Household needs assessment form
The form prepared for field use and the method behind it: the coding that prevents duplicate records, the rules of a household visit and how the data collected is protected. Your organisation may use it as it stands.
Field tool 10 min read Print-ready CC BY-NC 4.0
Adapt it for your organisation. Print the form from this page and use it as it is, or rebuild it under your own letterhead (CC BY-NC 4.0). If you need it in an editable file format, write to us and we will send one.
Why
Fair aid depends on the quality of the record
In the first days of a disaster, aid goes to whoever asks loudest. The households that go unheard — those with a housebound older relative, those who do not speak the language, those working without papers, those afraid of being stigmatised — are usually the ones in greatest need. Systematic household visiting is the only known way to correct that inequity.
The second problem is duplication: three teams visit the same house, all three fill in a form, one leaves a box, and two households are never visited at all. The coding below exists precisely to stop that.
Third and most important: collecting data is itself an intervention. Knocking on a door, asking questions and then doing nothing damages that household's trust in aid for a long time. Do not collect information you cannot act on.
Coding
The household code that prevents duplicates
Each household is given a code that stays fixed across visits. The code contains no identity number — which matters both for privacy and for matching.
Structure of the code
LFK · 07 · 0142 · A
- LFK
- District abbreviation — Nicosia (LFK), Famagusta (MGS), Kyrenia (GRN), Morphou (GZY), Iskele (ISK)
- 07
- Neighbourhood or zone number, from the field map used to allocate teams
- 0142
- Household sequence number — issued in order within the zone and never reused
- A
- A separate household at the same address — A and B for two families living together
Three rules in the field
- The code goes on the form, not on the door. Marking doors stigmatises a household and exposes it to theft. Marking is only the standard practice of search and rescue teams.
- A revisit does not get a new code. A new dated line is opened under the same code, so that changes in need over time are visible.
- One person holds the code book. The zone lead enters the day's codes into the central list; two teams can never issue the same number.
Field rules
Before you knock
Introduce yourself and ask consent
Name, organisation, visible badge. Explain in three sentences why you are asking, where the information goes and how long it will take. Refusing is their right, and refusing does not remove them from assistance.
Make no promises
Do not say "a tent will come tomorrow". Say: "I will pass this to the distribution team; the decision is not mine." A broken promise ends the next team's work before it starts.
Pairs, mixed gender
Household visits are never done alone. Where possible the pair includes a woman; some needs are only voiced then.
The household, not the head of it
One person's account can hide the needs of the women, older people and children in the house. Speak with more than one person where you can.
No photographs
Do not photograph inside homes, children or damage. If images are needed for fundraising, they are gathered separately with explicit consent.
Report protection risks
If you see neglect, violence, abuse or an unaccompanied child, do not stop at filling in the form; report it to the protection lead the same day.
Data protection
What you collect is personal data
The health, disability and household information on this form falls under the North Cyprus Personal Data Protection Law (89/2007). Teams using the form must follow these rules:
- Only the minimum information needed to plan assistance is collected
- Paper forms are collected into a locked cabinet at the end of the day and never left in the field
- Digital records are encrypted and accessible only to authorised staff
- Sharing with third organisations happens only with the person's informed consent
- Records are destroyed once the purpose no longer applies
- Everyone has the right to access, correct and request erasure of their own data
For detail, see our privacy notice.
Form
Household needs assessment
Household code: Date / time: Team: Visit no:
A · Household composition
Total people · adults · children (0–17)
Number aged 0–2 · 3–5 · 6–11 · 12–17
Number aged over 65
Anyone pregnant or breastfeeding
Languages spoken in the household
B · Shelter
- At home — no damage
- At home — light damage
- Home unusable — staying with relatives
- Tent / temporary shelter site
- In a vehicle or in the open
Current address / site
Heating · lighting
C · Basic needs
Mark as have / partial / none; note quantities.
Drinking water · washing water
Food · infant formula
Blankets · clothing · shoes
Hygiene · nappies · sanitary items
Access to a toilet and to washing
D · Health
Anyone injured or needing treatment
Chronic conditions · medication running out
Disability · equipment used
Request for mental health support
Medical device dependent on electricity
E · Protection and education
- An unaccompanied child in the household
- Someone separated from their family
- An older or housebound person living alone
- Children unable to attend school
- An urgent protection report has been made
If reported — to whom, when
F · Prioritisation
Team judgement; sets the distribution order.
- Urgent — medical emergency, exposure, unprotected child
- High — one basic need entirely unmet
- Medium — needs partly met
- Monitor — sufficient for now, revisit
Referral made — where to
Revisit date
G · Team notes and sign-off
Observations / notes
Interviewer — name, signature
Second team member
Information given and consent obtained
This form contains personal data. It is handed to the zone lead at the end of the day and never left in the field or in a vehicle. It is processed under North Cyprus law 89/2007; the household has the right to access its data and request erasure.
Common mistakes
Four ways the form stops working
- Too many questions. A thirty-minute interview exhausts the household and cuts the team's daily capacity. A form that fills in ten minutes is a form that gets filled in.
- Skipping the code. A code left for later is never written, and that form becomes a duplicate record.
- Data not connected to distribution. If what is collected does not become a distribution list the same day, the process stalls and trust in the household is gone.
- Settling for one account. What the person who opens the door describes is not the need of everyone in the house.
References
Where the information on this page comes from
The form headings and field rules are adapted from the standards below. The household coding system and the priority tiers are TAKDER's recommendation.
- Minimum humanitarian standards
- Sphere Association (2018). The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. spherestandards.org
- Accountability and community participation
- CHS Alliance (2014). Core Humanitarian Standard on Quality and Accountability. corehumanitarianstandard.org
- Needs assessment methodology
- IASC Needs Assessment Task Force (2012). Multi-Sector Initial Rapid Assessment (MIRA) Guidance. interagencystandingcommittee.org
- Child protection reporting
- The Alliance for Child Protection in Humanitarian Action (2019). Minimum Standards for Child Protection in Humanitarian Action. alliancecpha.org
- Data protection
- North Cyprus Personal Data Protection Law, no. 89/2007.
Links go to the publisher; last accessed 11 September 2026. If you spot an error in a citation, tell us and we will correct it.