Household Data Collection

Please fill out all required fields

Surveyor Information

Survey Code *

Please provide your survey code.

Survey Date *

Please select survey date.

Household Information

House Number *

Please provide house number.

Ward Number *

Please provide ward number.

Full Address *

Please provide full address.

House Type *

Please select house type.

Ownership Status *

Please select ownership status.

Family Members *

Please provide number of family members.

Household Head Information

Full Name *

Please provide household head's name.

Age *

Please provide household head's age.

Gender *

Please select gender.

Phone Number *

Please provide phone number.

Occupation *

Please provide occupation.

Additional Information

Electricity Connection

Yes

Water Supply Source

Toilet Facility

Vehicles Owned (Select all that apply)

Bicycle

Motorcycle

Car

Other

Additional Comments

Survey Instructions

Survey Code

Enter your unique survey code provided by Epanthoi.

Example: EP-SURV-2023-001

House Identification

Provide accurate house number and ward number to ensure proper identification.

Include landmarks if house numbering system is unclear.

Household Head

The household head is the primary decision maker or main income earner.

If no clear head, select the eldest member.

Required Fields

Fields marked with * are mandatory.

Ensure all required information is collected before submission.

Data Privacy

All collected data will be kept confidential and used only for official purposes.

Do not share personal information with unauthorized parties.

Important Notes

Verify all information with respondents
Be polite and professional at all times
Record accurate GPS coordinates if possible
Take photos only with permission