CBMS FORM 2 VN 11201401

PSA Approval No: DILG-1540-02

Expires on 31 October 2016
Barangay Profile Questionnaire
Year _____

NOTE: The respondent for this questionnaire should be the Chairperson or the Secretary of the Barangay

Name of Respondent:
Position:

Date:

Time Started:

Time Ended:
Name of Enumerator:
Signature of Enumerator:

I. Physical and Demographic Characteristics

(1) Province:

(2) City / Municipality:

(3) Barangay:

(4) Classification: 1 Rural 2 Urban (enter code)

(5) Number of Puroks/ Sitios:

(6) Land Area: (7) General Description and Characteristics

of the Barangay: 1 Yes 2 No
Total Area (in sq. km.)

Residential 1 Plains

Commercial 2 Upland

Industrial 3 Mountainous

Agricultural 4 Coastal
Mineral 5 Others, specify

Timberland
Special Classes
Total Land Area

(8) Boundaries:

East West

North South

(9) Major Sources of Livelihood:

 Barangay ID__________
Demographic Reference:
(10) Population: Male: (enter number)

Female: (enter number)

Total: (enter number)

Reference period:
Source of data:

(11) Number of Households/Families Households: (enter number)

Families: (enter number)

Reference period:
Source of data:

(12) Registered Voters: Male: (enter number)

Female: (enter number)

Total: (enter number)

Reference period:
Source of data:

(13) Number of Barangay Personnel:

Total Female Male

a. Tanod (enter number)

b. Health Worker (enter number)

c. Nutrition Scholar (enter number)

d. Purok Leaders (enter number)

e. Librarian (enter number)

f. Day Care Worker (enter number)

g. Utility Worker (enter number)

h. Others, specify ___________ (enter number)

(e.g. Midwife)
Reference period:

(14) Nutritional Status of Children 0–5 Years Old:

Total Female Male

Above normal (enter number)
Normal (enter number)
Below normal (moderate) (enter number)
Below normal (severe) (enter number)
Total (enter number)
Reference period:
Source of data:

CBMS Form 2 Page 2

 Barangay ID__________

II. Service Institutions and Infrastructure

(15) IF YES IN (15) IF NO IN (15)
Is the facility (16) (17) (18) (19) (20)
present in the How many facilities are present in the Does the facility Does the facility Geopoint What is the
barangay? barangay? List the name/s of facilities in the have access to have access to distance from
Facility
space provided. safe drinking sanitary toilets? the barangay
1 Yes (GO TO 16) water? 1 Yes 2 No hall to the
Latitude Longitude
2 No (GO TO 20) 1 Yes 2 No nearest facility
(in km)?

Health Facility (16A) (16B)

a. Barangay Health Center

1.
b. Hospitals
2.

1.
c. Maternity Clinic
2.

1.
d. Child Clinic
2.

1.
e. Maternity and Child Clinic
2.

1.
f. Private Medical Clinic
2.

g. Botika ng Barangay 1.

h. Botika ng Bayan 1.

1.
i. Private Drugstores
2.

1.
j. Others, specify ________
2.

(16C) Levels
Educational Facility (15) (16A) (16B) offered (e.g., (17) (18) (19) (20)
Grade 1–4)

1.
a. Day Care Centers
2.

1.
b. Preschool
2.

1.
c. Elementary
2.

1.
d. Secondary
2.

1.
e. Vocational
2.

1.
f. College/University
2.

1.
g. Others, specify ___________
2.

CBMS Form 2 Page 3

 Barangay ID__________

(15) IF YES IN (15) IF NO IN (15)

(16) (17) (18) (19) (20)

Is the facility
present in the How many facilities are present in the Does the Does the What is the
barangay? List the name/s of facilities in facility have facility have Geopoint distance from
Facility and Input Dealer barangay?
the space provided. access to access to the barangay
safe drinking sanitary hall to the
1 Yes (GO TO 16) water? toilets? Latitude Longitude nearest facility
2 No (GO TO 20) 1 Yes 2 No 1 Yes 2 No (in km)?

