I get electricity supply only in certain time 02
I can not predict when my house get electricity supply 03
Other _________________________ 04
Don't know 99
RESPONDENT CLASSIFICATION
Q20 ASK ALL Does this house own a toilet/ water closet? What we mean by toilet/ water closet is a place where you usually defecate. [SA]
Code (327)
Route
Yes 1 Q22
No 2 Q21
81027-PVT Private Time (1 July, 2008) Page 8 of 63
Q21 ASK IF RESPONDENT DON'T HAVE TOILET IN THEIR HOUSE (CODED 2 IN Q20 ) Where do you usually defecate? [SA]
Code (328)
Route
In the open 01 Q26
River 02 Q26
Wood 03 Q26
Bush 04 Q26
Other Open site (Please Mention 05
Public Place 41 Q26
Public Toilet 42 Q26
Toilet that belong to my neighbour/ 43 Q26
Q22 ASK IF RESPONDENT HAVE THEIR OWN TOILET/WC (CODED 1 IN Q20 ) You mentioned earlier that you have a toilet/ water closet. Does your toilet/ water closet have a septic-tank? What we mean by septic-tank is a proper facility to store feces. [SA]
Code (333)
Route
Yes 1 Q26
No 2 Q23
Q23 ASK IF CODED 2 IN Q22 Earlier you mentioned that the toilet/ water closet you own in your household do not have a septic-tank as a basin to store feces. If so, then where does the disposal channel lead to? [SA]
Code (334)
Route
to a digged hole 01 Q24
to the river 02 Q26
to the gutter 03 Q26
Others, _____________________ 04 Q26
Q24 ASK IF CODED 1 IN Q23 If you previously digged a hole, is the hole closed shut ? [SA]
Code (344)
Route
Yes 1 Q25
No 2 Q26
Q25 ASK IF THE HOLE CLOSED SHUT (CODE 1 IN Q24) What material do you use to shut the hole closed?[SA]
Code (345)
Route
Leaves (Unimproved) 1
Wood slab (Unimproved) 2
Bricks (Improved) 3
Rock Slab (Improved) 4
Cement Slab (Improved) 5
81027-PVT Private Time (1 July, 2008) Page 9 of 63
Q26 Classification using the Following procedure 1. If Q20 Code 2 and Q21 Code 1 - 40; Classified as Open Defecator (CODE 1) 2. If Q20 Code 2 and Q21 Code 41 etc Classified as Sharer (CODE 2) 3. If Q20 Code 1 and Q22 Code 1; Classified as Owner Improved (CODE 3) 4. IfQ20 Code 1 and Q22 Code 2; and Q23 code 1; and Q24 Code 1; and Q25 Code 3-5; Classified as Owner Improved (CODE 3) 5. If Q20 Code1 and Q22 Code 2; and Q23 code 2 and up; Classified as Owner Unimproved (CODE 4) 6. IfQ20 Code1 and Q22 Code 2; and Q23 Code 1; and Q24 Code 2; and Q25 Code 1-2; Classified as Owner Unimproved (CODE 4) [SA]
Code (346)
Route
Open Defecator 1
Sharer 2
Owner Improved 3
Owner Unimproved 4
Q27a ASK ALL I have a list of activities that someone might buy/ do whenever they have extra money. Should you have extra money, what will you do first? [SA]
Q27b And what next? what next?[MA]
Q27a Q27b
First Do Other Priorities
(347) (349)
Pay debt 01 01
Buy the necessity for my children 02 02
Buy the household appliances 03 03
Buy a Color TV 04 04
Buy a VCD/DVD player 05 05
Buy a Motorcycle 06 06
Buy a Computer 07 07
Buy a Mobile phone 08 08
Buy a Fixed-line telephone 09 09
Buy a Radio cassette 10 10
Renovate the House 11 11
Other Needs 12 12
Build/ Renovate the Toilet/ Water Closet 13 13
Q28 ASK ALL Had you or your family for any reasons, defecate and store the stools in a container before throw it away? [SA]
Code (351)
Route
Yes 1 Q29
No 2 Q32
81027-PVT Private Time (1 July, 2008) Page 10 of 63
Q29 ASK IF RESPONDENT EVER DEFECATE USING FLYING TOILET (CODE 1 IN Q28) When did the last time you/your family member do that? [SA]
Code (352)
Route
Today 1
Yesterday 2
Within this week 3
Within this month 4
A few months ago 5
Forgot 6
Q30 ASK IF RESPONDENT EVER DEFECATE USING FLYING TOILET (CODE 1 IN Q28) Why did you/ your family do that? [MA]
Code (353)
Route
It was in the middle of the night 01
I/ We were in the middle of a trip 02
It was rainy 03
Diarrhea 04
Afraid of the dark 05
Other (Specify ___________________________ ) 06
_____________________________ 07
_____________________________ 08
_____________________________ 09
81027-PVT Private Time (1 July, 2008) Page 11 of 63
Q31a Who did it in the past 1 month?[MA]
Q31b And who did it latest?[SA]
Q31a Q31b
Head of
Household
Husband/
Wife
Child Parents
Other Head of
Household
Husband/
Wife
Child Parents
Others
(363) (532)
(R1) Adult Woman 1 2 3 4 5 1 2 3 4 5
(364) (533)
(R2) School Aged Female 1 2 3 4 5 1 2 3 4 5
(365) (534)
(R3) Adult Man 1 2 3 4 5 1 2 3 4 5
(366) (535)
(R4) School Aged Male 1 2 3 4 5 1 2 3 4 5
(367) (536)
(R5) Pre School Child 1 2 3 4 5 1 2 3 4 5
(368) (537)
(R6)
Other ________________________
__
1 2 3 4 5 1 2 3 4 5
(369) (538)
(R7) 1 2 3 4 5 1 2 3 4 5
Q32 ASK ALL Speaking about your habit in defecate, where was the last time you defecate?[SA]
Code (666)
Route
At toilet/ water closet in my house 01
At toilet/ water closet in my neighbour 02
At public toilet/ water closet 03
In the river 04
In the bushes 05
In the woods 06
Other (Specify __________________________ ) 07
Tidak ada 98
Tidak tahu 99
81027-PVT Private Time (1 July, 2008) Page 12 of 63
SECTION 1 ASK THIS SECTION TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26 )
Q33 SHOWCARD How satisfied are you with your current habit in defecate? [SA]
Code (676)
Route
Very dissatisfied 1
Dissatisfied 2
Neither satisfied nor dissatisfied 3
Satisfied 4
Very satisfied 5
Q34 Do you share your toilet/ water closet (where you usually defecate) with your neighbor or other families?[SA]
Code (677)
Route
Yes 1 Q35
No 2 Q36
Q35 ASK IF CODED 1 IN Q34 Earlier you mentioned that you share toilet/ water closet with your neighbor or other families. According to you, how many families do you share that toilet/ water closet with?
(R1) Number of Family (678-679)
Q36 Within the past 1 year, Had you defecate in the open, such as in the river or woods? [SA]
Code (680)
Route
Yes 1 Q37
No 2 Q43
Q37 ASK IF EVER DEFECATE IN THE OPEN (CODED 1 IN Q36) Do you regularly defecate in the open?[SA]
Code (716)
Route
Yes 1 Q38
No 2 Q39
Q38 ASK IF DEFECATE REGULARLY IN THE OPEN (CODED 1 IN Q37) Why do you still defecate in the open regularly?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(717-766)
81027-PVT Private Time (1 July, 2008) Page 13 of 63
Q39 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 ) Where in the open do you usually defecate?[SA]
Code (767)
Route
In the river 01
In the woods 02
In the bushes 03
Others, ________________________ 04
Q40 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36) Where was the last time you defecate in the open?[SA]
Code (777)
Route
In the river 01
In the woods 02
In the bushes 03
Other (Specify ______________________________ ) 04
Q41 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 ) Earlier you mentioned that you have defecated in the open, when was the last time you defecated in the open?[SA]
Code (822)
Route
Today 1
Yesterday 2
Within this week 3
Within this month 4
A few months ago 5
Forgot 6
Q42 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 ) Can you tell me your reasons for defecating in open air?[MA] PROBE What other reason? What other reason?
