Questionnaire For Civil Society Organizations

QUESTIONNAIRE FOR CIVIL SOCIETY ORGANIZATIONS (CSOs)
on the results of the

CITIZEN SATISFACTION INDEX SYSTEM (CSIS) Survey
TALATANUNGAN PARA SA SAMBAYANANG ORGANISASYON sa naging resulta ng Sarbey ukol sa
CITIZEN SATISFACTION INDEX SYSTEM (CSIS)
A. Profile of the CSO
Civil Society Organization (Sambayanang Organisasyon): _________________________
Office Address (in Moncada) (Lugar ng Opisina): _____________________________
Name of Representative (Pangalan ng kinatawan): _____________________
Current Position (Kasalukuyang Katungkulan): _________________
Number of years active as a CSO member (Bilang ng taong aktibong miyembro ng CSO):
______________
Estimated Number of Organization Members (Tantiyadong bilang ng miyembro sa Organisasyon):

________
Sector Represented (Sektor na kinakatawan): __________________
Residence of the members (Tirahan ng mga miyembro)

(pls check the Barangays) Lagyan ng tsek
___Ablang-Sapang ___Calamay ___Lapsing ___San Juan ___Santa Monica
___Aringin ___Calapan ___Mabini ___San Julian ___Tolega Norte
___Atencio ___Camangaan East ___Maluac ___San Leon ___Tolega Sur
___Banaoang East ___Camangaan West ___Poblacion 1 ___San Pedro ___Tubectubang
___Banaoang West ___Camposanto 1 - ___Poblacion 2 ___San Roque ___Villa
Norte
___Baquero Norte ___Camposanto 1 - ___Poblacion 3 ___Santa Lucia
Sur East
___Baquero Sur ___Camposanto 2 ___Poblacion 4 ___Santa Lucia
West
___Burgos ___Capaoayan ___Rizal ___Santa Maria
Regular Programs/Projects/Services Conducted Annually (Karaniwang Programa/ Proyekto/ Serbisyo na

isinasagawa taon-taon) (Pls Enumerate) Maaaring isa-isahin.
Name of Program/Project/Service (Pangalan ng Programa/ Coverage (Please check)
Proyekto/ Serbisyo) Saklaw (Lagyan ng tsek)
All Members in all Selected Members/
(Please use a separate sheet if necessary) Barangays Selected Barangays
(Maaaring gumamit ng ibang papel kung kinakailangan) Lahat ng miyembro only
sa lahat ng Piling miyembro/
barangay Piling barangay
lamang
1.
2.
3.
4.
5.
Special Programs/Projects/Services Conducted in 2018-2019 (Pls Enumerate) Natatanging Programa/

Proyekto/ Serbisyong isinagawa noong taong 2018-2019 (Maaaring isa-isahin)
Name of Program/Project/Service (Pangalan ng Programa/ Coverage (Please check)

Proyekto/ Serbisyo) Saklaw (Lagyan ng tsek)
All Members in all Selected Members/
(Please use a separate sheet if necessary) Barangays Selected Barangays
(Maaaring gumamit ng ibang papel kung kinakailangan) Lahat ng only
miyembro sa lahat Piling miyembro/
ng barangay Piling barangay
lamang
1.
2.
3.
4.
5.
A. Awareness and Understanding of the CSIS Survey (as a whole)

(Pagbatid at Pag-unawa sa CSIS Sarbey)
Level of Awareness on the CSIS Survey (pls check)
Antas ng pagbatid sa CSIS Sarbey (Lagyan ng tsek)
__ I am Extremely __ I am Very ___ I am ___ I am Slightly ___ I am Not

Aware Aware Moderately Aware Aware Aware at all
Lubusang Nabatid Katamtamang Bahagyang Hindi nabatid
nabatid nabatid nabatid
Level of Understanding on the purpose of CSIS Survey (pls check)
Antas ng Pag-unawa sa layunin ng CSIS Sarbey (Lagyan ng tsek)
__ I tremendously __I Very much ___ I Moderately ___ I Slightly ___I do Not
understand Understand Understand Understand Understand at all
Lubusang Naunawaan Katamtamang Bahagyang Hindi naunawaan
naunawaan naunawaan naunawaan
B. Feedback per Service Area

Tugon sa bawat Serbisyo
i. Health Services
Serbisyong Pangkalusugan
Level of Acceptability of the Results
Antas ng pagtanggap sa resulta
__ Highly __Acceptable ___ Neutral ___ Unacceptable ___Highly

