CSWDO TOOL Republic of the Philippines

CONTROL NO. DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

LOCAL SOCIAL WELFARE AND DEVELOPMENT OFFICE SERVICE DELIVERY ASSESSMENT TOOL
CONFIDENTIALITY
As this survey is being conducted only for a specific purpose, we would like to assure you that all your answers will be kept confidential. Responses will not be attributed to any
individual and your name will not be used in any document. Your participation to the survey is valuable to the assessment being conducted.

INTERVIEW RECORD GEOGRAPHIC IDENTIFICATION

REGION CORDILLERA ADMINISTRATIVE REGION

DATE PROVINCE
MONTH/DAY/YEAR CITY
OFFICE ADDRESS
TIME BEGAN Telephone/Mobile Nos:
HOUR: MINUTE EMAIL ADDRESS:
TIME ENDED RESPONDENT IDENTIFICATION
HOUR: MINUTE NAME OF RESPONDENT
DESIGNATION/POSITION TITLE
LGU RESIDENTIAL & COMMUNITY-BASED CENTER NUMBER OF YEARS IN THE CURRENT POSITION
SALARY GRADE
Number of Residential Based Center STAFFCOMPLEMENT
Number of Community Based Center
Staff working in LSWDOs (use extra sheet if Designation/ No. of years SG /
Number of Day Care Center
necessary) Postion working in Employment
Number of Day Care Worker LSWDOs Status
1
ACCESS TO ICT 2
3
Number of Desktop Computer 4
Number of Laptop Computer 5
Others, pls specify_____________ 6
7
Availability of Wired Internet Connection Yes No 8
9
10
11
12

CERTIFICATION Total Number of Social Worker No. of Job Order No. of Regular
Employee
Total Number of Technical Staff
Total Number of Administrative Staff
I hereby certify that the data set forth herein were obtained/reviewed by me personally
and in accordance with the instructions given by DSWD

FISCAL DATA

ASSESSORS
SIGNATURE OVER PRINTED NAME Total Annual Regular Income of LGUs (from
PHP________________
the previous year)
Total Approved LSWDO Budget PHP________________
DATE ACCOMPLISHED (from the previous
Total Social year)
Services and Welfare PHP________________
Expenditure (from the previous year)

TEAM LEADER LGU DATA OF VULNERABLE SECTOR

SIGNATURE OVER PRINTED NAME Sector Number Year Source
Number of PWDs
DATE ACCOMPLISHED Number of Senior Citizens
Number of CICL
Number of WEDC
TEAM DESIGNATED ENCODER Number of IP families
SIGNATURE OVER PRINTED NAME Number of Street Children/Families
Number of Families Living in Disaster Prone
DATE ACCOMPLISHED Areas

Concurred by: Concurred by: Noted by:

______________________________________________ _________________________ ______________________
SIGNATURE OF RESPONDENT SIGNATURE OF LSWDO SIGNATURE OF LCE/REPRESENTATIVE
Date: Date: Date: