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A. DEMOGRAPHIC CHARACTERISTICS |
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Family Members as of Date of Visit (Last Name, First Name) |
Relationship to HH Head |
Sex |
Age |
Date of Birth |
Marital Status |
Religious Affiliation |
Mother Tongue |
Language |
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B. EDUCATION AND LITERACY |
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Has ___ ever attended school? |
What is the highest educational attainment completed by ___? |
What is the total numbers of years of schooling ___ successfully completed? |
Can ___ read and write a simple message in any language or dialect? |
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09 |
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C. EMPLOYMENT/ECONOMIC ACTIVITY |
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Did ___ work at all or have a job or business during the past twelve months? |
What was ___'s usual activity/occupation during the past twelve months? |
In what kind of business or industry did ___ work during the past twelve months? |
Did ___ look for a job at any time during the past twelve months? |
Why did ___ not look for work? |
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D. HEALTH STATUS |
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Did ___ get ill or injured during the past month? |
What type of illnesses or injuries did ___ have during the past month? |
Did ___ visit any health facility like a hospital or clinic etc. during the past month? |
What health facility(ies) did ___ visit during the past month? |
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E. INCOME |
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E1. Income Source Please specify from which sources you and your household members earned an income and how much was earned from each source. |
Amount in Philippine Pesos Over Twelve-Month Period |
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a. Catching fish (and selling catch after landing) |
a. |
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b. Operation of fish ponds |
b. |
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c. Renting out fish ponds to others |
c. |
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d. Renting out fishing boats/engines/gear to others |
d. |
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e. Processing of fish (e.g. smoking, drying) |
e. |
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f. Marketing of fish |
f. |
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g. Farming of crops and selling of harvest to others |
g. |
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h. Buying crops from farmers and selling to others for profit |
h. |
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i. Herding and raising cattle (livestock) |
i. |
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j. Income from homestead (e.g. vegetable gardening) |
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k. Buying and selling cattle |
k. |
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l. Raising/selling poultry, geese, sheep, pigs and other small farm animals |
l. |
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m. Income from business other than fishing |
m. |
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n. Income from wage labour (all types) |
n. |
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o. Income from salaried employment (service sector) |
0. |
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p. Income from doing domestic work for others |
p. |
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q. Income from remittances from relatives/friends/family members |
q. |
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r. Income from lending money to others |
r. |
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s. Income from savings (bank, insurance) |
s. |
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t. Income from pension |
t. |
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u. Other sources not listed above |
u. |
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Estimated Total Income |
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E2. Perception of welfare level a. How would you rate the financial situation of the household with regard to satisfying all the basic household needs (food, clothing, goods, services)?
b. If you compare the financial situation of this household to the financial situation of other households in your neighbourhood, would you say that your household is:
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F. HOUSING AND HOUSEHOLD FACILITIES |
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At the time of visit... F1. Type of building/house
F2. Construction material of the roof
F3. Construction material of the outer walls
F4. Tenure status of housing unit and lot
F5. Fuel for lighting
F6. Household convenience
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G. WATER AND SANITATION |
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G1. Main source of water supply
G2. Kind of toilet facility
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