Acceptable Katanggap- Katamtaman Hindi katanggap- Unacceptable
Lubos na tanggap tanggap Lubhang hindi
katanggap- katanggap-
tanggap tanggap
Level of Agreement on the Results
Antas ng Pagsang-ayon sa resulta
__ Strongly Agree __ Agree ___ Neither Agree ___ Disagree ___ Strongly
Lubos na Sumasang-ayon Nor Disagree Hindi sumasang- Disagree
sumasang-ayon Ni sumasang- ayon Lubos na hindi
ayon o di- sumasang-ayon
sumasang-ayon
Level of Agreement on the Comments/Suggestions of the Citizens
Antas ng Pagsang-ayon sa puna at mungkahi ng mga mamamayan
sumasang-ayon Ni sumasang- ayon Lubos na hindi
ayon o hindi sumasang-ayon
sumasang-ayon
Justification for the Feedback of Citizens
Pangangatuwiran sa puna ng mamamayan
What do you think is the reason why respondents gave the above comments/suggestions about the Health
Services of the LGU? What is your response to those?
Ano sa tingin mo ang naging dahilan kung bakit nagbigay ang mga tagatugon ng katulad na
puna/suhestiyon ng nasa itaas tungkol sa Serbisyong Pangkalusugan ng LGU? Ano ang iyong tugon
sa mga ito?
Programs of the Organization and Future Plan of Action
Programa ng Organisasyon at Mga Planong hakbang
Do you have programs that help address health What are your future plans of action taking into
concerns of the citizens? If yes, please enumerate account their current concerns?
these.
May mga programa bang tumutugon sa Ano ang iyong planong hakbang na
pangangailangang pangkalusugan ng magsasaalang-alang sa kanilang
mamamayan? Kung oo, isa-isahin ang mga kasalukuyang pangangailangan?
ito.
ii. Support to Education

Suporta sa Edukasyon

tanggap tanggap
sumasang-ayon Ni sumasang-ayon ayon Lubos na hindi
o di-sumasang- sumasang-ayon
ayon
o hindi sumasang- sumasang-ayon
ayon
What do you think is the reason why respondents gave the above comments/suggestions about the Support to
Education Services of the LGU? What is your response to those?
puna/suhestiyon ng nasa itaas tungkol sa Serbisyong Sumusuporta sa Edukasyon ng LGU? Ano ang
iyong tugon sa mga ito?
Do you have programs that help address support What are your future plans of action taking into
to education concerns of the citizens? If yes, account their current concerns?
please enumerate these.
pangangailangang sumusuporta sa magsasaalang-alang sa kanilang
edukasyon ng mamamayan? Kung oo, isa- kasalukuyang pangangailangan?
isahin ang mga ito.
iii. Social Welfare

Kapakanang Panlipunan

tanggap tanggap
ayon
ayon
What do you think is the reason why respondents gave the above comments/suggestions about the Social
Welfare Services of the LGU? What is your response to those?
puna/suhestiyon ng nasa itaas tungkol sa Serbisyong Kapakanang Panlipunan ng LGU? Ano ang
Do you have programs that help address social What are your future plans of action taking into
welfare concerns of the citizens? If yes, please account their current concerns?
enumerate these.
pangangailan sa kapakanang panlipunan ng magsasaalang-alang sa kanilang
ito.
iv. Governance and Response
Pamamahala at Pagtugon

tanggap tanggap
ayon
ayon
What do you think is the reason why respondents gave the above comments/suggestions about the
Governance and Response Services of the LGU? What is your response to those?
puna/suhestiyon ng nasa itaas tungkol sa Serbisyong Pamamahala at pagtugon ng LGU? Ano ang
Do you have programs that help address What are your future plans of action taking into
governance and response concerns of the account their current concerns?
citizens? If yes, please enumerate these.
pangangailangan sa pamamahala at pagtugon magsasaalang-alang sa kanilang
ng mamamayan? Kung oo, isa-isahin ang mga kasalukuyang pangangailangan?
ito.
v. Public Works and Infrastructure

Pagawaing-bayan at Imprastraktura

tanggap tanggap
ayon
ayon
What do you think is the reason why respondents gave the above comments/suggestions about the Public
Works and Infrastructure Services of the LGU? What is your response to those?
puna/suhestiyon ng nasa itaas tungkol sa Serbisyong Pagawaing-bayan at Imprastraktura ng LGU?
Ano ang iyong tugon sa mga ito?
Do you have programs that help address public What are your future plans of action taking into
works and infrastructure concerns of the citizens? account their current concerns?
If yes, please enumerate these.
pangangailangan sa pagawaing-bayan at magsasaalang-alang sa kanilang
imprastraktura ng mamamayan? Kung oo, isa- kasalukuyang pangangailangan?
isahin ang mga ito.
vi. Environmental Management

Pamamahalang pangkapaligiran

tanggap tanggap
ayon
ayon
What do you think is the reason why respondents gave the above comments/suggestions about the
Environmental Management Program Services of the LGU? What is your response to those?
puna/suhestiyon ng nasa itaas tungkol sa Serbisyo at Programang Pamamahalang Pangkapaligiran ng
LGU? Ano ang iyong tugon sa mga ito?
environmental concerns of the citizens? If yes, account their current concerns?
please enumerate these.
pangangailangang pangkapaligiran ng magsasaalang-alang sa kanilang
ito.
vii. Economic and Investment Promotion

