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| Participant's identification code | |__||__||__||__||__||__| |
| Person measuring weight (identification code) | |__||__| |
| Date (ddmmyyyy) | |__||__|.|__||__|.|__||__||__||__| |
| Weight (kg) | |__||__||__|.|__| |
| If participant is not weighed, give reason: 1 = pregnant women 2 = wheelchair bound 3 = unsteady stance 4 = weight exceeds upper limit of scale (upper limit of the scale: |__||__||__| kg) 5 = refused 6 = other, specify: |
|__| |
| Describe special conditions, if any: |
| Person measuring height (identification code) | |__||__| |
| Date (ddmmyyyy) | |__||__|.|__||__|.|__||__||__||__| |
| Height (cm) | |__||__||__|.|__| |
| If no height measurement was made, give reason: 1 = hairstyle, head gear 2 = wheelchair bound 3 = unsteady stance 4 = height exceeds upper limit of stadiometer (upper limit of the stadiometer: |__||__||__| cm ) 5 = refused 6 = other, specify: |
|__| |
| Describe special conditions, if any: |
| Person measuring waist and hip (identification code) | |__||__| |
| Date (ddmmyyyy) | |__||__|.|__||__|.|__||__||__||__| |
| Waist circumference (cm) | |__||__||__|.|__| |
| Hip circumference (cm) | |__||__||__|.|__| |
| If no waist/hip circumference measurement was
made, give reason: 1 = pregnant woman 2 = wheelchair bound 3 = unsteady stance 4 = circumference exceeds length of tape (length of tape: |__||__||__| cm ) 5 = refused 6 = other, specify: |
|__| |
| Describe special conditions, if any: |