Code (823)
Route
There's no toilet in the place where I work 01
Can not hold any longer 02
As a social time 03
My own toilet is dirty 04
Others ___________________________________________ 05
81027-PVT Private Time (1 July, 2008) Page 14 of 63
Q43 TANYAKAN SEMUA Earlier you mentioned that you have your own toilet/ water closet in the house. When did you build it?[SA]
Code (833)
Route
1 month ago 01 Q44
2-3 months ago 02 Q44
4-5 months ago 03 Q44
6-12 months ago 04 Q44
The toilet/ water closet is already in the house when we moved in 05 Q50
Others, ______________________________ 06
Q44a ASK THE FOLLOWING QUESTIONS AMONG THOSE WHO JUST RECENTLY BUILT THEIR TOILET (CODE 1-4 AT Q43 ) Can you tell me your main reason for building a toilet/ water closet for your house? [SA]
Q44b What other reason? What other reason?[MA]
Q44a Q44b
Main Reason Other Reasons
(843) (853)
Privacy 01 01
Avoid sharing with others 02 02
Avoid disturbing neighbours 03 03
Avoid embarrasment/ humiliation 04 04
Higher pride and status for my family 05 05
Accepted as part of the community in my area 06 06
My family is thought to have more cultural values 07 07
Personal discretion 08 08
Safety 09 09
Satisfaction 10 10
Can become a good host when guests visit 11 11
Convenience 12 12
Easy to defecate more cleanly 13 13
Cleaner and healthier living 14 14
Avoid contaminating the environment 15 15
For good health/ Avoid disease 16 16
Other (Specify ________________________ ) 17 17
________________________ 18 18
________________________ 19 19
________________________ 20 20
None 98 98
Don't Know 99 99
81027-PVT Private Time (1 July, 2008) Page 15 of 63
Q45 How much does the construction cost you?
(R1) Cost (Record in Thousands) (863-866)
Q46 Where did you know about different options for the toilet, such as the features, the types and other information before you make your toilet?[MA]
Code (867)
Route
Neighbourhood 01
Friends 02
Mason/ Building coolie 03
Building supplier 04
Government 05
Environmental Health Officer 06
Mass Media : TV 07
Radio 08
Newspaper 09
Other (Mention ____________________________ ) 10
Q47 Where did you know about different options for the toilet, such as the features, the types and other information before you make your toilet?[MA]
Code (877)
Route
Neighbourhood 01
Friends 02
Mason/ Building coolie 03
Building supplier 04
Government 05
Environmental Health Officer 06
Mass Media : TV 07
Radio 08
Newspaper 09
Other (Mention ____________________________ ) 10
Q48 How easy or difficult was it to make a new latrine? [SA]
Code (922)
Route
Very easy 1
Easy 2
Neutral 3
Difficult 4
Very difficult 5
81027-PVT Private Time (1 July, 2008) Page 16 of 63
Q49 You said earlier that it is ____________________ [INTERVIEWER: MENTION THE ANSWER FROM Q48 ] to build a latrine for your household. Why did you say it?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(923-972)
Q50 ASK TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26) Had you renovate/ add something to your existing toilet/ build new facility? [SA]
Code (973)
Route
Yes 1 Q51
No 2 Q53
Q51a ASK IF RESPONDENTS HAD RENOVATE/ BUILD NEW FACILITY FOR THEIR TOILET (CODE 1 IN Q50) What did you do to your toilet/ water closet? [MA]
Q51b ASK Q51b IF RESPONDENTS ANSWERS ARE MORE THAN 1 ANSWER And which one is the latest?[SA]
Q51a Q51b
Things that have been
done
The latest thing that has
been done
(974) (1019)
Install a new closet 01 01
Install the new tile for the toilet 02 02
Put the roof for the toilet 03 03
Build a new wall for the toilet 04 04
Paint the wall 05 05
Install a lockable door 06 06
Build a new "stool" storage 07 07
Shut the hole and dig a new one 08 08
Others (Specify ____________________ ) 09 09
____________________ 10 10
____________________ 11 11
____________________ 12 12
81027-PVT Private Time (1 July, 2008) Page 17 of 63
Q52 ASK TO THOSE WHO HAD RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q50) Why do you _______________________ (Interviewer: Respondent answer in Q51) ?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1029-1078)
Q53 ASK TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26) Do you plan to renovate/build new facilities to your toilet/ water closet?[SA]
Code (1079)
Route
Yes 1 Q54
No 2 Q58
Q54 ASK IF RESPONDENTS PLAN TO RENOVATE/ BUILD NEW FACILITY FOR THEIR TOILET (CODE 1 IN Q53) What will you do to your toilet/ water closet? [MA]
Code (1080)
Route
Install a new closet 01
Install the new tile for the toilet 02
Put the roof for the toilet 03
Build a new wall for the toilet 04
Paint the wall 05
Install a lockable door 06
Build a new "stool" storage 07
Shut the hole and dig a new one 08
Others (Specify ____________________ ) 09
____________________ 10
____________________ 11
____________________ 12
81027-PVT Private Time (1 July, 2008) Page 18 of 63
Q55 ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q53) Why do you want to _______________________ (Interviewer: Respondent answer in Q54) ?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1125-1174)
Q56 ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q53) How much money would you be willing to spare if you intend to do the renovation? (Interviewer: record in thousands)
(R1) Actual budget (1175-1178)
Q57 ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q53) Earlier you had a plan to renovate for your toilet/ water closet? Approximately when do you think that plan can be realized? [SA]
Code (1179)
Route
In 1 month ahead 1
In 2-3 months ahead 2
In 4-5 months ahead 3
In 6-12 months ahead 4
In more than 1 year ahead 5
Could not say the exact time 6
Q58 Earlier you mentioned that you own a toilet/ water closet in your household. How often do you or your family members clean the toilet/ water closet?[SA]
Code (1180)
Route
Every time after using it 1
Everyday 2
4-5 times a week 3
2-3 times a week 4
Once a week 5
2-3 times in a month 6
Once a month 7
Rarely, only on certain occasions 8
81027-PVT Private Time (1 July, 2008) Page 19 of 63
Q59 ASK TO THOSE WHO HAVE SEPTIC TANK FOR THEIR TOILET (CODE 3 IN Q26) Have you ever emptying your septic tank/ feces storage?[SA]
Code (1216)
Route
Yes 1 Q60
No 2 Q61
Q60 ASK TO THOSE WHO HAVE EVER EMPTYING THEIR SEPTIC TANK (CODE 1 IN Q59) When was the last time you emptied your septic tank/ feces storage?[SA]
Code (1217)
Route
Within this week 1
Witihin this month 2
A month ago 3
2 months ago 4
3 months ago 5
6 months ago 6
1 year ago 7
More than 1 year ago 8
Q61 What is your opinion on people who still defecate in open air?[MA]
Code (1218)
Route
They are dirty 01
They are poor 02
They are Causing Disturbance - sometimes they use our latrine 03
They are uneducated 04
They are people that we should avoided 05
They are people that have a lower status than us 06
They are people that we feel sorry for 07
They are people that should be understand 08
They are like us 09
They do it because they accustomized to it 10
Nothing wrong with them 11
Other (Specify _____________________ ) 12
_________________________ 13
_________________________ 14
_________________________ 15
None 98
Don't Know 99
81027-PVT Private Time (1 July, 2008) Page 20 of 63
SECTION 2 ASK THESE QUESTIONS TO THE SHARER (CODED 2 IN Q26)
Q62 SHOWCARD How satisfied are you with your current habit in defecate? [SA]
Code (1228)
Route
Very dissatisfied 1
Dissatisfied 2
Neither satisfied nor dissatisfied 3
Satisfied 4
Very satisfied 5
Q63 Earlier you mentioned that you/ your family member use the public toilet for defecate. May I know how many family who use that public toilet?
(R1) Number of Family (1229-1231)
Q64 In the last 1 year, had you defecate in the open, such as in the river or woods? [SA]
Code (1232)
Route
Yes 1 Q65
No 2 Q69
Q65 ASK TO RESPONDENTS WHO EVER DEFECATE IN OPEN (CODED 1 IN Q64) Where in the open do you usually defecate?[SA]
Code (1233)
Route
In the river 01
In the woods 02
In the bushes 03
Others, ________________________ 04
Q66 ASK TO RESPONDENTS WHO EVER DEFECATE IN OPEN (CODED 1 IN Q64) Where was the last time you defecate in the open?[SA]
Code (1243)
Route
In the river 01
In the woods 02
In the bushes 03
Others, ________________________ 04
81027-PVT Private Time (1 July, 2008) Page 21 of 63
Q67 ASK TO RESPONDENT WHO EVER DEFECATE IN OPEN (CODE 1 IN Q64) Earlier you mentioned that you have defecated in the open, when was the last time you defecated in the open?[SA]
Code (1253)
Route
Today 1
Yesterday 2
Within this week 3
Within this month 4
A few months ago 5
Forgot 6
Q68 Can you tell me your reasons for defecating in open air?[MA] PROBE What other reason? What other reason?
