Demorgraphic Survey Questionnaire

June 28, 2011

A demographic survey questionnaire is one which is used to find out the statistics of a given population such as the number of births, deaths, population census and infant mortality rate.
Demographic survey questionnaires can be used by governments, institutions and businesses in preparation for budgets, to determine a project that would work for a certain society and to account for the population growth and development in a country.
Below is an example of a demographic survey questionnaire for a population census:
Demographic Survey Questionnaire
1. Names of the members of the household (Only those above eighteen)
Number___________________________________
Full name__________________________________
Social security number_______________________
2. What is the average age of the people in the household?
Below 18
Between 18-24
Between 24-35
Between 35-65
Above 65
3. Gender
(i) Total number of males ____________
(ii) Total number of females___________
4.  Contact
1.    i.      Physical address__________________
2.    ii.      Telephone_______________________
3.    iii.      Postal address_____________________
4.    iv.      Fax_______________________________
5. Average level of education of the members of the household
Basic education
High School
University
Other
6. How many members of the household are:
(i)  Employed fulltime?
(ii) Employed part time?
(iii) Unemployed?
(iv) Self employed?
7. Are there any members of the family who are physically disabled?
____________________________________________
If the answer is yes, kindly state the impairment
________________________________________
8. What is the average annual income of the household?
Below $10,000
$10,000- $30,000
$ 40,000-$60,000
$60,000-$100,000
Above $ 100,000
Confidential
9. Which is the household’s main source of information?
Newspaper
Television/Radio
Internet
…………………………………………………

Download Demorgraphic Survey Questionnaire in Word Format

 

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