CAMBODIA NATIONAL
LEVEL 1 SURVEY
MINE/UXO VICTIMS
PERIOD FROM 1 AUGUST 1998 TO PRESENT
 
Revision as of 8 July 2001       QUESTIONNAIRE DATA                            
                                                             
Inside Suspected Area Dead     Injury     Sub-total
 
      TOTAL          
                                                       
Outside Suspected Area Dead     Injury     Sub-total                  
                                                             
 
Phum                     Phum Code       Date of interview  
Number Location of Incident Date of Incident             Sex Age Assosiated Activity Outcome
In Suspected Outside Suspected Area Don't Know Name of victims injured or killed in this village Farminig/Herding Attemping Business Travelling Collection forestry product Fishing Military activity Other activity Don't know Dead Injury Detail Don't know dead or injury
Known Area Unknown Area   Amputation Other injury Don't know
Khmer Latin
                                                             
                                                             
                                                             
                                                             
                                                             
                                                             
                                                             
                                                             
Village Chief comment DT#  
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