| Q. No | Questions | Response | Code |
| 1 | Interviewer number: | …………………………………………….………………… |
|
| 2 | Community name | ……………………………………………………………… |
|
| 3 | Sub-district | ……………………………………………………………… |
|
| 4 | District | ……………………………………………………………… |
|
| 5 | Sex of respondent | Male………………………………………………………… Female……………………………………………………… | 1 2 |
| 6 | Age | 20 and below ……………………………………………… 21 - 30……………………………………………………… 31 - 40…………………………………………….................. 41 - 50……………………………………………………… 51 - 60……………………………………………………… 61 and above………………………………………………… | 1 2 3 4 5 6 |
| 7 | Education | No formal education ……………………………………. Primary ……………………………………………… JHS ……………….................................................................. SHS ………………................................................................. Voc/Tech …………………………………………………… Tertiary …………………………………..………………… | 1 2 3 4 5 6 |
| 8 | Ethnic Group | Ga…………………………………………………………… Ewe………………………………………………………… Akan…………………………………………………............. Other…………………………………………………............ | 1 2 3 96 |
| 9 | Religion | Christianity……………………………………………… Islamic……………………………………………………… Traditional…………………………………………………… No religion ….……………………………………………… Other………………………………………………………… | 1 2 3 4 96 |
| 10 | Main occupation | Trade/Business……………………………………………… Farming……………………………………………………… Fishing………………………………………………….......... Farming + Fishing…………………………….…………….. Casual labour/Sand winning……………………………… Official employee…………………………………….…….. Other specify……………………………………………….. | 1 2 3 4 5 6 96 |