Canoog cbm system by sitio
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This document contains a household profile questionnaire with demographic information about 5 individuals living in Cebu, Philippines. Key details include: - The household is located in Barangay Sac-sac, Purok Asucena in Consolacion, Cebu. - Of the 5 individuals, 3 are male and 2 are female, with ages ranging from 21 to 61-65. - All 5 individuals are Catholic and have at least a high school education. - 2 individuals are members of a religious community organization and 4 out of 5 voted in the last local election. - Only 1 individual had a job in the last 3 months working as an official in government.
Canoog cbm system by sitio
- 1. Community-Based Monitoring System Household Profile Questionnaire CONFIDENTIALITY A. IDENTIFICATION I. Identification of Location a. Province : Cebu______________________________________ b. City/Municipality :_Consolacion__________________________________________ c. Barangay : _Sac-sac_________________________________________ d. Purok: _Asucena_________________________________________ B. Demography Frequency Percentage 4. Sex 1. Male 3 60% 2. Female 2 40% 5. Date of birth 6. AGE 0-5 0 0% 6 10 0 0% 11 15 0 0% 16 20 0 0% 21 25 1 20% 26 30 1 20& 31 35 1 20% 36 40 0 0% 41 45 0 0% 46 50 0 0% 51 55 0 0% 56 60 0 0% 61 65 2 40% 7. Marital status 1 - Single 3 60% 2 - Legally Married 2 40& 3 - Widowed 0 0% 4 - Divorced/ Separated 0 0% 5 - "Live in" 0 0% 6 - Unknown 0 0% 1
- 2. 8. Religious affiliation 1 - Catholic 5 100% 2 - Protestant 0 0% 3 - IglesianiKristo 0 0% 4 - Aglipay 0 0% 5 - Islam 0 0% 6 - Others, specify 0 0% 7 - None 0 0% 1 - Catholic C. EDUCATION AND LITERACY 9. Attending school Yes 1 20% No 10. What grade or year 1. No Grade Completed 2. Day Care 3. Kindergarten 4. Grade I 5. Grade II 6. Grade III 7. Grade IV 8. Grade V 9. Grade VI 10. Elementary Graduate 11. 1st Year HS 12. 2nd Year HS 13. 3rd Year HS 14. 4th Year HS 15. HS Graduate 16. 1st Year COLLEGE 1 20% 17. 2nd Year 18. 3rd Year 19. 4th Year 20. College Graduate 21. Post Grad w/ units 22. Graduate (specify PhD /Master's course) 11. Type of school? 1. Public 0 0% 2. Private 5 100% 3. Vocational 12. Highest educational attainment? 1. No Grade Completed 1 2. Day Care 3. Kindergarten 4. Grade I 5. Grade II 1 20% 2
- 3. 6. Grade III 7. Grade IV 8. Grade V 9. Grade VI 10. Elementary Graduate 1 20% 11. 1st Year HS 12. 2nd Year HS 13. 3rd Year HS 14. 4th Year HS 15. HS Graduate 2 40% 16. 1st Year COLLEGE 17. 2nd Year 18. 3rd Year 19. 4th Year 20. College Graduate 21. Post Grad w/ units 22. Graduate (specify PhD /Master's course) 13. Can __ read and write a simple message in any language or dialect Yes 5 100% No 0 0% D. COMMUNITY & POLITICAL PARTICIPATION 14. Member of a community organization Yes 2 40% No 3 60% 15. Name of community organization 1 - Religious 2 - Youth 3 - Cultural 4 - Political 5 - Womens 6 Agricultural 7 - Labor 8 Civic 9 Cooperatives 10 - Senior citizens 2 40% 11 - Others, specify 16. Registered voter in the municipality Yes 5 100% No 0 0% 17. Voted in the last election Yes 4 80% No 1 20% 3
- 4. E. NUTRITION 18. NUTRITIONAL STATUS OF CHILDREN 0-5 YEARS OLD 1) Above normal 2) 3) 4) Normal 5) Below normal F. ECONOMIC ACTIVITY 19. Have a job or business during the last three months Yes 1 20% No 4 80% 20. Primary job, occupation or business during the past three months 1. Officials of government and 1 20%1 special interest organization, corporate executives, managers, managing proprietors and supervisors 2. Professionals 3. Technicians and associate professionals 4. Clerks 5. Service workers and shop and market sales workers 6. Farmers, forestry workers and fisherfolk 7. Trades and related workers 8. Plant and machine operators and assemblers 9. Laborers and unskilled workers 10. Special occupations 21. Nature of employment 1. Permanent job, business unpaid family work 2. Short-term or seasonal or casual job/ business 3. Worked on different jobs on day to day or week to week 22. Average Monthly Income 1. No Income 2. Below P5,000 3. 5,001 10,000 1 20% 4. 10,001 20,000 5. 20,001 40,000 6. 40,001 60,000 7. 60, 001 100,000 8. 100,001 - above 4
- 5. 23. Classification of job or employment 1.Worked for a household 2.Worked for a private 1 20% establishment 3.Worked for government/government corporation 4.Self employed without employees 5.Employer in own family operated farm or business 6.Worked with pay on own family operated farm or business 7. Worked without pay on own family operated farm or business 24. Looking for work/try to establish business during the past three months Yes 4 80% No 25. Activities to look for work 1. Registered in public employment agency 2. Registered in private 1 20% employment agency 3. Approached employer 2 40% directly 4. Approached relatives / friends 5. Placed or answered private advertisements 6. Others (specify) 26. Reasons did not look for work during the past three months 1. Believes no work is available 2. Awaiting results of previous job application 3. Temporary illness/ disability 4. Bad weather 5. Waiting for rehire/job recall 6. Too young/old, retired permanently disabled 7. Housekeeping 8. Schooling 9. Other reasons (specify) 27. The last time looked for work 28. Opportunity for work existed during 5
- 6. the last 3 months or the next month, would __ have been available 29. Willingness to take up work during the past 3 months or within the next month G. HEALTH 31. has been sick and unable to engage in normal activities Yes 0 0% No 5 100% 32. nature of illness 1. Diarrhea 2. Pneumonia 3. Stomach ailment 4. TB/Pulmonary illness 5. Dengue fever 6. Typhoid 7. Asthma 8. UTI 9. Animal Bites 10. Skin Disease 11. Cough/Cold 12. Flu/Fever 13. Others pls specify: 33. avail of medical treatment for the illness Yes No 34. Where did you go to avail medical treatment 1. Public hospital (Provincial hospital) 2. Public hospital (Municipal/City hospital) 3. Public hospital (District hospital) 4. Public hospital (National) 5. Private Hospital/Clinic 6. Rural Health Units 1 7. Brgy. Health Center 8. Non-medical/non-trained Hilot/Personnel 9. Others, specify 35. reason why did not seek health care 1. Illness was not severe 2. Lack of available health care 3. Cost of medicine 6
- 7. 4. Distance 5. Lack of transportation 6. No one available to take the child 7. Other, pls specify 8. Illness was not severe H. PEACE AND ORDER 36. member of the household been a victim of any crime Yes 0 0% No 5 100% 37. type of crime 1. Murder/ Homicide 2. Theft/ Robbery 3. Rape 4. Physical Injury 5. Others, specify I. WATER AND SANITATION 38. main source of drinking water 1. Community water system 1 20% - own use 2. Community water system - shared with other households 3. Artesian deep well - own use 4. Artesian deep well - shared with other 5. Artesian shallow well - own use 6. Artesian shallow well - shared with other households 7. Dug/shallow well - own use 8. Dug/shallow well - shared with other households 9. River, stream, lake, spring and other bodies of water 10. Bottled water/Purified/Distilled water 11. Tanker truck/Peddler 12. Other sources (specify) 39. distance of the source of drinking water from your house 1. Within premises 2. Outside premises but 250 1 100% meters or less 3. 251 meters or more 4. Don't know 7
- 8. 40. kind of toilet facility does the household use 1. Water sealed flush to 1 100% sewerage system/ septic tank - own use 2. Water sealed flush to sewerage system/ septic tank - shared with other house holds 3. Closed pit 4. Open pit 5. No toilet 6. Others pls specify J. HOUSING 41. tenure status of the housing unit and lot occupied by your household 1. Owner, owner-like 1 100% possession of house and lot 2. Rent house/ -room including lot 3. Own house, rent lot 4. Own house, rent-free lot with consent of owner 5. Own house, rent-free lot without consent of owner 6. Rent-free house and lot with consent of owner 7. Rent-free house and lot without consent of owner 8. Other, pls specify 41. appliances in the household own any of the following item 1. Radio / Radio Cassette 1 2. Television 1 3. CD/VCD/DVD player 1 4. Stereo/Component 5. Karaoke 6. Videoke 7. Refrigerator / Freezer 8. Electric Fan 1 9. Electric Iron 1 10. LPG Gas Stove/Range 1 11. Washing Machine 12. Microwave Oven 13. Personal Computer 14. Mobile Phone / 1 Cellular Phone 15. Landline Telephone 16. Air-conditioner 17. Sewing Machine 18. Car, Jeep, 8
- 9. Motorcycle/other motorized vehicles Others (specify) 19. Radio / Radio Cassette 20. Television 21. CD/VCD/DVD player 22. Stereo/Component 42. Construction materials used on the WALLS of the house 1. Strong materials (concrete, 1 100% brick, stone, wood, galvanized iron, asbestos) 2. Light materials (bamboo, sawali, cogon, nipa) 3. Salvaged/make-shift materials 4. Mixed but predominantly strong materials 5. Mixed but predominantly light materials 6. Mixed but predominantly salvaged materials 43. Construction materials used on the ROOF of the house 1. Strong materials (concrete, 1 100% brick, stone, wood, galvanized iron, asbestos) 2. Light materials (bamboo, sawali, cogon, nipa) 3. Salvaged/make-shift materials 4. Mixed but predominantly strong materials 5. Mixed but predominantly light materials 6. Mixed but predominantly salvaged materials 9