Code (1254)
Route
There's no toilet in the place where I work 01
Can not hold any longer 02
As a social time 03
Others, ___________________________________________ 04
Q69 What is your opinion on people who still defecate in open air?[MA]
Code (1264)
Route
They are dirty 01
They are poor 02
They are Causing Disturbance - sometimes they use our latrine 03
They are uneducated 04
They are people that we should avoided 05
They are people that have a lower status than us 06
They are people that we feel sorry for 07
They are people that should be understand 08
They are like us 09
They do it because they accustomed to it 10
Nothing wrong with them 11
Other (Specify _____________________ ) 12
__________________________________ 13
__________________________________ 14
__________________________________ 15
None 98
Don't Know 99
81027-PVT Private Time (1 July, 2008) Page 22 of 63
Q70 SHOWCARD What is your opinion on people who have their own toilet? [MA]
Code (1274)
Route
They are clean 01
They are reach 02
They think we are causing disturbance (We sometimes/ always use their latrine) 03
They are educated 04
They would shun us 05
They would look down on us 06
They would feel sorry for us 07
Others (Specify ____________________ ) 08
None 98
Don't know 99
Q71 Speaking of toilet/ water closet ownership in your household, can you tell me your reasons for not having your own toilet? [MA]
Code (1319)
Route
Tenant 01
No space 02
Don't have money 03
Can use neighbours 04
Others (Specify __________________________ ) 05
__________________________ 06
__________________________ 07
__________________________ 08
None 98
Don't Know 99
Q72 Does your house have an adequate land size to build a toilet/ water closet?[SA]
Code (1329)
Route
Yes 1
No 2
Q73 Do you wish to own a place to defecate/ toilet/ water closet/ for your household? [SA]
Code (1330)
Route
Yes 1 Q74
No 2 Q81
81027-PVT Private Time (1 July, 2008) Page 23 of 63
Q74a ASK Q74- Q79 IF RESPONDENT WISH TO OWN THEIR OWN TOILET (CODED 1 IN Q73 ) Earlier you mentioned that you intend to own a place to defecate/ toilet/ water closet for your household. Can you tell me your main reason? [SA]
Q74b What other reason? What other reason?[MA]
Q74a Q74b
Main Reason Other Reasons
(1331) (1341)
Privacy 01 01
Avoid sharing with others 02 02
Avoid disturbing neighbours 03 03
Avoid embarrasment/ humiliation 04 04
Higher pride and status for my family 05 05
Accepted as part of the community in my area 06 06
My family is thought to have more cultural values 07 07
Personal discretion 08 08
Safety 09 09
Satisfaction 10 10
Can become a good host when guests visit 11 11
Convenience 12 12
Easy to defecate more cleanly 13 13
Cleaner and healthier living 14 14
Avoid contaminating the environment 15 15
For good health/ Avoid disease 16 16
Other (Specify ________________________ ) 17 17
___________________ 18 18
________________ 19 19
________________ 20 20
None 98 98
Don't know 99 99
Q75 SHOWCARD What kind of latrine do you want to build? [SA]
Code (1351)
Route
Type 1 1
Type 2 2
Type 3 3
Type 4 4
Type 5 5
Type 6 6
81027-PVT Private Time (1 July, 2008) Page 24 of 63
Q75 SHOWCARD What kind of latrine do you want to build? [SA]
Code (1351)
Route
Not yet decided 7
Q76 SHOWCARD What kind of feces disposal that you wish to build? [SA]
Code (1352)
Route
Type 1 1
Type 2 2
Type 3 3
Type 4 4
Type 5 5
Not yet decided 6
Q77 How much money would you be willing to spare if you intend to build a toilet/ water closet for your household?
(R1) Actual Budget (1353-1356)
Q78 Earlier you had a plan to build a toilet/ water closet. Approximately when do you think that plan can be realized?[SA]
Code (1357)
Route
In 1 month ahead 1
In 2-3 months ahead 2
In 4-5 months ahead 3
In 6-12 months ahead 4
In more than 1 year ahead 5
Could not say the exact time 6
Q79 Will you borrow money to build this toilet/ water closet for your household?[SA]
Code (1358)
Route
Yes 1 Q80
No 2 Q81
Q80 ASK IF CODED 1 IN Q79 Earlier you mentioned that you will borrow money to build your toilet/ water closet, who will you borrow the money from?[MA]
Code (1359)
Route
Neighbor 01
Relative 02
Bank 03
Cooperation 04
Others ______________________ 05
________________________ 06
81027-PVT Private Time (1 July, 2008) Page 25 of 63
Q81 ASK ALL Are you aware that there is a SAVING SYSTEM to provide financial assistance to build a toilet/ water closet? [SA]
Code (1369)
Route
Yes 1 Q82
No 2 Q83
Q82 ASK FOR THOSE WHO KNOW ABOUT THE SAVING SYSTEM (CODE 1 IN Q81) Does the SAVING SYSTEM to provide financial assistance to build a toilet/ water closet exist in your neighbourhood?[SA]
Code (1370)
Route
Yes 1 Q83
No 2 Q83
Q83 ASK ALL Would you be interested in using this SAVING SYSTEM that provide financial assistance to build a toilet/ water closet? [SA]
Code (1371)
Route
Yes 1 Q84
No 2 Q84
Q84 ASK FOR THOSE INTERESTED AND NOT INTERESTED Earlier you mentioned that you are interested/ not interested (INTERVIEWER: REFER TO RESPONDENT ANSWER IN Q83) in using this SAVING SYSTEM, can you tell me your reasons?
(R1) Reason of interest
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1372-1456)
(R2) Reason of not interested
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1457-1541)
81027-PVT Private Time (1 July, 2008) Page 26 of 63
Q85a ASK ALL Does your local government provide subsidies for building materials to build a toilet/ water closet for the people in your area? [SA]
Q85b Does your local government care about sanitation and environmental health problems in your area? [SA]
Q85a Q85b
Subsidies Care
(1542) (1543)
(R1) Yes 1 1
(R2) No 2 2
(R3) Don't Know 3 3
Q86 What might prevent you from building a toilet/ water closet in your house? [MA]
Code (1544)
Route
Cost of the Latrine 01
Hard to Find a Mason 02
Hard to Find the Materials 03
Water Table/Soil Conditions 04
Don't Have the Money 05
Nothing 06
Don't Know 07
Other ( Specify _____________________ ) 08
______________________________ 09
______________________________ 10
______________________________ 11
Q87 ASK THIS QUESTION IF RESPONDENTS DO NOT WISH TO OWN THEIR OWN TOILET (Q73 CODE 2) Earlier you mentioned that you do not intend to own a toilet/ water closet for your household, can you tell me the reason?[MA]
Code (1554)
Route
Tenant 01
No Space 02
Don't have money 03
Can use Neighbours 04
Others (Specify ___________________ ) 05
81027-PVT Private Time (1 July, 2008) Page 27 of 63
SECTION 3 ASK THIS SECTION TO THE OPEN DEFECATOR (CODED 1 IN Q26)
Q88a What is your main reason why do you still defecate in the open?[SA]
Q88b What are the other reasons why do you still defecate in the open?[MA]
Q88a Q88b
Main Reason Other Reasons
(1564) (1574)
As a socialization time 01 01
Have become accustomed to defecate in the open 02 02
Never thought before to defecate in toilet/ water closet 03 03
I have no toilet/ water closet in my house 04 04
More practical 05 05
Still can use my neighbour's toilet 06 06
Other (Specify __________________ ) 07 07
_______________________________ 08 08
_______________________________ 09 09
_______________________________ 10 10
Q89 SHOWCARD How satisfied are you with your current habit in defecate? [SA]
Code (1619)
Route
Very dissatisfied 1
Dissatisfied 2
Neither satisfied nor dissatisfied 3
Satisfied 4
Very satisfied 5
81027-PVT Private Time (1 July, 2008) Page 28 of 63
Q90 SHOWCARD What is your opinion on people who have their own toilet?[MA]
Code (1620)
Route
They are clean 01
They are reach 02
They think we are causing disturbance (We sometimes/ always use their latrine) 03
They are educated 04
They would shun us 05
They would look down on us 06
They would feel sorry for us 07
Others (Specify ____________________ ) 08
________________________ 09
________________________ 10
________________________ 11
None 98
Don't Know 99
Q91 Have you tried to use a toilet before? [SA]