Service Facility (16A) (16B)

a. Multipurpose Hall

b. Police Station

c. Women's/Crisis Center

1.
d. Bank
2.

e. Post Office

f. Market

g. Others, specify __________

Agricultural Facility (16A) (16B)

1.
a. Rice Mill
2.

b. Corn Mill 1.
2.

c. Feed Mill 1.
2.

d. Agricultural Produce Market 1.

(bagsakan/bulungan) 2.
1.
e. Others, specify ________
2.
Input Dealer
1.
a. Fertilizer Dealer
2.

1.
b. Pesticide Dealer
2.

1.
c. Seeds Dealer
2.

1.
d. Feeds Dealer
2.

1.
e. Others, specify __________
2.

Public Transport
(21) What types of public transportation are present in the barangay?
1-Yes 2-No
1 Bus
2 Taxi
3 Van/FX
4 Jeepney
5 Tricycle
6 Pedicab
7 Boat
8 Others, specify
CBMS Form 2 Page 4
 Barangay ID __________

Road Network
IF YES IN (22)
(22)
(23) (24) (25)
Are any of the following roads/streets present in What is the length of the road/street? What is the present condition of the Who is maintaining the
the barangay? 1-Yes (GO TO 23) (IN KM) road/street? road/street?
2-No (SEE CODES BELOW) (SEE CODES BELOW)

a. Concrete (IF NO, GO TO 26)

b. Asphalt (IF NO, GO TO 27)

c. Gravel (IF NO, GO TO 28)

d. Natural/Earth surface (IF NO, GO TO 28)

(24) Present condition of the road/street (25) Maintained by

1. Good 1. Private 4. Municipality/City
2. Fair 2. National Government 5. Barangay
3. Poor 3. Province 6. Others, specify _______________
(26) If there are no concrete roads or streets in the barangay, what is the
distance from the barangay to the nearest concrete road or street? (in kilometers)
(27) If there are no asphalt roads or streets in the barangay, what is the
distance from the barangay to the nearest asphalt road or street? (in kilometers)

Water Supply
(28) Is the barangay being served by a water IF YES IN (28)
station/company ?
(29) (30) (31) (32)
1-Yes (GO TO 29) Is the source located
How many Geopoint
2-No What is the name of the water in the barangay?
households are
company? 1 Yes (GO TO 32) Latitude Longitude
being served?
2 No (GO TO 33)

a Level II water system 1

b Level III water system 1

2
(33) Are any of the following water facilities IF YES IN (33)
present in the barangay?
(34) (35) (36) (37) (38)
1-Yes (GO TO 34)
How many Is the facility How many Geopoint
2-No
units/stations? Name functioning? households are being
1 Yes (GO TO 37) Latitude Longitude
(Total) 2 No
served?

1.
a. Deep Well (Level I)
2.
1.
b. Artesian Well (Level I)
2.
1.
c. Shallow Well (Level I)
2.
1.
d. Commercial Water Refill Stations
2.
1.
e. Others, specify
2.
Garbage/Waste Disposal System

IF YES IN (39) IF NO IN (39)

(39)
(40) (41) (42) (43) (44)
Are any of the following community garbage
disposal facilities present in the barangay? How many Geopoint What is the distance
How many
1 - Yes (GO TO 40) households from the barangay to
units? Name
2 - No are being Latitude Longitude the nearest disposal
(Total)
served? facility? (in km)

1.
a. Open Dump Site
2.
1.
b. Sanitary Landfill
2.
1.
c. Compost Pits
2.
1.
d. Material Recovery Facility (MRF)
2.
1.
e. Others, specify
2.

