Family Profile Data

Date: ____________
Primary Health Center:
Name of the Barangay:
I. Identification Information
Head of Family:
Age:
Occupation:
Address:
Type of Family:
___Nuclear ___Joint ___Single Parent ___Extended
Religion:
___Christian ___Muslim ___Hindu ___Others
II. Housing condition
Type of House:
___Completed ___Tiled ___Hut ___Owned ___Rented
Ventilation:
___Adequate ___Inadequate
Bathroom:
___Separate ___Common
Lighting:
___Electricity ___Oil lamp
Drainage:
___Open ___Close
Disposal of Waste:
___Composing ___Burning ___Buying

III. Family Composition

Name Relationshi Age Sex Educatio Occupatio Health Immunization
p with the n n Status
head of
family

Community Profile Data

Name of the Community:
Head of the Barangay/Community:

Name of the Street Number of Population Number of Registered

Voters

Total land area:

Barangay Basic Services:

Facilities Number of Facilities

Education Facilities
1. Day Care
2. Elementary
3. Secondary
4. Vocational
Health Facilities
1. Public medical Clinic
2. Hospitals
3. Maternal and Child Clinic
4. Barangay Health Centers
5. Drugstores
Services Facilities
1. Post Office
2. Police Station
3. Bank
4. Evacuation Center
5. Barangay Hall
6. Market
7. Church

Mode of Transportation:
Water Supply:
Electricity:
Waste Management:
Number of Employed:
Number of Unemployed: