USDA/FAS Tanzania Poultry Value Chain Study - Household Questionnaire
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Surveyor Name
*
First Name
Last Name
Name of Supervisor:
*
Please Select
Revocatus Kimario
Eric Mtey
Survey Date & Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
LOCATION
Region:
*
District:
*
Community/Town
*
Interviewee Name:
*
Interviewee Position:
*
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HOUSEHOLD MEMBERSHIP/COMPOSITION
How many household members are there in your household(HH), including yourself?
*
Name
*
First Name
Last Name
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agriculture activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0")
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
0 - 300,000
300,001 - 500,000
500,001 - 1,000,000
1,000,001 and above
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
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Save
2nd Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
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Next
Save
3rd Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
4th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
5th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
6th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
7th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
8th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
9th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
Do you need to list additional members?
*
Yes
No
Back
Next
Save
10th Member
*
First Name
Last Name
Relation with the Household (HH)
*
Please Select
Spouse
Son
Daughter
Employee to HH
Other
Marital Status
*
Please Select
Married
Single
Separated
Widow
Divorced
Age:
*
Sex:
*
Please Select
Male
Female
Primary Activity:
*
Please Select
Poultry Farmer
Other Agric activity
Civil Servant
Trading
Other
If this HH member does not have employment from any of the sources, enter dash "0"
*
Wage employment
Poultry farm
Crop farm
Other agricultural income
Renting out land
Renting out livestock
Renting out agric. equipment
Amt.(TZS)
If this HH member does not have employment from any of the sources, enter dash "0")
*
Non-farm rent income
House rental income
Profit from non-farm enterprises
Net remittances
Water Sold
Misc. Income
Others
Amt.(TZS)
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Next
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HOUSEHOLD EXPENDITURES IN A MONTH
*
Expenditure?
Expenditure in TZS
Food & Non Alcoholic beverage
Yes
No
Alcoholic Beverage & Tobacco
Yes
No
Clothing & Footwear
Yes
No
Housing , Water, Electricity & Gas
Yes
No
Furnishings, Household equipment& Maintenance
Yes
No
Health
Yes
No
Transport
Yes
No
Communication
Yes
No
Recreation & Culture
Yes
No
Education
Yes
No
Restaurants & Hotels
Yes
No
Miscellaneous Goods & Services
Yes
No
Other
Yes
No
INVESTMENTS
*
Investments
Monetary value of the Investment (TZS)
Poultry production
Yes
No
Other Agricultural activities
Yes
No
Automobiles/Motors/Bicycles
Yes
No
Land
Yes
No
Precious metals
Yes
No
Monetary Savings
Yes
No
Other
Yes
No
EGG CONSUMPTION
How often do you consume/take eggs?
*
Please Select
Never
Once a month
Twice a month
Weekly
Daily
Reason if never of once a month
*
Please Select
Accessibility
Availability
Cost
Quality
Vegetarian
Allergies
Other
The average number of eggs consumed by the household in a Month
*
What is your Perception on egg consumption?
*
POULTRY MEAT CONSUMPTION
How often do you consume/take poultry meat?
*
Please Select
Never
Once a month
Twice a month
Weekly
Daily
Reason if never of once a month.
*
Please Select
Accessibility
Availability
Cost
Quality
Vegetarian
Other
How many birds are consumed by the household in a Month?
*
State the Volume
*
None
Less than 1 Kg
Between 1Kg and 2Kg
Greater than 2Kg
Select the part(s) of bird you consume/eat.
*
WC - Whole Chicken
LQ - Leg Quarters
W – Wings
T - Thighs
D/L – Drumsticks or Legs
CF - Chicken Feet
N&B – (Necks and Backs)
State the Volume
*
None
Less than 1 Kg
Between 1Kg and 2Kg
Greater than 2Kg
How often do you consume/take domestically produced poultry meat?
Please Select
Never
Once a month
Twice a month
Weekly
Daily
State the Volume
None
Less than 1 Kg
Between 1Kg and 2Kg
Greater than 2Kg
How often do you consume/take imported poultry meat?
Please Select
Never
Once a month
Twice a month
Weekly
Daily
State the Volume
None
Less than 1 Kg
Between 1Kg and 2Kg
Greater than 2Kg
How often do you consume/take local poultry meat?
Please Select
Never
Once a month
Twice a month
Weekly
Daily
State the Volume
None
Less than 1 Kg
Between 1Kg and 2Kg
Greater than 2Kg
COMMENTS:
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