[YEAR] [COUNTRY] MIS INTERVIEWER’S ASSIGNMENT SHEET PAGE _______ OF _______ PAGES INTERVIEWER NAME COUNT OF CLUSTER INTERVIEWER BLOOD NUMBER NUMBER ----------------------------------------------------------------------- SLIDES HOUSEHOLD CHILDREN WOMEN LINE LMIS TOTAL NUMBER LINE NUMBER NAME OF ELIGIBLE OF TOTAL NUMBER OR HOUSEHOLD FINAL CHILDREN ELIGIBLE TESTED FOR MALARIA ELIGIBLE OF ELIG. FINAL NUMBER ADDRESS HEAD RESULT 6-59 MOS CHILD AND ANEMIA WOMEN WOMAN RESULT NOTES (1) (2) (3) (4)* (5) (6) (7) (8) (9) (10)* (11) Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N CODES FOR COLUMN (4)* CODES FOR COLUMN (10)* 1 COMPLETED 1 COMPLETED 6 DWELLING VACANT/ADDRESS NOT A DWELLING 2 NOT AT HOME 2 NO HH MEMBER AT HOME 7 DWELLING DESTROYED 3 POSTPONED 3 ENTIRE HH ABSENT FOR EXTENDED PERIOD 8 DWELLING NOT FOUND 4 REFUSED 4 POSTPONED 9 OTHER 5 PARTLY COMPLETED 5 REFUSED 6 INCAPACITATED 7 OTHER TOTAL NUMBER TOTAL NUMBER OF NUMBER OF NUMBER OF OF HOUSEHOLD CHILDREN ELIGIBLE CHILDREN TESTED WOMAN’S QUESTIONNAIRE QUESTIONNAIRES FOR ANEMIA AND FOR ANEMIA AND MALARIA TESTING MALARIA
[YEAR] [COUNTRY] MIS INTERVIEWER’S ASSIGNMENT SHEET PAGE _______ OF _______ PAGES CLUSTER NUMBER INTERVIEWER NAME ----------------------------------------------------------------------- INTERVIEWER NUMBER COUNT OF BLOOD SLIDES HOUSEHOLD CHILDREN WOMEN NOTES LMIS NUMBER NUMBER OR ADDRESS NAME OF HOUSEHOLD HEAD FINAL RESULT TOTAL ELIGIBLE CHILDREN 6-59 MOS LINE NUMBER OF ELIGIBLE CHILD TESTED FOR MALARIA AND ANEMIA TOTAL ELIGIBLE WOMEN LINE NUMBER OF ELIG. WOMAN FINAL RESULT (1) (2) (3) (4)* (5) (6) (7) (8) (9) (10)* (11) Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N CODES FOR COLUMN (4)* CODES FOR COLUMN (10)* 1 COMPLETED 2 NO HH MEMBER AT HOME 3 ENTIRE HH ABSENT FOR EXTENDED PERIOD 4 POSTPONED 5 REFUSED 6 DWELLING VACANT/ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND 9 OTHER 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER TOTAL NUMBER OF HOUSEHOLD TOTAL NUMBER OF WOMAN’S QUESTIONNAIRES NUMBER OF CHILDREN ELIGIBLE FOR ANEMIA AND MALARIA TESTING NUMBER OF CHILDREN TESTED FOR ANEMIA AND MALARIA QUESTIONNAIRE
06%20MIS%20Interviewers%20Manual.docx