SAK09 L Versi English

SAK09- L
One set for BPS
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THE NATIONAL LABOR FORCE SURVEY 2009
LIST OF BUILDING AND HOUSEHOLD
[AUGUST 2009]
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CONFIDENTIAL

I. LOCATION IDENTIFICATION
1.

PROVINCE

2.

REGENCY/MUNICIPALITY *)

3.

SUB-REGENCY

4.

VILLAGE/POLITICAL DISTRICT ADMINISTERED BY LURAH *)

5.

VILLAGE CATEGORY

URBAN - 1

RURAL

-2

A. CENCUS BLOCK CODE

6.
B. SUB-CENCUS BLOCK CODE
7.

SERIAL NUMBER OF SAMPLED SAKERNAS

II. SUMMARY
NUMBER OF HOUSEHOLD
1.

{LAST SERIAL NUMBER COLUMN (5) BLOCK IV LAST PAGE}
2.

NUMBER OF HOUSEHOLD MEMBERS

.....................................................................

{C COLUMN (7)

BLOCK IV LAST PAGE}

NUMBER OF HOUSEHOLD MEMBERS AGED 10 YEARS AND
3.
OVER {C COLUMN (8) BLOCK IV LAST PAGE}
NUMBER OF HOUSEHOLD MEMBERS AGED 5-17 YEARS WHO
4.
EMPLOYED {C COLUMN (9) BLOCK IV LAST PAGE}

.....................................................................

III. INFORMATION OF FIELD WORKER
1.

CODE OF LISTING WORKER:
NAME OF LISTING WORKER:

DATE OF LISTING:

SIGNATURE:

.........................................................................

................................

......................

DATE OF SUPERVISION:

SIGNATURE:

.........................................

......................

2.

NAME OF TEAM COORDINATOR:
3.
.........................................................................
*)

Please, crossed it out the inapplicable one

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9

Page ... from ... page (s)

IV. LIST OF BUILDING AND HOUSEHOLD
Number of
Address and Set Area of

Number

Environment

of Physical

(Name of Street/Gangway, RT, RW,

Building

Number

Segment

Number of

Number of

Household

Household

Members

Members Aged 10

Number
of

Number

Household

Name of Household Head

Cencus
of Sampled

Members Aged 5-

Building
Household

17 Years who

Orchard)

Years and Over

Employed

(1)

(2)

(3)

A. NUMBER OF CURRENT PAGE
B. CUMMULATIVE OF PREVIOUS PAGE
C. TOTAL CUMMULATIVE OF CURRENT PAGE (A + B)

(4)

(5)

(6)

(7)

(8)

(9)