Pagtaguyod ng Pangkabuhayan at Pamumuhunan

tanggap tanggap
ayon
ayon
What do you think is the reason why respondents gave the above comments/suggestions about the Economic
and Investment Programs and services of the LGU? What is your response to those?
puna/suhestiyon ng nasa itaas tungkol sa Serbisyo at Programang Pagtataguyod ng Pangkabuhayan
at Pamumuhunan ng LGU? Ano ang iyong tugon sa mga ito?
economic and investment concerns of the account their current concerns?
citizens? If yes, please enumerate these.
pangangailangang pangkabuhayan at magsasaalang-alang sa kanilang
pamumuhunan ng mamamayan? Kung oo, isa- kasalukuyang pangangailangan?
isahin ang mga ito.
C. Feedback of the Overall Results of the Survey

Tugon sa Pangkalahatang Resulta ng Sarbey
Level of Acceptability of the Overall Results
Antas ng pagtanggap sa Pangkalahatang resulta

tanggap tanggap
Level of Agreement on the Overall Results
Antas ng Pagsang-ayon sa Pangkalahatang resulta
ayon
Level of Agreement on the Overall Comments/Suggestions of the Citizens
Antas ng Pagsang-ayon sa Pangkalahatang puna at mungkahi ng mga mamamayan
ayon
Level of Agreement on the Conclusion of the Study
Antas ng Pagsang-ayon sa Kongklusyon ng Pag-aaral
ayon
Level of Agreement on the Recommendations of the Study
Antas ng Pagsang-ayon sa Rekomendasyon ng Pag-aaral
ayon

Questionnaire For Civil Society Organizations

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QUESTIONNAIRE FOR CIVIL SOCIETY ORGANIZATIONS (CSOs)

on the results of the

A. Profile of the CSO

Civil Society Organization (Sambayanang Organisasyon): _________________________

Office Address (in Moncada) (Lugar ng Opisina): _____________________________

Name of Representative (Pangalan ng kinatawan): _____________________

Current Position (Kasalukuyang Katungkulan): _________________

Estimated Number of Organization Members (Tantiyadong bilang ng miyembro sa Organisasyon):

Sector Represented (Sektor na kinakatawan): __________________

Residence of the members (Tirahan ng mga miyembro)

Regular Programs/Projects/Services Conducted Annually (Karaniwang Programa/ Proyekto/ Serbisyo na

Special Programs/Projects/Services Conducted in 2018-2019 (Pls Enumerate) Natatanging Programa/

Name of Program/Project/Service (Pangalan ng Programa/ Coverage (Please check)

A. Awareness and Understanding of the CSIS Survey (as a whole)

Level of Awareness on the CSIS Survey (pls check)

Antas ng pagbatid sa CSIS Sarbey (Lagyan ng tsek)

__ I am Extremely __ I am Very ___ I am ___ I am Slightly ___ I am Not

Level of Understanding on the purpose of CSIS Survey (pls check)

Antas ng Pag-unawa sa layunin ng CSIS Sarbey (Lagyan ng tsek)

B. Feedback per Service Area

Level of Acceptability of the Results

Antas ng pagtanggap sa resulta

__ Highly __Acceptable ___ Neutral ___ Unacceptable ___Highly

Level of Agreement on the Results

Antas ng Pagsang-ayon sa resulta

Level of Agreement on the Comments/Suggestions of the Citizens

Antas ng Pagsang-ayon sa puna at mungkahi ng mga mamamayan

Justification for the Feedback of Citizens

Pangangatuwiran sa puna ng mamamayan

Programs of the Organization and Future Plan of Action

Programa ng Organisasyon at Mga Planong hakbang

ii. Support to Education

Level of Acceptability of the Results

Antas ng pagtanggap sa resulta

__ Highly __Acceptable ___ Neutral ___ Unacceptable ___Highly

Level of Agreement on the Results

Antas ng Pagsang-ayon sa resulta

Antas ng Pagsang-ayon sa puna at mungkahi ng mga mamamayan

Justification for the Feedback of Citizens

Pangangatuwiran sa puna ng mamamayan

Programs of the Organization and Future Plan of Action

Programa ng Organisasyon at Mga Planong hakbang

iii. Social Welfare

Level of Acceptability of the Results

Antas ng pagtanggap sa resulta

__ Highly __Acceptable ___ Neutral ___ Unacceptable ___Highly

Level of Agreement on the Results

Antas ng Pagsang-ayon sa resulta

Level of Agreement on the Comments/Suggestions of the Citizens

Antas ng Pagsang-ayon sa puna at mungkahi ng mga mamamayan

Justification for the Feedback of Citizens

Pangangatuwiran sa puna ng mamamayan

Programs of the Organization and Future Plan of Action

Programa ng Organisasyon at Mga Planong hakbang

Level of Acceptability of the Results

Antas ng pagtanggap sa resulta

__ Highly __Acceptable ___ Neutral ___ Unacceptable ___Highly

Level of Agreement on the Results

Antas ng Pagsang-ayon sa resulta

Level of Agreement on the Comments/Suggestions of the Citizens

Antas ng Pagsang-ayon sa puna at mungkahi ng mga mamamayan

Justification for the Feedback of Citizens

I am Extremely I am Very _ I am _ I am Slightly ___ I am Not

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly

Highly Acceptable _ Neutral _ Unacceptable ___Highly