Code (1630)
Route
Yes 1 Q92
No 2 Q95
Q92 ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91) When was the last time you used toilet? [SA]
Code (1631)
Route
Today 1
Within this week 2
Within this month 3
2-3 months ago 4
3-4 months ago 5
4-6 months ago 6
6 months ago or more 7
Forgot 8
81027-PVT Private Time (1 July, 2008) Page 29 of 63
Q93 ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91) Where the last time do you use the toilet? [MA]
Code (1632)
Route
One of my neighbour 01
Public toilet 02
Toilet in my working place 03
Other (Specify _____________________ ) 04
_______________________ 05
_______________________ 06
_______________________ 07
Q94 ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91) SHOWCARD In the last time you used a toilet, what kind of toilet do you use? [MA]
Code (1642)
Route
Type 1 1
Type 2 2
Type 3 3
Type 4 4
Type 5 5
Type 6 6
Q95 TANYAKAN SEMUA Speaking of toilet/ water closet ownership in your household, can you tell me your reasons for not having your own toilet?[MA]
Code (1643)
Route
Tenant 01
No space 02
Do not have enough money 03
Can use neighbours 04
Others (Specify _________________________ ) 05
_____________________________ 06
_____________________________ 07
_____________________________ 08
None 98
Don't Know 99
Q96 ASK ALL Does your house have an adequate land size to build a toilet/ water closet?[SA]
Code (1653)
Route
Yes 1
No 2
81027-PVT Private Time (1 July, 2008) Page 30 of 63
Q97 Do you wish to own a toilet/ water closet for your household? [SA]
Code (1654)
Route
Yes 1 Q98
No 2 Q105
Q98a ASK Q98 - Q103 IF RESPONDENT WISH TO OWN THEIR OWN TOILET (CODED 1 IN Q97 ) Earlier you mentioned that you intend to own a toilet/ water closet for your household. Can you tell me your main reason? [SA]
Q98b What other reason? What other reason?[MA]
Q98a Q98b
Main Reason Other Reasons
(1655) (1665)
Privacy 01 01
Avoid sharing with others 02 02
Avoid disturbing neighbours 03 03
Avoid embarrasment/ humiliation 04 04
Higher pride and status for my family 05 05
Accepted as part of the community in my area 06 06
My family is thought to have more cultural values 07 07
Personal discretion 08 08
Safety 09 09
Satisfaction 10 10
Can become a good host when guests visit 11 11
Convenience 12 12
Easy to defecate more cleanly 13 13
Cleaner and healthier living 14 14
Avoid contaminating the environment 15 15
For good health/ Avoid disease 16 16
Other (Specify ________________________ ) 17 17
________________________ 18 18
________________________ 19 19
________________________ 20 20
None 98 98
Don't Know 99 99
81027-PVT Private Time (1 July, 2008) Page 31 of 63
Q99 SHOWCARD What kind of latrine do you want to build? [SA]
Code (1675)
Route
Type 1 1
Type 2 2
Type 3 3
Type 4 4
Type 5 5
Type 6 6
Not yet decided 7
Q100 SHOWCARD What kind of feces disposal that you wish to build? [SA]
Code (1676)
Route
Type 1 1
Type 2 2
Type 3 3
Type 4 4
Type 5 5
Not yet decided 6
Q101 How much money would you be willing to spare if you intend to build a toilet/ water closet for your household? (Interviewer: record in thousands)
(R1) Actual budget (1677-1680)
Q102 Earlier you had a plan to build a toilet/ water closet. Approximately when do you think that plan can be realized?[SA]
Code (1716)
Route
In 1 month ahead 1
In 2-3 months ahead 2
In 4-5 months ahead 3
In 6-12 months ahead 4
In more than 1 year ahead 5
Could not say the exact time 6
Q103 Will you borrow money to build this toilet/ water closet for your household?[SA]
Code (1717)
Route
Yes 1 Q104
No 2 Q105
81027-PVT Private Time (1 July, 2008) Page 32 of 63
Q104 ASK IF CODED 1 IN Q103 Earlier you mentioned that you will borrow money to build your toilet/ water closet, who will you borrow the money from?[MA]
Code (1718)
Route
Neighbor 01
Relative 02
Bank 03
Cooperation 04
Others ______________________ 05
_____________________ 06
. 07
. 08
. 09
. 10
Q105 ASK ALL Are you aware that there is a SAVING SYSTEM to provide financial assistance to build a toilet/ water closet? [SA]
Code (1728)
Route
Yes 1 Q106
No 2 Q107
Q106 ASK FOR THOSE WHO KNOW ABOUT THE SAVING SYSTEM (CODE 1 IN Q105) Does the SAVING SYSTEM to provide financial assistance to build a toilet/ water closet exist in your neighbourhood?[SA]
Code (1729)
Route
Yes 1 Q107
No 2 Q107
Q107 ASK ALL Would you be interested in using this SAVING SYSTEM that provide financial assistance to build a toilet/ water closet? [SA]
Code (1730)
Route
Yes 1 Q108
No 2 Q108
81027-PVT Private Time (1 July, 2008) Page 33 of 63
Q108 ASK FOR THOSE INTERESTED AND NOT INTERESTED Earlier you mentioned that you are interested/ not interested (INTERVIEWER: REFER TO RESPONDENT ANSWER IN Q107) in using this SAVING SYSTEM, can you tell me your reasons?
(R1) Reason of interest
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1731-1780)
(R2) Reason of not interested
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1816-1865)
Q109a ASK ALL Does your local government provide subsidies for building materials to build a toilet/ water closet for the people in your area? [SA]
Q109b Does your local government care about sanitation and environmental health problems in your area? [SA]
Q109a Q109b
Subsidies Care
(1866) (1867)
(R1) Yes 1 1
(R2) No 2 2
(R3) Don't Know 3 3
81027-PVT Private Time (1 July, 2008) Page 34 of 63
Q110 What might prevent you from building a toilet/ water closet in your house? [MA]
Code (1868)
Route
Cost of the Latrine 01
Hard to Find a Mason 02
Hard to Find the Materials 03
Water Table/Soil Conditions 04
No Access to Credit 05
Don't Have the Money 06
Nothing 07
Don't Know 08
Other ( Specify _____________________ ) 09
____________________________ 10
____________________________ 11
____________________________ 12
None 98
Don't Know 99
Q111 ASK THIS QUESTION IF RESPONDENTS DO NOT WISH TO OWN THEIR OWN TOILET ( Q97CODE 2) Earlier you mentioned that you do not intend to own a toilet/ water closet for your household, can you tell me the reason?[SA]
Code (1878)
Route
Tenant 01
No Space 02
Don't have enough money 03
Can Use Neighbours 04
Others (Specify ____________________ ) 05
________________________ 06
________________________ 07
________________________ 08
________________________ 09
None 98
Don't Know 99
81027-PVT Private Time (1 July, 2008) Page 35 of 63
SECTION 4 HABIT, KNOWLEDGE, AND ATTITUDE DAILY HABITS
Q112 ASK ALL On what occasions do you usually wash your hands?[MA] PROBE What other occasions? What other occasions?
Code (1923)
Route
After I urinate 01
After I defecate 02
Before eating 03
After eating 04
Before cooking 05
Others, _______________________________ 06
_____________________________ 07
Never 99
Q113a ASK IF NOT CODED 99 IN Q112 RECORD FIRST MENTION AND OTHER MENTIONS SEPARATELY Why do you wash your hands after these activities? INTERVIEWER: Write down separately between the first answer and other answer [SA]
Q113b What other reason? What other reason? [MA]
Q113a Q113b
1st Mention Other Mention
(1933) (1943)
Want to get rid of the smell 01 01
Want to be cleaned from dirt 02 02
Want to get rid of germs/ bacteria 03 03
To be protected from disease 04 04
Others, ______________________________ 05 05
________________________________ 06 06
________________________________ 07 07
81027-PVT Private Time (1 July, 2008) Page 36 of 63
Q114 Do you usually use other substances when washing your hands? If yes, what is the name of the substance you use?[SA]
Code (1953)
Route
Special soap to wash hand 01
Bath soap 02
"Sabun Colek"/ Cream soap 03
Others, _____________________________ 04
None 98
Don't Know 99
Q115 Where do you usually wash your hands?[SA]
Code (1963)
Route
Lavatory 01
Kitchen 02
Premises 03
Other _________________ 04
______________________ 05
______________________ 06
______________________ 07
. 08
. 09
. 10
Q116 Where else do you usually wash your hands?[MA] PROBE where else? where else?
