Professional Documents
Culture Documents
Year 2023
NOTE: The respondent for this questionnaire should be the Chairperson or the Secretary of the Barangay
Position:
Date:
Time Started:
Time Ended:
Name of Enumerator:
Signature of Enumerator:
(1) Province:
(2) City/Municipality:
(3) Barangay:
1 Plain
2 Upland
3 Mountainous
4 Coastal
5 Others, specify
(8) Boundaries:
East West
South
North
Demographic Reference:
(10) Population: Male: (enter number)
Female:
Total: (enter number)
Reference period:
Source of data: (enter number)
(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
(e.g. Midwife)
Reference period:
(14) Nutritional Status of Children 0–5 Years Old:
(enter number)
(enter number)
(enter number)
(enter number)
(enter number)
Reference period:
Source of data:
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.
( IF YES IN IF NO IN
1 (15) (15)
5
)
Facility and Input Dealer (16) (17) (18) (19) (20)
Is the facility
How many facilities are present in the Does the Does the What is the
present in the
barangay? List the name/s of facilities in the facility have facility have Geopoint distance from
barangay? space provided. access to safe access to the barangay
drinking sanitary hall to the
water? toilets? Latitude Longitude nearest facility
1 Yes (GO TO 16)
1 Yes 2 No 1 Yes 2 No (in km)?
2 No (GO TO 20)
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
b. Hospitals
c. Maternity Clinic
d. Child Clinic
h. Botika ng Bayan
i. Private Drugstores
j. Others, specify
Educational Facility
b. Preschool
c. Elementary
d. Secondary
e. Vocational
f. College/University
g. Others, specify
Service Facility
a. Multipurpose Hall
b. Police Station
c. Women's/Crisis Center
d. Bank
e. Post Office
f. Market
g. Others, specify
Agricultural Facility
a. Rice Mill
b. Corn Mill
c. Feed Mill
d. Agricultural
Produce Market
(bagsakan)
e. Others, specify
Input Dealer
a. Fertilizer Dealer
b. Pesticide Dealer
c. Seeds Dealer
d. Feeds Dealer
e. Others, specify
Road Network
IF YES IN (22)
(22)
(23) (24) (25)
Are any of the following roads/streets present in the What is the length of the road/street? What is the present condition of the Who is maintaining the
barangay? 1-Yes (GO TO 23) (IN KM) road/street? road/street?
2-No (SEE CODES BELOW) (SEE CODES BELOW)
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 in Geopoint
How many
2-No What is the name of the water the barangay?
households are
company? 1 Yes (GO TO 32) Latitude Longitude
being served?
2 No (GO TO 33)
1
a Level II water system b
1
Level III water system
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) Is the facility Geopoint
How many How many households
2-No functioning?
units/stations? Name are being served?
(Total)
1 Yes (GO TO 37) Latitude Longitude
2 No
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.
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.
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 households Is there an electric Geopoint
(GO TO 46) company or association that is are being served by the substation present in
2 - No providing or maintaining the source of electricity? the barangay?
1 Yes (GO TO 49) Latitude Longitude
electricity supply?
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
1 Yes (GO TO 52)
2
2 No (GO TO 54)
3
Registered Business Firms (based on latest records of the barangay)
(54) How many business firms/establishments are registered in the barangay?
Reference period:
(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/F rst 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
V. Evacuation Center
VII. Programs, Projects, and Activities (based on the barangay's Annual Investment Program during the past year)
(65) (66) (67) (68)
What programs, projects, and activities Provide a brief description of the How much was allotted for the How many benefited from
(PPAs) were implemented in the barangay PPA. PPA? the PPA during the past
during the past year? year?
(Indicate unit)
a.
b.
c.
d.
e.
f.
g.
h.
VIII. Budget, Revenue, and Expenditure
(69) How much was the barangay's budget, revenue, and expenditure during the past 3 years?
Year Budget Revenue Expenditure
1
2
3
IX. 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