Republic of the Philippines

Department of Education
Region VI – Western Visayas
Division of Capiz
VICENTE ANDAYA SR. NATIONAL HIGH SCHOOL
Sigma, Capiz

Dear Respondents:

We are presently conducting a study entitled “Level of

Awareness in the Implementation of Anti-Smoking Ordinance no.1
Series of 2015”. In partial fulfilment of the requirements for
our subject Research Report. In this connection, we would like to
solicit your kind indulgence as a respondent to this study.
Please do not leave any item unanswered. And rest assured that
whatever information you will import will be used for research
purposes only.

Thank you very much.

Very truly yours,

AFRILYN FALCO
APRIL GHIE ANN FABRIGAR
ZION MARC OBERA
JIMMUEL VERNISTO
Researchers

QUESTIONNAIRE

Part I. PROFILE OF RESPONDENTS

Direction: Indicate your answer by filling in the blank or

by putting a check (√) on the boxes that corresponds to
your choice.

A. Name (Optional):

Sex: /__/ Male /__/ Female

Age: Monthly income:

Occupation:
Part II. SURVEY QUESTIONNAIRE

Direction: Put a check in the box provided if you are highly

aware (5 pts), Aware (4 pts), moderately aware (3 pts), slightly
aware (2 pts), Unaware (1 pt).

HA A MA SA UA
Awareness
5 4 3 2 1
A. Implementing Rules and Regulations
Act- refers to Republic Act No. 9211,
otherwise known as the Regulation Act
Cigarette refers to any roll or tubular
construction, which contains tobacco or
its derivatives and its intended to be
burned or heated under ordinary
conditions of use.
There is a designated smoking and non-
smoking areas on private and public
places.
There is a standard for designated
smoking – area.
There is a signage for designated smoking
and non-smoking areas.
B. Penalties
Violations of Section 5 and 6 of the Act.
On the first offense, a fine of not less
than Five Hundred Pesos (Php500.00) but
not more than One Thousand (Php1,000.00)
shall be imposed.
C. Health
Tobacco use is a global epidemic among
young people. As with adults, it poses a
serious health threat to youth and young
adults in the United States and has
significant implications for this
nation’s public and economic health in
the future (Perry et al. 1994; Kessler
1995). The impact of cigarette smoking
and other tobacco use on chronic disease,
which accounts for 75% of American
spending on health care (Anderson 2010),
is well-documented and undeniable.
Although progress has been made since the
first