Code (1973)
Route
Lavatory 01
Kitchen 02
Premises 03
Other __________________ 04
_______________________ 05
_______________________ 06
_______________________ 07
. 08
. 09
. 10
Q117 In those places that you usually wash your hands, do soap always available?[SA]
Code (2018)
Route
Yes 1
No 2
81027-PVT Private Time (1 July, 2008) Page 37 of 63
Q118 How do you clean yourself after you defecate? [MA]
Code (2019)
Route
Wipe with leaves 01
Wipe with paper 02
Wipe with fiber 03
Rinse with water that is in a container 04
Rinse with water that flows 05
Rinse with soap and water 06
Others, _________________________ 07
________________________________ 08
. 09
. 10
SOURCE OF WATER
Q119a ASK ALL What is the source of water that your household use for cooking and for drinking water during the rainy season? [MA]
Q119b What is the source of water that your household use for cooking and for drinking water during the dry season? [MA]
Q119a Q119b
Rainy season Dry season
(2029) (2039)
River 01 01
Well 02 02
Water pump 03 03
Dew 04 04
PAM, the municipal water supplier 05 05
Others, _____________________ 06 06
. 07 07
. 08 08
. 09 09
. 10 10
Q120 Does your source of water for cooking and drinking located around your house? [SA]
Code (2049)
Route
Yes 1 Q125
No 2 Q121
ASK Q121 - Q124 IF RESPONDENTS' SOURCE OF WATER FOR DRINKING AND COOKING IS NOT IN THEIR HOUSE/ PREMISES (CODED 1 IN Q120)
81027-PVT Private Time (1 July, 2008) Page 38 of 63
Q121 How long does it take from your house to reach the water supply, take the water and then go back to your house?
(R1) Distance (in Minute) (2050-2052)
Q122 And who usually get the water from the water supply for your household need?[SA]
Head of Household
Spouse Children Parents Other
(2053)
(R1) Adult Woman 1 2 3 4 5
(2054)
(R2) School Aged Female 1 2 3 4 5
(2055)
(R3) Adult Man 1 2 3 4 5
(2056)
(R4) School Aged Male 1 2 3 4 5
(2057)
(R5) Pre School Child 1 2 3 4 5
(2058)
(R6) Other __________________________ 1 2 3 4 5
(2059)
(R7) 1 2 3 4 5
(2060)
(R8) 1 2 3 4 5
(2061)
(R9) 1 2 3 4 5
(2062)
(R10) 1 2 3 4 5
Q123 In what type of container is the water carried from your main source?[MA]
Code (2222)
Route
Gallon 01
Bucket 02
Drum 03
Other ______________________ 04
___________________________ 05
_________________________________ 06
_________________________________ 07
_________________________________ 08
_________________________________ 09
_________________________________ 10
81027-PVT Private Time (1 July, 2008) Page 39 of 63
Q124 How many times in a week do you go to get the water for cooking and drinking from the water source?
(R1) Times in week (2232-2234)
Q125 ASK ALL Do you have any difficulties to obtain clean water during the dry season?[SA]
Code (2235)
Route
Yes 1 Q126
No 2 Q127
Q126 ASK IF CODED 1 IN Q125 Earlier you mentioned that have difficulties in obtaining clean water during the dry season. What actions do you undertake to overcome the water crisis during dry season?[MA]
Code (2236)
Route
Store water in a container during rainy season 01
Obtain water from dew 02
Use water from the river 03
Others, _____________________________ 04
____________________________________ 05
____________________________________ 06
None 98
Don't know 99
Q127 ASK ALL Does your water supply that your household use for bathing and washing is the same from your water supply for cooking and drinking? [SA]
Code (2246)
Route
Yes 1 Q134
No 2 Q128
81027-PVT Private Time (1 July, 2008) Page 40 of 63
Q128a ASK IF CODED 2 IN Q127 What is the source of water that your household use for bathing and washing during the rainy season? [MA]
Q128b What is the source of water that your household use for bathing and washing during the dry season? [MA]
Q128a Q128b
Rainy season Dry season
(2247) (2257)
River 01 01
Well 02 02
Water pump 03 03
Dew 04 04
PAM, the municipal water supplier 05 05
Others, _________________________ 06 06
07 07
08 08
09 09
10 10
Q129 ASK IF CODED 2 IN Q127 Does your source of water that your household use for bathing and washing is in your house/ premise? [SA]
Code (2267)
Route
Yes 1 Q134
No 2 Q130
ASK Q130 - Q133 IF SOURCE OF WATER FOR BATHING AND WASHING IS NOT IN THEIR HOUSE/ PREMISE (CODED 2 IN Q129 )
Q130 How long does it take from your house to reach the water supply, take the water and then go back to your house?
(R1) Distance (in Minute) (2268-2270)
81027-PVT Private Time (1 July, 2008) Page 41 of 63
Q131 And who usually get the water from the water supply for your household need?[SA]
Head of
Household
Spouse Children Parents Other
(2271)
(R1) Adult Woman 1 2 3 4 5
(2272)
(R2) School Aged Female 1 2 3 4 5
(2273)
(R3) Adult Man 1 2 3 4 5
(2274)
(R4) School Aged Male 1 2 3 4 5
(2275)
(R5) Pre School Child 1 2 3 4 5
(2276)
(R6) Other __________________________ 1 2 3 4 5
(2277)
(R7) 1 2 3 4 5
(2278)
(R8) 1 2 3 4 5
(2279)
(R9) 1 2 3 4 5
(2280)
(R10) 1 2 3 4 5
Q132 In what type of container is the water carried from your main source?[MA]
Code (2440)
Route
Gallon 01
Bucket 02
Drum 03
Other ______________________ 04
05
06
07
08
09
10
Q133 How many times in a week do you go to get the water for bathing and washing from the water source?
(R1) Times in a week (2450-2452)
81027-PVT Private Time (1 July, 2008) Page 42 of 63
Q134 ASK ALL Do you have any difficulties to obtain clean water for bathing and washing during the dry season? [SA]
Code (2453)
Route
Yes 1 Q135
No 2 Q137
Q135 ASK IF CODED 1 IN Q134 Earlier you mentioned that have difficulties in obtaining clean water during the dry season. What actions do you undertake to overcome the water crisis during dry season?[MA]
Code (2454)
Route
Store water in a container during rainy season 01
Obtain water from dew 02
Use water from the river 03
Others, _____________________________ 04
____________________________________ 05
____________________________________ 06
____________________________________ 07
____________________________________ 08
____________________________________ 09
____________________________________ 10
Q136 ASK IF CODED 1 IN Q134 When you experience water crisis during the dry season, does it affect any of your routine activities? If yes, can you tell me what activities are affected by the water crisis? [MA]
Code (2464)
Route
Take a bath less frequently 01
Do not take a bath during the water crisis 02
Defecate in the river or the woods 03
Wash clothes in the river 04
Do not wash clothes 05
Others, ________________________ 06
____________________________________ 07
____________________________________ 08
None 98
Don't Know 99
Q137 ASK ALL Does your area have a water source that is enough to supply water for your toilet/ water closet? [SA]
Code (2474)
Route
Yes 1
No 2
81027-PVT Private Time (1 July, 2008) Page 43 of 63
KNOWLEDGE ON HEALTH
Q138 ASK ALL Do you have a child below 5 year old in your household?[SA]
Code (2475)
Route
Yes 1 Q139
No 2 Q141
Q139 ASK IF HAVE CHILD UNDER 5 YEARS OLD The last time your youngest child defecate, how did you dispose your child's feces? [SA]
Code (2476)
Route
My child defecated in the toilet/ water closet 01
Dispose my child's feces in the toilet/ water closet 02
Dispose it into the gutter 03
Dispose it into the wastebasket 04
Bury it under ground 05
Dispose it outside the house 06
Others, _____________________________ 07
98
99
Q140 ASK IF HAVE CHILD UNDER 5 YEARS OLD Why do you do that, can you explain it to me? ( ___________________ INTERVIEWER: MENTION THE ANSWER FROM Q139 ) PROBE What other reason? What other reason?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2521-2570)
Q141a Does your under 5 y.o child got diarrhea within past 2 weeks? [SA]
Q141b Does any child within your neighbourhood got diarrhea?[SA]
Q141a Q141b
Own children (in the last 2
weeks)
Neighbourhood children
(2571) (2572)
Yes 1 1
No 2 2
DK 3 3
81027-PVT Private Time (1 July, 2008) Page 44 of 63
Q142 ASK ALL According to you, what causes diarrhea? Please explain.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2573-2657)
Q143 In your opinion, how could you / someone prevented from diarrhea?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2658-2742)
Q144 ASK ALL INTERVIEWERS: ASK THIS QUESTION CAREFULLY REFER TO RESPONDENT CATEGORY (CHECK Q26 ) (Ask if coded 1 in Q26) You mention earlier that you defecated in the open, do you think the feces might have impact to people around you? (Ask if coded 4 in Q26) You mention earlier that although you have toilet but the feces will go to the open, do you think the feces might have impact to people around you? (Ask if coded 2/3 in Q26) Some people still dispose in open, do you think the feces might have impact to people around you? [SA]
Code (2743)
Route
Yes 1 Q145
No 2 Q146
Don't Know 3 Q146
81027-PVT Private Time (1 July, 2008) Page 45 of 63
Q145 ASK IF RESPONDENT THINK THAT FECES WILL IMPACT ENVIRONMENT (Q144 CODE 1) What is the impact for people around you? PROBE What else? What else?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2744-2828)
Q146 Has anybody or any institution explained to you about sanitation issues, defecating in open air, and habits of clean living?[SA]
Code (2829)
Route
Yes 1
No 2
Q147a Where did you know/ get information about sanitation issues? [MA]
Q147b Where do you hope to get more information on sanitation issues? [MA]
