PRO POOR (PEPSA)
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Name of Enumerator
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Phone Number of Enumerator
Untitled Page
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Community
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Name of Pro Poor / Vulnerable
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Age (60 - 100)
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Gender
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Phone number of the vulnerable household
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Occupation of the Vulnerable household
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Number of children
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Occupation of children
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Type of material used in constructing the house
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Type of roofing
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Is the wall of the house plastered?
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Type of floor
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Do you have a smart phone?
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Do you have a radio?
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do you have a TV
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Is the house connected with hydro electric power?
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Take at least 4 pictures of the house (Inside and Outside)
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Add GPS Coordinates (Location)
