SURVEY QUESTIONNAIRE

Dear Respondent:
The researcher’s was conducting a study entitled, “THE EFFECTS OF VIOLENCE AGAINST
WOMEN ON THEIR DAILY LIVES IN BARANGAY LAGRO” as requirement for Bachelor’s
Degree.
In this regard, the researchers are requesting your utmost cooperation and support by answering the
questions objectively and honestly as possible.
Rest assured that your answer will be treated with utmost confidentiality.
Thank you very much.
PART I. Assessment in how may the respondents described the usual violence committed against
women:

Direction: Please check the column on the right that corresponds with your answers using the following

scale:

Point Value Mean Scale Descriptive Rating

5 4.50-5.00 Always (A)

4 3.50-4.49 Sometimes (S)

3 2.50-3.49 Very Often (VO)

2 1.50- 2.49 Often (O)

1 1.00-1.49 Never (N)

1. How does the respondent be described in terms of the:

1.1 Age [ ] 17-20 [ ] 21-30 [ ] 31-40 [ ] 41- ABOVE

1.2 Sex: Woman

1.3 Civil Status [ ] Married [ ] Live-in Partner [ ] Others

1.4 Relationship with the offender? [ ] Father [ ] Husband [ ] Boyfriend [ ] Friend [ ] Others
 INDICATORS A S VO O N

5 4 3 2 1

1.5 How often does your abuser/offender

abuse you?

The Questions below are answerable by Yes and No YES NO

Only Check or mark YES if you experience some of the following below
✓
 Only Check or mark NO if you did not experience some of the following below
✓

2.The effect of violence in the physical condition of the victim Yes No

Does the following physical condition below was been experience by a victim

from an abuser/offender?

1. Bruises and Wounds

2. Laceration

3. Fractures

4. Deformation of a certain part of the body

3. The Effects of violence in the social condition of the victim Yes No

1. (Physical abuse) does the physical abuse can affect your occupation status?

2. (Emotional Abuse) do you feel isolated by your emotional distress?

3. (Economic Abuse) do you experience that your partner control how you

spend the money in your house (food, bills, (rent) and other expenses)?

4. The Effects of violence in the psychological condition of the victim YES NO

1. Trauma
2. Anxiety

3. Depression

Direction: Please check the column on the right that corresponds with your answers using the

following scale:

Point Value Mean Scale Descriptive Rating

5 4.50 - 5.00 Always (A)

4 3.50 - 4.49 Sometimes (S)

3 2.50 - 3.49 Very Often (VO)

2 1.50 - 2.49 Often (O)

1 1.00 - 1.49 Never (N)

5. The effects of the violence in the condition of the A S VO O N

victim. 5 4 3 2 1
On how often do you experience being abuse by the
abuser/offender in terms of:
1. Physical Abuse

2.Social Abuse

3. Psychological Abuse
6. Relationship of the victim to the

abuser/offender

Husband

Boyfriend

Live-in Partner

Friend

Others