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Section1: Identification and Tracking Form |
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* Date & Time of interview: |
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Month | Day | Year | | | |
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* Is the respondent Head of Household? |
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| If "No" above, name the Head of Household: | | |
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| Total persons normally living in this house | | |
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| Total number of families in this house | | |
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1. How long has your family been living in this house? |
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3. Who owns the land this house sits on? |
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4. Is anyone in this household married to a local landowner? |
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5. Are there any other relatives, not living in this house, married to a person from one of the Mine villages? |
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6. Is anyone in this household married to a person from Western Province (other than Mine villages)? |
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| 7. If you answered yes to any of the above questions, explain if these relationships have offered your household any benefits. | | |
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8. Do you pay rent to occupy this land and/or this house? |
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9. How much, how often and to whom do you pay rent?
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| 10. What is the size of land & house rented? | | |
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| 11. How many persons in this household work for a land-owner company? | | |
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| 12. How many persons in this household have a business partnership with a land-owner company? | | |
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| 12s. If not “0” or nil, specify type of business: | | |
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Section 3: Land-Use and Land Capacity |
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13. Does this household have a food garden? |
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| 14. What is the size of the food garden? | | |
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15. What is the age of the food garden? |
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16. How far away is the food garden? |
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18. How often do you attend the garden? |
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19. Does this household keep any commercial animals? |
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20. How long has this household kept commercial animals? |
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21. How far away are the animals kept? |
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22. In what kind of facilities are the animals kept? |
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Section 4: Access to Services |
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24. How often do you visit Tabubil town? |
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25. What was the main purpose of your last visit to Tabubil town? |
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26. How long was your last visit to Tabubil town? |
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27. How do household members usually travel to Tabubil town? |
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28. Does this household own any vehicles? |
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29. Enter the number of vehicles owned by the household.
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30. Do household members use PMVs? |
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31. How far is the nearest bus stop? |
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| 32. How many members of the household mostly walk (rather than using other forms of transport)? | | |
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33. How many members of the household travel between Tabubil & Kiunga by road? |
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34. How often do member(s) of the household travel between Tabubil & Kiunga by road? |
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35. What was the purpose of the last visit to Kiunga? |
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36. How much does the trip cost the household member(s) to Kiunga (one way)? |
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37. How many members of the household have undertaken air travel in the past 12 months? |
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38. What was the purpose of the last air travel undertaken? |
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39. Who paid for the last air travel undertaken? |
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40. How much does the household pay (per fortnight) for any water used? |
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41. How much does the household pay (per fortnight) for any electricity used? |
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42. How often does the household experience power outages? |
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43. If you use firewood for cooking, where do get most of your wood? |
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44. How often does waste (garbage) collection occur? |
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45. How much does household pay (per fortnight) for waste collection? |
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46. How is household waste (garbage) disposed? |
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47. How far away is the waste disposal site used by this household? |
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48. How is grey water (used dirty water) disposed? |
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| 49. How many operational mobile phones in household? | | |
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50. How much does household spend per fortnight on phone credits? |
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51. Is there a working computer in the house? |
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52. Do household members use a computer elsewhere? |
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53. Does any member of this household regularly access the internet? |
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54. What are the law and order problems and how serious are they, how often do they occur and, how are they resolved?
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55. Has any household member received any police assistance in the past 12 months? |
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56. Rate the quality of assistance received from the police. |
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57. In relation to law and order issues, have members in the household accessed any other services to seek assistance?
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58. What, if any, is the biggest obstacle to accessing law and justice services? |
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59. What are the major health issues affecting the household? |
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60. Where do you go to access health services?
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61. Other than health providers, who else provides the household with information and advice on health and health services? |
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62. What, if any, is the biggest obstacle for you in accessing health services? |
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63. Are there any children in this household? |
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64. Are there school aged children in this household (under 20 years old)? |
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65. Cost of Education – inclusive of fees, uniforms and extras
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66. At what grade are any children in this household expected to leave school?
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67. What do you expect your children to do when they leave school?
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68. Are there any school aged children in this household who are not enrolled in school? |
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69. If answered yes to above question, identify number and gender
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70. Reason why school aged child(ren) are not in school. |
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71. In the past 2 years have any adult members of this household undertaken any training courses?
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72. Do you ever meet with LLG Councillors? |
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| 73. If answered yes above, please list items of discussion. | | |
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74. Is anyone in the household a member of a board? |
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| 75. If answered yes above, please list boards. | | |
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76. Identify community organisations in your settlement, their purpose, examples of their success and quality of their work.
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77. Please rate the Basic Social Service listed below.
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End of Settlement Assessment Form |
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