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4F7
ACS - MARKET KUWAIT.
Y2012
Bldg. #:
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Floor #:
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Flat #:
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Tel. #:
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Expected date of Collection:
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Day
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Month
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Actual date of Collection:
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Day
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Month
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Date of Interview
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Details of trials of calls and interview
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Date
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Time
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Notes
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Trial 1
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1
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2
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3
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4
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5
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6
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Trial 2
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1
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2
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3
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4
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5
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6
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Trial 3
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1
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2
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3
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4
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5
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6
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1.Not available
2.Available but busy
3.Available but excused
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4.Available but not enough time
5.Successful interview
6.Interview not completed
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INT: BEFORE HANDING OVER THE QUESTIONNAIRE TO THE RESPONDENT MARK THE APPROPRIATE CODE AS PER HIS / HER ANSWER TO THE FOLLOWING QUESTIONS.
A. Thinking about all the products you purchase for household usage, whether you purchase them from the supermarkets, groceries, or any other markets, please tell me which of the following statements best describe your role of purchasing these products:
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I decide on all or almost all the quantity of products to be purchased
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1
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¾ or more of what is bought
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2
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I decide on more than ½ of the quantity of products to be purchased
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3
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I decide on ½ of the quantity of products to be purchased
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4
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I decide on less than ½ of the quantity of products to be purchased
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5
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I decide on ¼ or less of the quantity of products to be purchased
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6
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Do not have any role
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7
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B. Which of these languages do you know well enough in order to be able to read a newspaper in that language or listen to radio?
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English
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1
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For Official Use:
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Urdu / Hindi
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2
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Malayalam / Tamil
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3
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Telugu / Kannada
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4
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Gujarati / Marathi / Bangali
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5
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Others
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Province
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District
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Stratum
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City / Town / Village
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Admin. Unit
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Cluster
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Block
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Interviewer Number
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QNR. #
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Interview DATE
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Day
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Month
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Year
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