Q147a Q147b
Source of information
Expected source of
information
(2830) (2840)
Husband 01 01
Wife 02 02
Child 03 03
Friend that visits house 04 04
Family that visits house 05 05
At school 06 06
At work 07 07
At RT/RW meeting 08 08
Through mass media (radio & TV) 09 09
From religious leader (ustad) 10 10
From village head 11 11
From heath officer 12 12
From construction coolie 13 13
Others, _____________________ 14 14
__________________________________ 15 15
__________________________________ 16 16
Tidak ada 98 98
Tidak tahu 99 99
81027-PVT Private Time (1 July, 2008) Page 46 of 63
ACCESS
Q148 If there's a plan to build toilet/ water closet for your household, Who will be the decision maker for the building process ?[SA]
Code (2850)
Route
Myself 01
Spouse 02
My children 03
Me with my spouse 04
All of the family member 05
Other _______________________ 06
Q149 If you decided to build a toilet for your household, who will build the toilet?[SA]
Code (2860)
Route
Myself 01
Spouse 02
My Children 03
Building Coolie 04
Other ___________________ 05
Q150a Are there masons who specialized in building the whole component of the toilet within the neighborhood? [SA]
Q150b Is there any building material shop within the neighborhood which provide the material for building the toilet? [SA]
Q150a Q150b
Mason availability
Material shop availability
(2870) (2871)
Yes 1 1
No 2 2
Don't Know 3 3
Q151a Do you think you have adequate land within your household to build the toilet? [SA]
Q151b Do you think that the neighbourhood have an adequate water supply for any toilet related activity (anal cleansing and pour flush) ? [SA]
Q151a Q151b
Adequate land Adequate water
(2872) (2873)
Yes 1 1
No 2 2
81027-PVT Private Time (1 July, 2008) Page 47 of 63
Q152a If you decide to build a toilet/ water closet, who will decide the type of the middle structure of the latrine such as the type of the slab and the material of the slab? [MA]
Q152b And who will decide the type of the sub structure of the latrine such as the type of the hole, the wall for the hole and others related to feces disposal? [MA]
Q152a Q152b
Middle Structure
Sub Structure
(2874) (2919)
Myself 01 01
My spouse 02 02
My child 03 03
Both with my spouse 04 04
Building coolie 05 05
Others _____________________ 06 06
Q153 SHOWCARD How is the selling price given by the building material, spare part and toilet supply in your area? [SA]
Code (2929)
Route
Very expensive 1
Expensive 2
Neither expensive nor reasonable 3
Reasonable 4
Very reasonable 5
Don't Know 6
Q154 In your opinion, how much is the minimum total cost for building a latrine for your household in this neighbourhood?
(R1) Minimum Cost (2930-2933)
Q155 SHOWCARD How is the product quality offered by the supplier for building material, spare part and toilet in your area?[SA]
Code (2934)
Route
Unacceptable 1
Fair 2
Acceptable 3
81027-PVT Private Time (1 July, 2008) Page 48 of 63
Q156 Where do you know about the best type of toilet/ water closet for your household?[MA]
Code (2935)
Route
Neighbor 01
Relative 02
Building coolie 03
Health officer 04
Others, ______________________ 05
__________________________ 06
__________________________ 07
None 98
Don't Know 99
HYGIENE PRACTICE ASK THIS SECTION TO RESPONDENTS WHO HAVE UNDER 5 y.o CHILD
Q157 In your opinion, if your child get sick, could it be caused by the drinking water? [SA]
Code (2945)
Route
Yes 1 Q158
No 2 Q159
Q158 ASK IF CHILD ILLNESS COULD BE CAUSED BY DRINKING WATER (CODED IN Q157 ) What illness/ disease that caused by the drinking water? INTERVIEWER: Do not read answers, circle all the respondents answer. [MA] PROBE What else? What else?
Code (2946)
Route
Diarrhea 01
Cholera 02
Thypoid 03
Influenza 04
Cough 05
Other (Specify ____________________ ) 06
_________________________________ 07
_________________________________ 08
_________________________________ 09
Tidak ada 98
Tidak tahu 99
Q159 In your opinion, if your child get sick, could it be caused by not washing hands?[SA]
Code (2956)
Route
Yes 1 Q160
No 2 Q161
81027-PVT Private Time (1 July, 2008) Page 49 of 63
Q160 ASK IF CHILD DISEASE CAUSED BY NOT WASHING HANDS (CODED 1 IN Q159 ) What illness/ disease that caused by not washing hands? INTERVIEWER: Do not read answers, circle all respondent answers.[MA] PROBE What else? What else?
Code (2957)
Route
Diarrhea 01
Cholera 02
Thypoid 03
Influenza 04
Cough 05
Other (Specify ____________________ ) 06
_________________________________ 07
_________________________________ 08
_________________________________ 09
Tidak ada 98
Tidak tahu 99
Q161 What can you do to prevent your child from diarrhea? INTERVIEWER: Do not read answers, circle all respondents answers. [MA] PROBE What else? What else?
Code (2967)
Route
Cook the water first before drinking 01
Drink water containing chlorine 02
Use other way/ certain way to clean the water 03
Clean the house 04
Clean the neighbourhood 05
Defecating in toilet 06
Wash hands with soap 07
Wash the fruits/ vegetables 08
Prepare a well cooked food 09
Other (Specify ________________________ ) 10
_____________________________________ 11
_____________________________________ 12
_____________________________________ 13
Tidak ada 98
Tidak tahu 99
81027-PVT Private Time (1 July, 2008) Page 50 of 63
Q162 In your opinion, could diarrhea be the caused of under 5 y.o. child death?[SA]
Code (2977)
Route
Yes 1
No 2
IMAGERY QUESTION
Q163a READ DAN ROTATE STATEMENT I will read you several statements. Please give a value according to the best condition you know/ see in your surroundings, where 1 means STRONGLY DISAGREE and a score of 5 means STRONGLY AGREE. You are free to give an assessment, there is no right or wrong answer. [SA]
Q163a
Strongly Disagree
Disagree Neither disagree or agree
Agree Strongly Agree
(2978)
(R1) (SC) It is very easy to get emptying service
within my neighbourhood
1 2 3 4 5
(2979)
(R2) (F) Having my own toilet/ water closet facility will avoid my family as the subject of gossip
1 2 3 4 5
(2980)
(R3)
(B) Those who defecate in the open have certain disadvantages, such as parts of the
body can be seen by others
1 2 3 4 5
(3016)
(R4)
(E) A toilet/ water closet facility will make a village resident much better because they will
not pollute the environment
1 2 3 4 5
(3017)
(R5)
(B) Those who defecate in the river becomes vulnerable towards disease because of the
contaminated water in the river
1 2 3 4 5
(3018)
(R6) (SC) I know a person who had a skill in deciding
where to site a latrine
1 2 3 4 5
(3019)
(R7) (S) Majority of those I know usually defecate in
the toilet/ water closet
1 2 3 4 5
(3020)
(R8) (B) Those who defecate in the open pollute the
environment
1 2 3 4 5
(3021)
(R9) (B) Those who defecate in the river can be in
danger, e.g. carried by the current
1 2 3 4 5
(3022)
(R10) (E) Having a toilet/ water closet facility at homes
means giving the best for the family
1 2 3 4 5
(3023)
(R11) (S) If our grandfathers/ parents/ ancestors
defecated in the open, then it is OK for us today 1 2 3 4 5
(3024)
(R12) (SC) Most the emptying service that I am aware of have an adequate facility and skill to do their
1 2 3 4 5
81027-PVT Private Time (1 July, 2008) Page 51 of 63
Q163a
Strongly Disagree
Disagree Neither disagree or agree
Agree Strongly Agree
job
(3025)
(R13) (E) Having a toilet/ water closet facility will raise
our status by being a modern family
1 2 3 4 5
(3026)
(R14) (B) River is an ideal location to defecate
because there is water current
1 2 3 4 5
(3027)
(R15) (E) Having a toilet/ water closet facility will make
defecating process more pleasant 1 2 3 4 5
(3028)
(R16)
(S) Defecating in the river is common and acceptable because feces will be eaten by the
fish
1 2 3 4 5
(3029)
(R17) (F) Having my own toilet/ water closet facility
will bring comfort to me/ my family
1 2 3 4 5
(3030)
(R18)
(E) Having a toilet/ water closet facility will raise our status in the community by being an
educated family
1 2 3 4 5
(3031)
(R19) (S) It is not civilized to defecate in the open 1 2 3 4 5
(3032)
(R20) (F) Having my own toilet/ water closet facility
will add value to my house
1 2 3 4 5
(3033)
(R21) (SC) I know a person who is very good in
building a latrine sub-structure
1 2 3 4 5
(3034)
(R22) (S) Those who defecate in open air are very
dirty people
1 2 3 4 5
(3035)
(R23) (S) It is not acceptable to defecate in the open 1 2 3 4 5
(3036)
(R24) (SC) I control my own destiny (internal) 1 2 3 4 5
(3037)
(R25)
(F) Having my own toilet/ water closet facility will prevent me/ my family from disease such as
diarrhea
1 2 3 4 5
(3038)
(R26) (B) Water that flows in the river can clean dirt
after defecating in the river
1 2 3 4 5
(3039)
(R27) (S) Defecating in the river is common, and
everybody is doing so
1 2 3 4 5
(3040)
(R28) (S) Defecating in the open will not endanger
others
1 2 3 4 5
(3041)
(R29) (SC) One should not empty latrines into public
spaces
1 2 3 4 5
(3042)
(R30) (F) Having my own toilet/ water closet facility 1 2 3 4 5
81027-PVT Private Time (1 July, 2008) Page 52 of 63
Q163a
Strongly Disagree
Disagree Neither disagree or agree
Agree Strongly Agree
will allow me to protect my family
(3043)
(R31) (S) It is acceptable for young children to
defecate in the open.
