Literal question
INTERVIEWER VISITS
FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ___________
NEXT VISIT:
DATE__
TIME__
SECOND VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ___________
NEXT VISIT:
DATE__
TIME__
THIRD VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ___________
FINAL VISIT
DAY__
MONTH__
YEAR 2007
INT. NUMBER__
RESULT:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ___________
TOTAL NUMBER OF VISITS__