HEAD OF
HOUSEHOLD:.......................................................................................................
DISTRICT:.............................................................................................................................
SECTOR:..............................................................................................................................
PREPARED BY:....................................................................................................................
I. GENERAL FAMILY DATA
MEN................................................................
WOMEN..........................................................
BOYS..............................................................
GIRLS.............................................................
TOTAL MEMBERS...........................................
KNOWS HOW TO READ AND WRITE?
Husband |
Yes |
No |
Wife |
Yes |
No |
II. FARMING
Property ownership
Owner |
Deed |
Title |
Document |
Rent |
|
|
|
Collective |
CAP Cooperative |
Parcelled |
|
|
Title |
Deed |
Other |
Other |
Specify:...................................................................... |
Area
Total area in manzanas........................................
Individually
owned................................................
Collectively owned...............................................
Distribution of farm area
Land use |
Area |
Farming |
|
Pasture |
|
Grassland |
|
Forest |
|
Infrastructure |
|
Total area |
|
Agricultural activities
Agricultural activity |
Crop area |
Who does the work? |
Purpose of output |
||
Men |
Women |
Sale |
Consumption |
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Barnyard: |
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Livestock system Labour
Species |
Number |
Breed |
Large livestock |
|
|
Total |
|
|
Milking cows |
|
|
Bulls |
|
|
Calves |
|
|
Small livestock |
|
|
Poultry |
|
|
Pigs |
|
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Goats |
|
|
Productive resources owned
Water for irrigation |
Knapsack sprayer |
Pulper |
Tractor |
Team of oxen |
Other |
Labour
Family
Salaried workers
Other |
Specify:.............................................. |
Other activities generating family income
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
III. HOUSING
The house you live in is
Your own |
A cooperative |
Your family's |
Household drinking-water comes from
Stream or river |
Well |
Water hole |
Distance from the house is..............................................
Is there a privy/toilet/lavatory? |
Yes |
No |
Is there electricity? |
Sí |
No |
Tipe of stove
Earth oven |
Improved |
Other |
Specify:............................................................................ |
Where does the fuelwood supply comes from?................................
How far away is the source of fuelwood?.........................................
IV. ORGANIZATION AND PARTICIPATION
Do you participate in a community organization? Yes No
Type |
Man |
Woman |
Other member |
Union |
|
|
|
Community |
|
|
|
Project |
|
|
|
Religious |
|
|
|
Do you receive assistance from a project? Yes No What kind?
Type of assistance |
Man |
Woman |
Credit |
|
|
Technology |
|
|
Basic services |
|
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