1 2 3 4 5
(3044)
(R32) (S) Those who defecate in open air will
endanger the community they live in
1 2 3 4 5
(3045)
(R33) (F) Having my own toilet/ water closet facility
will bring personal discretion to me/ my family 1 2 3 4 5
(3046)
(R34) (B) Defecating in the open is very
uncomfortable because you can catch the rain
1 2 3 4 5
(3047)
(R35) (S) It is acceptable to defecate in the open if
you can not access a toilet 1 2 3 4 5
(3048)
(R36) (B) Open air (river/ bushes/ woods) is a place to
comfortably defecate
1 2 3 4 5
(3049)
(R37) (F) Having my own toilet/ water closet allows
me to be a better host to guests 1 2 3 4 5
(3050)
(R38) (F) Having my own toilet/ water closet facility
will make my house become more comfortable
1 2 3 4 5
(3051)
(R39) (SC) It is very important that every house must
have a latrine 1 2 3 4 5
(3052)
(R40) (S) Those who defecate in open air will not be
accepted in the community they live in
1 2 3 4 5
(3053)
(R41) (SC) A good latrine must have a hand washing
station nearby
1 2 3 4 5
(3054)
(R42) (E) A toilet/ water closet facility will raise family's
pride, e.g. when guests visit
1 2 3 4 5
(3055)
(R43) (B) Those who defecate in the open can be in
danger, e.g. attacked or bit by animals
1 2 3 4 5
81027-PVT Private Time (1 July, 2008) Page 53 of 63
TANYAKAN KEPADA OPEN DEFECATOR, SHARER, OWNER UNIMPROVED (TERKODE 1 ATAU 2 ATAU 4 DI Q26) INTERVIEWER: Berikan setiap PHOTOCARD beserta dengan SHOWCARD skala, beri nilai untuk setiap nilai keinginan responden pada setiap kombinasi pada PHOTOCARD.
Q164a ASK TO OWNER UNIMPROVED AND OPEN DEFECATOR (OTHER THAN CODE 3 IN Q26) SHOWCARD AND PHOTOCARD Here I have several photocard describing about combinations of toilet and its septic tank. In every Photocard, there's a price to buy the material and cost for the mason. Please give your score about how much you want the toilet for your household, septic tank with the consideration about the price. You can give your score in 1 to 5 scale where 1 is you don't want it at all and 5 is you really want it for your household. [SA]
Q164a
Don't have
willingness at all
2 3 4 5 6 7 8 9 10 - Really have
willingness
(3056)
(R1) Photocard 1 01 02 03 04 05 06 07 08 09 10
(3057)
(R2) Photocard 2 01 02 03 04 05 06 07 08 09 10
(3058)
(R3) Photocard 3 01 02 03 04 05 06 07 08 09 10
(3059)
(R4) Photocard 4 01 02 03 04 05 06 07 08 09 10
(3060)
(R5) Photocard 5 01 02 03 04 05 06 07 08 09 10
(3061)
(R6) Photocard 6 01 02 03 04 05 06 07 08 09 10
(3062)
(R7) Photocard 7 01 02 03 04 05 06 07 08 09 10
(3063)
(R8) Photocard 8 01 02 03 04 05 06 07 08 09 10
(3064)
(R9) Photocard 9 01 02 03 04 05 06 07 08 09 10
(3065)
(R10) Photocard 10 01 02 03 04 05 06 07 08 09 10
(3066)
(R11) Photocard 11 01 02 03 04 05 06 07 08 09 10
(3067)
(R12) Photocard 12 01 02 03 04 05 06 07 08 09 10
(3068)
(R13) Photocard 13 01 02 03 04 05 06 07 08 09 10
(3069)
(R14) Photocard 14 01 02 03 04 05 06 07 08 09 10
(3070)
(R15) Photocard 15 01 02 03 04 05 06 07 08 09 10
(3071)
(R16) Photocard 16 01 02 03 04 05 06 07 08 09 10
81027-PVT Private Time (1 July, 2008) Page 54 of 63
Q165a ASK TO OWNER UNIMPROVED AND OPEN DEFECATOR (OTHER THAN CODE 3 IN Q26) SHOWCARD AND PHOTOCARD Here I have other several photocard describing about combinations of toilet and its septic tank. In every Photocard, there's a price to buy the material and cost for the mason. Please give your score about how much you want the toilet for your household, septic tank with the consideration about the price. You can give your score in 1 to 5 scale where 1 is you don't want it at all and 5 is you really want it for your household. [SA]
Q165a
1 - Don't have
willingness at all
2 3 4 5 6 7 8 9 10 - Really have
willingness
(3072)
(R1) Photocard 1 01 02 03 04 05 06 07 08 09 10
(3073)
(R2) Photocard 2 01 02 03 04 05 06 07 08 09 10
(3074)
(R3) Photocard 3 01 02 03 04 05 06 07 08 09 10
(3075)
(R4) Photocard 4 01 02 03 04 05 06 07 08 09 10
(3076)
(R5) Photocard 5 01 02 03 04 05 06 07 08 09 10
(3077)
(R6) Photocard 6 01 02 03 04 05 06 07 08 09 10
(3078)
(R7) Photocard 7 01 02 03 04 05 06 07 08 09 10
(3079)
(R8) Photocard 8 01 02 03 04 05 06 07 08 09 10
(3080)
(R9) Photocard 9 01 02 03 04 05 06 07 08 09 10
81027-PVT Private Time (1 July, 2008) Page 55 of 63
MEDIA EXPOSURE & COMMUNICATION CHANNEL
Q166 TANYAKAN SEMUA Do you like to listen to Radio?[SA]
Code (3116)
Route
Yes 1 Q167
No 2 Q169
Q167 ASK IF CODED 1 IN Q166 What time do you usually listen to the radio most often?[MA]
Code (3117)
Route
05.00 - 05.59 am 01
06.00 - 07.59 am 02
08.00 - 10.59 am 03
11.00 - 12.59 am 04
01.00 - 02.59 pm 05
03.00 - 04.59 pm 06
05.00 - 05.59 pm 07
06.00 - 06.59 pm 08
07.00 - 08.59 pm 09
09.00 - 09.59 pm 10
10.00 - 10.59 pm 11
11.00 - 11.59 pm 12
12.00 - 01.59 am 13
02.00 - 03.59 am 14
Q168a What is the name of the radio station you have ever listened to?[MA]
Q168b Name of radio station most often listened to?[SA]
Q168a Q168b
Ever listened to
Most listened to
(3119) (3129)
. 01 01
. 02 02
. 03 03
. 04 04
. 05 05
. 06 06
. 07 07
. 08 08
. 09 09
. 10 10
99 99
81027-PVT Private Time (1 July, 2008) Page 56 of 63
Q169 Do you like to watch Television? [SA]
Code (3139)
Route
Yes 1 Q170
No 2 Q172
Q170 ASK IF CODED 1 IN Q169 What time do you usually watch TV most often? [MA]
Code (3140)
Route
05.00 - 05.59 am 01
06.00 - 07.59 am 02
08.00 - 10.59 am 03
11.00 - 12.59 am 04
01.00 - 02.59 pm 05
03.00 - 04.59 pm 06
05.00 - 05.59 pm 07
06.00 - 06.59 pm 08
07.00 - 08.59 pm 09
09.00 - 09.59 pm 10
10.00 - 10.59 pm 11
11.00 - 11.59 pm 12
12.00 - 01.59 am 13