CBMS Form 2 Page 5

 Barangay ID __________

Electricity Service
(45) What is the source of IF YES IN (45)
electricity in the barangay? (46) (47) (48) (49)
1 - Yes What is the name of the How many Is there an electric Geopoint
(GO TO 46) company or association that households are substation present
2 - No is providing or maintaining being served by the in the barangay?
Latitude Longitude
the electricity supply? source of electricity? 1 Yes (GO TO 49)
2 No (GO TO 51)
1 Electric Company
2 Generator
3 Solar
4 Battery
5 Others, specify
6 None
IF NO IN (45.1)
(50)
What is the distance from the barangay to the nearest electrical station/company?
(in kilometers)

Credit Institutions
(51) Are there credit institutions IF YES IN (51)
operating in the barangay? (52) (53)
Contact person and details
What are the names of the credit institutions?
(Office Address, Telephone, E-mail)
1 Yes (GO TO 52) 1
2 No (GO TO 54) 2
3
Registered Business Firms (based on latest records of the barangay)

(54) How many business firms/establishments are registered in the barangay?

Reference period: _____

III. Significant Events in the Barangay During the Past 3 Years

(55) During the past 3 years, how many times did the event occur? Write the number in the box provided.
1 Typhoon 7 Tsunami 13 Armed Conflict
2 Flooding 8 Fire in Houses/Properties 14 Closure of Large Firm
3 Drought 9 Forest Fire 15 Closure of Many Small Firms
4 Earthquake 10 Epidemic 16 Mass Layoff
5 Volcanic Eruption 11 Pest Infestation 17 Opening of Large Firm
6 Landslide 12 Livestock/Poultry Diseases 18 Opening of Many Small Firms

IV. Disaster Risk Reduction and Preparedness

(56) Does the barangay have a written disaster risk reduction plan?
1-Yes 2-No

(57) Does the barangay have a disaster/emergency response team?

1-Yes 2-No

(58) Does the barangay have any of the following disaster/emergency response equipment? 1-Yes 2-No
1 Rubber Boats 5 Flashlights 9 Others, please
specify __________
2 Handheld Radios 6 Medicines/First Aid Supplies
3 Rain Gear (e.g., raincoats and boots) 7 Life Vests
4 Emergency/Service Vehicle 8 Megaphone

(59) Does the barangay have IF YES IN (59)

designated evacuation (60) (61)
centers?
Geopoint
List the names of the evacuation centers
Latitude Longitude
1 Yes (GO TO 60) 1
2 No (GO TO 62) 2
3

CBMS Form 2 Page 6

 Barangay ID __________

V. Peace and Order

(62) Does the barangay have reported 1 - Yes IF YES IN (62)
cases on the following crimes during (GO TO 63) (63) How many were the victims in the reported cases?
the past 12 months? 2 - No Male Female
18 years 18 years
Total 0–17 years 0–17
Crimes against Persons Total old & Total old &
old years old
above above
a. Murder/Homicide
b. Physical Injury
c. Rape
Crimes against Property
a. Theft
b. Robbery
Other Crimes
a. Prohibited Drug Use
b. Human Trafficking
c. Illegal Recruitment
d. Prostitution
e. Spousal/Partner Abuse
f. Sexual Harassment
g. Other types of crimes, specify

VI. Programs, Projects, and Activities (based on the barangay's Annual Investment Program during the past year)
(64) (65) (66) (67)
What programs, projects, and activities Provide a brief description of the How much was allotted for the How many benefited
(PPAs) were implemented in the PPA. PPA? from the PPA during
barangay during the past year? the past year?
(Indicate unit)
a.
b.
c.
d.
e.
f.
g.
h.
VII. Budget, Revenue, and Expenditure
(68) How much was the barangay's budget, revenue, and expenditure during the past 3 years?
Year Budget Revenue Expenditure
1
2
3
VIII. Spotmap
(Attach a duly accomplished spotmap of the barangay before submitting this form to the supervisor.)
(69) When was the spotmap prepared? (MM/DD/YY) _______________________
(70) Does the spotmap contain the locations of the following?: 1- Yes 2-No 3-Not Applicable

1. Creeks, Rivers, Waterfalls 4. Barangay Boundaries 8. Barangay Hall,

2. Road Networks, Bridges, 5. Schools Multipurpose Hall
Railroads 6. Hospitals, Clinics 9. Church, Chapel
3. Purok Boundaries 7. Barangay Health Center 10. Public Market
Note: For mobile data capture system, answer only the items 70.1 to 70.4, and indicate 3-Not Applicable for items 70.5 to 70.10

CBMS Form 2 Page 7