SURVEY A

NEO Baseline Survey (Training)

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CONTROL DATA
DATE: _____________________
INSTITUTION INFORMATION:
Name of Entity:
Parish: City:

BENEFICIARY INFORMATION:

FIRST AND LAST NAMES: _______________________________________________ _____

IDENTITY DOCUMENT: ________________________________________________________________________

IDENTITY DOCUMENT No.:

Gender: M F OTHER

Date of Birth (DD/MM/YYYY):

BENEFICIARY CONTACT INFORMATION:

Place of residence (address): ______________ __________________

Community/ District: __________________________________________ Parish: _________________________________________

Cell phone No.: ________________ Landline No.:

Email address:

Facebook (Email address):

Could you also provide another phone number where we can leave messages or locate you in the future?

Phone No. 1: Whose number is it?

ENROLLMENT DATE: EXPECTED END DATE:

I – SOCIODEMOGRAPHIC PROFILE
1.1. What is your marital status?
1. Single
2. Married
3. Common-law union
4. Divorced/Separated
5. Widowed
98. DK/NA

1.2. Do you have children? a. Yes. How many? _____________ b. No

 1.3. How many people live in your household? __________ (Interviewer: If the respondent lives alone, write “1”)

1.4. Answer with an “x”:

a. Who do you b. Which of these people
currently live with? would you say is the head of
(Multiple response) household? (Single
response)
1. Father
2. Mother
3. Siblings
4. Children
5. Spouse
6. Aunts/uncles
7. Grandparents
8. Friends
9. Others
10. No one

1.5. How many people in this household have paid employment? _____________

II. EDUCATIONAL LEVEL

2.1. Are you currently studying? 1. Yes 2. No (go to q 2.3)

2.2. In which educational system? 1. Formal 2. Informal 3. Both

2.3. What is the highest educational level you have reached?

1. Did not finish primary school
2. Finished primary school
3. Did not finish non-technical secondary school
4. Finished non-technical secondary school
5. Did not finish technical secondary education
6. Finished technical secondary education
7. Did not finish university
8. Finished university
9. No formal education
98. DK/NA

2.4. How many years of formal education have you successfully completed (not counting repeated
school years or preschool)?
2.4.1. What educational diploma or certificate do you have? ________________________________________
 2.5. What is the highest level of formal education reached by the person identified as head of household?
1. Did not finish primary school
2. Finished primary school
3. Did not finish non-technical secondary school
4. Finished non-technical secondary school
5. Did not finish technical secondary education
6. Finished technical secondary education
7. Did not finish university
8. Finished university
9. No formal education
98. DK/NA

III. EMPLOYMENT STATUS

3.1. Did you work at least one hour last week? (Paid or unpaid work, including internships)
1. Yes (go to q 3.3) ☐ Paid ☐Unpaid
2. No

3.2. Although you’ve already said you did not work last week, do you have any sort of job or business or
do you do any work on your own behalf?
1. Yes
2. Yes (go to q 3.12)

• For those who are employed:

The following questions refer to respondent’s main occupation (the one that takes up the most hours):
3.3. In which business sector do you work? (SINGLE Response)
1. Commercial
2. Industry
3. Services
4. Agricultural production (including livestock)
5. Construction
98. Other: _______________________

3.4. How long have you had this job?

Months

3.5. Are you ...?

1. Self-employed
q 3.5.1. Are you registered for tax purposes? 1. Yes 2. No
2. A worker or employee (salaried/dependent relationship)
q 3.5.2. Have you signed an employment contract? 1. Yes 2. No
3. An unpaid worker
98. DK/NA
 3.6. Is your current job
1. Permanent or indefinite?
2. Temporary or under a fixed-term contract?
3. Wage earner, by the hour or day?
4. An apprenticeship or internship?
5. Part of a government employment program?

3.7. Do you receive any of the following employment benefits from your current job? (Multiple response):
1. I do not receive any benefits
2. Paid vacation
3. Pension contributions (retirement)
4. Health plan
5. Year-end bonus (legally required extra payment)
6. Premium or benefit
7. Severance pay
8. Other. Specify: ______________

3.8. Could you tell me the approximate average number of hours you worked on a weekly basis last month?
(x week)
(If the job is unpaid: THE SURVEY ENDS HERE.)
3.9. Could tell me how much you earned from your job in the last month?
(in local currency)

3.10. Which of the following categories most accurately describes your monthly income? (in local currency)
1. More than (minimum wage in local currency)
2. Approximately (minimum wage in local currency)
3. Less than (minimum wage in local currency)
(THE SURVEY ENDS HERE)
• For youth who are unemployed:

3.12. Are you looking for work? 1. Yes. 2. No (Go to q 3.14)

3.13. How long have you been looking for work? Months
3.14. Have you ever worked? 1. Yes. 2. No (Conclude the survey)
3.15. How long has it been since your last job/temporary employment ended?

months

3.16. How many years of work experience do you have? months

3.17. Other comments: ____________________ (THE SURVEY ENDS HERE)