NAMD - 001

Revision 1
08 November 2018

EXPANDED NATIONAL NUTRITION SURVEY (ENNS): 2021

Name of Project

PRE-SURVEY NOTES AND INFORMATION

(City/Municipal and Barangay Profile)

SURVEY AREA : TUNASAN MUNTINLUPA CITY NATIONAL CAPITAL REGION

Barangay City/Municipality Province

TENTATIVE DATES OF SURVEY DATA COLLECTION:

MUNICIPAL/ CITY OFFICIALS
OFFICE CONTACT
DESIGNATION NAME ADDRESS NUMBER(S)
Municipal/City Mayor

Municipal/City Health Officer (M/CHO)

Municipal/City Nutrition Action Officer

(M/CNAO)
Municipal/City Nutrition Program
Coordinator

Other Officials

FACILITIES AVAILABLE IN THE MUNICIPALITY/CITY: (Check (√) all that applies)

ATM : GROCERY STORE/ SUPERMARKET: COURIER (JRS, LBC, 2GO)

Yes No Yes No Yes No

BARANGAY OFFICIALS:

DESIGNATION NAME OFFICE ADDRESS CONTACT NUMBER

Punong Barangay :
Barangay Kagawad :
(Health)
Barangay Secretary :
Rural Health Midwife :
BNS/BHW: :
Other Officials :

FACILITIES AVAILABLE IN THE BARANGAY: (check (√ ) all that applies)

Strong
Yes No Limited time
NETWORK Smart Globe Sun INTERNET Moderate
ELECTRICITY: period,
SIGNAL: Others, specify ________ SIGNAL: Weak
specify: _____

WATER SOURCE:
Water Sytem Bottled/ Rain water Surface Artesian/Pump Spring water Others, specify:
Ex. NAWASA mineral water (Tubig water (Tubig Poso) (Tubig Bukal) __________________
ulan) (Ilog/Dam)

ACCOMMODATION Hotel/ Pension House/ Gov’t Guest House/ Hostel/ Dorm Others,
OPTIONS FOR Budgetel/ Resort Cost P_______________ specify________________________
TEAM: Cost (per night/room) Cost P_______________
P ___________
OTHER PROFILE OF THE BARANGAY

GEOGRAPHY : Plain Mountainous Hilly Island Coastal

LANDMARKS OF LOCATION :
ENDEMIC DISEASE(S)/ILLNESS(ES) IN THE AREA: : Malaria Dengue Filariasis Others, specify
PEACE AND ORDER SITUATION :
ADVISORY/PRECAUTIONARY MEASURE(S) :
DATE OF BRGY. FIESTA/FESTIVAL :

TRANSPORTATION (HOW TO COMMUTE FROM MUNICIPAL/ CITY HALL TO BARANGAY)

Destination
From To Type of Vehicle Fare Frequency Duration of REMARKS
Travel

Prepared by:
Signature over printed name Designation Office Address Contact Number(s)

Pre-Survey Notes collected by: ___________________________________________ Date: ______________________