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Annex1-Settlement Study

Section1: Identification and Tracking Form

* Location ID:

* Interviewer

* Date & Time of interview:

Month	Day	Year

* Respondent Name:

* Respondent Gender:

* Is the respondent Head of Household?

If "No" above, name the Head of Household:

Total persons normally living in this house

Total number of families in this house

Section 2: Rights

1. How long has your family been living in this house?

1. Less than six months

2. Six months to 1 year

3. Over 1 year less than 3 years

4. 3 years to less than 5 years

5. 5 years to less than 10 years

6. 10 years plus

2. Who owns this house?

3. Who owns the land this house sits on?

4. Is anyone in this household married to a local landowner?

1. Yes

2. No

5. Are there any other relatives, not living in this house, married to a person from one of the Mine villages?

1. Yes

2. No

6. Is anyone in this household married to a person from Western Province (other than Mine villages)?

1. Yes

2. No

7. If you answered yes to any of the above questions, explain if these relationships have offered your household any benefits.

8. Do you pay rent to occupy this land and/or this house?

1. Yes

2. No

9. How much, how often and to whom do you pay rent?

	How Much	How Frequently (1_Weekly; 2_Fortnightly; 3_Monthly; 4_Half yearly; 5_Ad hoc; 6_Annually)	To Whom (1_OTML; 2_Private; 3_Governmet; 4_Church; 5_Landowner; 6_Don't know; 7_Other-Specify...)
House

Land

House & Land

10. What is the size of land & house rented?

11. How many persons in this household work for a land-owner company?

12. How many persons in this household have a business partnership with a land-owner company?

12s. If not “0” or nil, specify type of business:

Section 3: Land-Use and Land Capacity

13. Does this household have a food garden?

1. Yes

2. No

14. What is the size of the food garden?

15. What is the age of the food garden?

1. Less than six months

2. Six months to a year

3. One to two years

4. Three to five years

5. Over five years

16. How far away is the food garden?

1. Close by – 1 to 15 mins away

2. Some distance – 15 to 60 mins

3. Distant – 1 to 3 hrs away

4. Very distant – over 3 hrs away

Crops

	Crop Name	Size/Yield	% personal consumption	Income	Problem
Crop 1

Crop 2

Crop 3

Crop 4

Crop 5

Crop 6

Crop 7

Crop 8

Crop 9

Crop 10

18. How often do you attend the garden?

1. Daily

2. Few days a week

3. One day per weekly

4. A few days a month

19. Does this household keep any commercial animals?

1. Yes

2. No

20. How long has this household kept commercial animals?

1. Less than six months

2. Six months to a year

3. One to two years

4. Three to five years

5. Over five years

21. How far away are the animals kept?

1. Close by – 1 to 15 mins away

2. Some distance – 15 to 60 mins

3. Distant – 1 to 3 hrs away

4. Very distant – over 3 hrs away

22. In what kind of facilities are the animals kept?

1. Bush material fence & shelter

2. Semi-permanent fence & shelter/shed

3. Permanent, secure fence & sty/barn

Other

23. Commercial Animals

	Animal type	# of animals	Time allocated per week (1_Daily; 2_Few days a week; 3_One day per week; 4_A few days a month)	% personal consumption	How often sale made (1_Daily; 2_Few times a week; 3_Once per week; 4_Once per month; 5_Annualy; 6_Rarely)	How much per sale	Problems faced
Livestock 1

Livestock 2

Livestock 3

Livestock 4

Section 4: Access to Services

24. How often do you visit Tabubil town?

25. What was the main purpose of your last visit to Tabubil town?

26. How long was your last visit to Tabubil town?

27. How do household members usually travel to Tabubil town?

28. Does this household own any vehicles?

1. Yes

2. No

29. Enter the number of vehicles owned by the household.

	Number
Motor bike

2WD

4WD

Taxi

Minibus

Light Truck

PMV

30. Do household members use PMVs?

1. Yes

2. No

31. How far is the nearest bus stop?

1. Close by – 1 to 15 mins away

2. Some distance – 15 to 60 mins

3. Distant – 1 to 3 hrs away

4. Very distant – over 3 hrs away

32. How many members of the household mostly walk (rather than using other forms of transport)?

33. How many members of the household travel between Tabubil & Kiunga by road?

zero/nil

Other

34. How often do member(s) of the household travel between Tabubil & Kiunga by road?

35. What was the purpose of the last visit to Kiunga?

36. How much does the trip cost the household member(s) to Kiunga (one way)?

37. How many members of the household have undertaken air travel in the past 12 months?

Zero/Nil

Other

38. What was the purpose of the last air travel undertaken?

39. Who paid for the last air travel undertaken?

1. Household

2. Relative(s) outside of household

3. Community (fund raising)

4. Employer

Other

40. How much does the household pay (per fortnight) for any water used?

41. How much does the household pay (per fortnight) for any electricity used?

1. Does not pay

2. Less than K10

3. K10 to less than K20

4. K20 to less than K50

5. K50 or more

6. Household does not have power

Other

42. How often does the household experience power outages?

1. Several times a day

2. Several times a week

3. Several times a month

4. Never

43. If you use firewood for cooking, where do get most of your wood?

44. How often does waste (garbage) collection occur?

1. Weekly (or more)

2. Fortnightly

3. Monthly

4. No waste collection

45. How much does household pay (per fortnight) for waste collection?

1. Does not pay

2. Less than K5

3. K5 to less than K10

4. K10 to less than K20

5. K20 to less than K50

6. K50 or more

46. How is household waste (garbage) disposed?

1. Burnt

2. Buried

3. Removed by household to official town dump site

4. Removed by household to settlement dump site

Other

47. How far away is the waste disposal site used by this household?

1. Close by – 1 to 15 mins away

2. Some distance – 15 to 60 mins

3. Distant – 1 to 3 hrs away

4. Very distant – over 3 hrs away

48. How is grey water (used dirty water) disposed?

1. Thrown out on the ground

2. Thrown down sink (in-house piping)

3. Poured into drain/ditch

4. Don’t know

5. Creek

Other

49. How many operational mobile phones in household?

50. How much does household spend per fortnight on phone credits?

1. Does not pay

2. Less than K5

3. K5 to less than K20

4. K20 to less than K50

5. K50 to less than K100

6. K100 to less than K250

7. K250 to less than K500

8. Over K500

51. Is there a working computer in the house?

1. Yes

2. No

52. Do household members use a computer elsewhere?

1. School

2. Place of work

3. Friends/Relatives

4. Computer is not used by household member

Other

53. Does any member of this household regularly access the internet?

1. Yes

2. No

54. What are the law and order problems and how serious are they, how often do they occur and, how are they resolved?

	Law & Order Problem	Level of Problem (1_Small; 2_Serious; 3_Major)	Occurance of Problem (1_Daily; 2_Several times a week; 3_Several times a monht; 4_Rarely)	Problem Resolution (1_Not resolved; 2_Wantoks; 3_Police; 4_Security; 5_Magistrates; 6_Tabubil courts; 7_Provincial courts; 8_Other, specify ...)
Problem 1

Problem 2

Problem 3

Problem 4

Problem 5

55. Has any household member received any police assistance in the past 12 months?

1. Yes

2. No

56. Rate the quality of assistance received from the police.

57. In relation to law and order issues, have members in the household accessed any other services to seek assistance?

	Times sought in past 12 months	Quality of Assistance/Support	Importance of service to HH
Law & Order Committee

Community Leaders

Church Representative

Village Court

Mediators

OTML

Other Courts

Other ...

58. What, if any, is the biggest obstacle to accessing law and justice services?

59. What are the major health issues affecting the household?

60. Where do you go to access health services?

	# visits past 12 months	Estimated cost of service per visit	Rating of Service Provider (1_Poor; 2_Fair; 3_Average; 4_Good; 5_Excellent)	Importants of Service to HH (1_Not important; 2_Important; 3_Very important)
Govt. Health Facility

OTML Health Facility

Private Health Facility

Aid Post

Church

Other

61. Other than health providers, who else provides the household with information and advice on health and health services?

62. What, if any, is the biggest obstacle for you in accessing health services?

1. No obstacles

2. Communications (phone, either end)

3. Transport / Road Access

4. Language

Other

63. Are there any children in this household?

1. Yes

2. No

64. Are there school aged children in this household (under 20 years old)?

1. Yes

2. No

65. Cost of Education – inclusive of fees, uniforms and extras

	Number of children attending	Language of Instruction (1_Tok Ples; 2_Tok Pisin; 3_English)	Total expense for all children in these levels (K per year)	Any support received (1_Employer; 2_CMCA trust; 3_Other trust; 4_Family; 5_Other; 6_None)	How much support is received? (K per year)
Elementary (EP – E2)

Primary (P3 – P8)

Secondary (G9 – G10)

Secondary (G11 – G12)

Other

66. At what grade are any children in this household expected to leave school?

67. What do you expect your children to do when they leave school?

68. Are there any school aged children in this household who are not enrolled in school?

1. Yes

2. No

69. If answered yes to above question, identify number and gender

	Number
Boys

Girls

70. Reason why school aged child(ren) are not in school.

71. In the past 2 years have any adult members of this household undertaken any training courses?

	# of people from this Household who participated	Name of Course	Supplier	Cost	Who paid? (1_Employer; 2_CMCA trust; 3_Other trust; 4_Family; 5_Self; 6_Other)
Course 1

Course 2

Course 3

72. Do you ever meet with LLG Councillors?

1. Yes

2. No

73. If answered yes above, please list items of discussion.

74. Is anyone in the household a member of a board?

1. Yes

2. No

75. If answered yes above, please list boards.

76. Identify community organisations in your settlement, their purpose, examples of their success and quality of their work.

	Name of organisation or committee	Purpose	Examples of their success and why?	Quality of their Work? (1_Poor; 2_Fair; 3_Average; 4_Good; 5_Excellent)
CommOrg1

CommOrg2

CommOrg3

77. Please rate the Basic Social Service listed below.

End of Settlement Assessment Form

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