02.00 - 03.59 am 14
Q171a What is the name of the TV station you have ever watched?[MA]
Q171b Name of TV station most often watched?[SA]
Q171a Q171b
Ever watched Watched most often
(3142) (3152)
TVRI 01 01
RCTI 02 02
SCTV 03 03
TPI 04 04
Trans TV 05 05
Global TV 06 06
Trans 7 07 07
Indosiar 08 08
TV One 09 09
ANTV 10 10
Lativi 11 11
Metro TV 12 12
JTV 13 13
Space Toon 14 14
Deli TV 15 15
TV Borobudur/ TV B 16 16
Makassar TV 17 17
O Channel 18 18
STV 19 19
Other, specify ____________________________ 20 20
____________________________ 21 21
____________________________ 22 22
Tidak Ada 98 98
Tidak Tahu 99 99
81027-PVT Private Time (1 July, 2008) Page 57 of 63
Q172a What is the name of the newspaper you have ever read?[MA]
Q172b Name of newspaper that you read most often?[SA]
Q172a Q172b
Ever read Most often read
(3162) (3172)
Agrobur 01 01
Analisa 02 02
Banjarmasin Post 03 03
Berita Kota 04 04
Berita Kota Makasar ( BKM) 05 05
bina baru 06 06
Bisnis Indonesia 07 07
B'Post 08 08
Fajar 09 09
Galamedia 10 10
Jawa Pos 11 11
Kompas 12 12
Koran Pendidikan 13 13
Koran Tempo 14 14
Lampu Merah 15 15
Medan Pos 16 16
Media Indonesia 17 17
Merdeka 18 18
Meteor 19 19
Metro Bandung 20 20
Metro Banjar 21 21
Momerandum 22 22
Pedoman Rakyat 23 23
Pikiran Rakyat 24 24
Pos Kota 25 25
Pos Metro 26 26
Pos metro Medan 27 27
Radar Banjarmasin 28 28
Radar Surabaya 29 29
Republika 30 30
Seputar Indonesia 31 31
Serambi 32 32
81027-PVT Private Time (1 July, 2008) Page 58 of 63
Q172a Q172b
Ever read Most often read
Sinar Indonesia Baru 33 33
Suara Karya 34 34
Suara Merdeka 35 35
Suara Pembaruan 36 36
Sumut Pos 37 37
Surya 38 38
Terbit 39 39
Top Score 40 40
Tribun Jabar 41 41
Tribun Timur 42 42
Ujung Pandang Expres 43 43
Warta Kota 44 44
Waspada 45 45
Wawasan 46 46
Other, ___________________________ 47 47
___________________________________ 48 48
None 98 98
Don't Know 99 99
81027-PVT Private Time (1 July, 2008) Page 59 of 63
PRODUCT RANGE ASSESSMENT
Q173 ASK ALL SHOWCARD Of all the durables listed below, which ones does your household own? [MA] PROBE What else? What else?
Code (3217)
Route
Black & White TV 01
Colour TV 02
Bicycle 03
Motorcycle 04
Car 05
Livestock 06
VCD/ DVD Player 07
Radio 08
Radio Cassette 09
AC 10
Camera 11
Video Camera 12
Washing Machine 13
Credit Card 14
Computer 15
Microwave/ Oven 16
Handphone 17
Home Phone 18
Internet 19
Electric Fan 20
Electric Water Pump 21
Mixer/ Blender 22
Rice Cooker 23
Magic Jar 24
Refrigerator 25
Gas Stove 26
Kerosene Stove 27
INTERVIEW FINISHED. SAY THANK YOU TO RESPONDENTS
81027-PVT Private Time (1 July, 2008) Page 60 of 63
Q174 Quality Control done by : [MA]
Code (3220)
Route
Coordinator/RFM/FE 1
Supervisor 2
Team Leader 3
Quality Controller 4
Checker 5
Q175 Quality Control, action taken : [SA]
Code (3221)
Route
Witnessed 1
Recalled 2
Slip collected 3
Checked on the spot 4
Telephone 5
Checked Questionnaire 6
Q176 Start
(R1) Start (3222-3225)
Q177 Finish
(R1) Finish (3226-3229)
Q178 Date/month of interview
(R1) DATE/MONTH (3230-3233)
Q179 Day of interviewing [SA]
Code (3234)
Route
Monday 1
Tuesday 2
Wednesday 3
Thursday 4
Friday 5
Saturday 6
Sunday 7
81027-PVT Private Time (1 July, 2008) Page 61 of 63
Q180 INTERVIEWER : ASK YOUR SUPERVISOR TO FILL THIS CODE PSU [SA]
Code (3235)
Route
ORIGINAL 1
SUBSTITUTE 2
ADDITIONAL 3
Q181a Filled by Supervisor/ Leader/ Quality Control Witnessed/ Recalled [MA]
Q181b Spv/ Leader/ QC Number
Q181a Q181b
QC that has been done
4 Digits
(3236) (3237-3240)
(R1) Witness 1 _ _ _ _
(3241-3244)
(R2) Recall 2 _ _ _ _
(3245-3248)
(R3) Slip 3 _ _ _ _
(3249-3252)
(R4) On the spot 4 _ _ _ _
(3253-3256)
(R5) Check 5 _ _ _ _
Q182 FILLED IN BY CODERS/SPV/LEADER TYPE OF MISTAKES [MA]
Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Type 7 Type 8 Type 9 Type 10
(3257)
(R1) Mistakes 01 02 03 04 05 06 07 08 09 10
Q183 No PSU
(R1) No PSU (3258-3263)
Q184 Method[SA]
Code (3264)
Route
Random PSU 1
Substitute 2
81027-PVT Private Time (1 July, 2008) Page 62 of 63
Q185 Coders
(R1) R1 (3265-3267)
(R2) R2 (3268-3270)
Q186 Coder [SA]
Code (3271)
Route
. 1
Q187 coders [MA]
Code (3272)
Route
. 1
. 2
. 3
. 4
. 5
. 6
. 7
. 8
Q188 Interviewer Number
(R1) Interviewer No. (3277-3317)
"Herewith I declare that the interview done and recorded by me today, is correct and with accurate data, according to survey methods, given instructions, and to ESOMAR standard." Interviewer : Date of interview : time :
FIELD : THIS PAGE SHOULD BE COPIED SEPARATELY CODERS/DATA ENTRY : AFTER FINISH CODED AND ENTRY, THIS PAGE SHOULD BE SEPARATED
Q189 Would you like to participate in our future survey?[SA]
Code (3318)
Route
Yes 1 Q190
No 2 CLOSE
Q190 Do you have a phone number?[SA]
Code (3319)
Route
Yes 1
No 2 Q192
81027-PVT Private Time (1 July, 2008) Page 63 of 63
Q191a Ingatkan Responden bahwa semua data akan digunakan secara rahasia dan bukan untuk komersil RECORD : Respondent's Phone number Area code
Q191b Phone no.
Q191a Q191b
Area code Phone no.
(3320-3323) (3324-3333)
(R1) . _ _ _ _ _ _ _ _ _ _ _ _
_ _
Q192 Do you have a personal cell phone?[SA]
Code (3334)
Route
Yes 1 Q193
No 2 Q194
Q193 HP no.
(R1) Cellular Number (3335-3346)
(R2) Cellular Number (3347-3358)
Q194 Do you have a personal e-mail address?[MA]
Code (3359)
Route
Yes 1 Q195
No 2 Q196
Q195 Would you please tell me your personal email address that you access most often? RECORD : Respondent's e-mail address (if any) Only most often used address
(R1) Name (3360-3363)
Q196 What is your full name? RECORD : Respondent's Name
(R1) Name (3419-3422)