Barangay Profile Questionnaire by htt39969

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									CBMS Form 2
                               Barangay Profile Questionnaire
                                        Year _____

   NOTE: The respondent for this questionnaire should be the Barangay Captain or
         the Barangay Secretary of the barangay.

           Name of Enumerator:
           Name of Respondent:
           Position:
           Date:
           Time Started:
           Time Ended:

   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.      Total land area :                                               (in square kilometers)


   7.      General Description and Characteristics of the Barangay :




   8.      Boundaries :




   Note: Attachments to this Barangay Profile are the following:
   a. Duly accomplished Barangay spotmap
   b. Copy of GAD Plan and Budget (if available)
   c. Masterlist of names and types of community organizations present in the barangay
                                                                                 Barangay ID_______




   9.      Major source of livelihood :

   Demographic Reference :

   10.     Population :                          Male:                       (enter number)

                                                 Female:                     (enter number)

                                                 Total:                      (enter number)
                               Reference period:
                               Source of data:


   11.     Number of Households :                                            (enter number)

                               Reference period:
                               Source of data:


   12.     Total number of                       Male:                       (enter number)
           registered voters :
                                                 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. Utiliy worker:                                                 (enter number)

           h. Others, specify:                                               (enter number)
                               Reference period:




CBMS Form 2 (GRB)                                                                             PAGE 2
                                                                                                                                       Barangay ID_______



II. Proximity of Barangay Location to Basic Services and Service Institutions* :
        Educational                           Is facility present in                         How many                         What is the distance
          Facility                               the barangay?                          facilities are present             from the barangay to the
                                            1 Yes (GO TO 16)                              in the barangay?                 nearest facility? (in kms.)
                                            2 No (GO TO 17)
               (14)                                        (15)                                    (16)                               (17)
  a. day care centers

  b. pre-school

  c. elementary

  d. secondary

  e. vocational

  f. college/university

  g. others, specify


            Health                            Is facility present in                         How many                         What is the distance
            Facility                             the barangay?                          facilities are present             from the barangay to the
                                            1 Yes (GO TO 20)                              in the barangay?                 nearest facility? (in kms.)
                                            2 No (GO TO 21)
               (18)                                        (19)                                    (20)                               (21)
  a. private medical
     clinic
  b. hospitals

  c. maternal and
      child clinic
  d. barangay
      health centers
  e. family planning
      centers
  f. health posts

  g. drugstores

  h. others, specify


            Service                           Is facility present in                         How many                         What is the distance
            Facility                             the barangay?                          facilities are present             from the barangay to the
                                            1 Yes (GO TO 24)                              in the barangay?                 nearest facility? (in kms.)
                                            2 No (GO TO 25)
               (22)                                        (23)                                    (24)                               (25)
  a. post office

  b. police station

  c. women's center /
     crisis center
  d. bank

  e. market

  f. multi-purpose hall

  g. others, specify


      * Reference point for the following questions is the barangay hall which is considered the center of the barangay.


       CBMS Form 2 (GRB)                                                                                                                            PAGE 3
                                                                                                                                              Barangay ID _______




26. What are the types of public transportation present within the barangay?
      (Check all applicable answers.)
                                        1   Bus                                      5 Pedicab
                                        2   Taxi                                     6 Boat
                                        3   Jeepney                                  7 Other modes of transportation (please specify)
                                        4   Tricycle

Road Network (State the type and length of roads/streets existing in the barangay)**

          Type of Road                                      length                          present condition                 Maintained by:
                                                          (in kms.)                     1. good 2. fair 3. poor             (see codes below)
            (27)                                              (28)                                (29)                             (30)
     a. concrete

     b. asphalt

     c. gravel

     d. natural/earth
         surface

Codes : Maintained by :
      1. private                                                    3. provincial                       5. barangay
      2. national                                                   4. municipal                        6. others (specify) _____________

31.        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)

32.        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

33.        Is the barangay being served by a water station/company (Level III System) ?

           1 Yes (GO TO 34)                                         2 No (GO TO 36)                                                     (enter code)

34. What is the name of the water company?                                                              35. How many households are being served?
1
2
3

36. What are the other sources of water                             37. How many units/stations?           38. How many households
    in the community?                                                   total  functioning not functioning     are being served?
   a. deep well (Level I)

     b. artesian well (Level I)

     c. shallow well (Level I)

     d. commercial water refill stations

     e. others (specify)

** To be filled by at the municipal/ city level if information at the barangay level is not available




CBMS Form 2 (GRB)                                                                                                                                        PAGE 4
                                                                                         Barangay ID _____



Credit Institutions

39. How many credit institutions operate in the barangay?

40. Name of Institution                                                 41. Contact Person
  a.
  b.
  c.
  d.
  e.

Garbage/Waste Disposal System
42. Is a community garbage disposal facility present in the barangay?

         1 Yes (GO TO 43)         2 No (GO TO 45)                                         (enter code)

43. What garbage disposal facility              44. How many            45. What is the distance from
    is present in the barangay?                     households are          the barangay to the nearest
    (Check the appropriate box)                     being served?           disposal facility? (in kms.)
   a. open dump site

   b. sanitary landfill

   c. incinerators

   d. compost pits

   e. others (specify)


Electricity Service
46. Is the barangay being serviced by any electrical cooperative/company?

         1 Yes (GO TO 47)         2 No (GO TO 49)                                         (enter code)

47. If yes, what is the name of the             48. How many households are
    electric company?                               being served by the company?
1
2
3

49. If no, what is the distance from the barangay to the
    nearest electrical station/company?                                                   (in kilometers)




       CBMS Form 2 (GRB)                                                                           Page 5
                                                                                                        Barangay ID _____


III. Barangay Programs and Services
What are the                Provide a brief description of the    What is the barangay             How many were the
programs/services           program or service                    committee primarily              beneficiaries to the
implemented for the past                                          spearheading in providing        program for the past
12 months?                                                        the program or service?          12 months?


           (50)                             (51)                                (52)                       (53)
a.

b.

c.

d.

e.


IV. Peace and Order
54.    Types of crimes                      Number of reported cases during the past 12 months:
                                               Total                Male                           Female
Crimes against persons                                    Total    0-17 y.o   18 & above   Total    0-17 y.o   18 & above
a. murder
b. physical injury
c. spousal/ partner abuse
d. rape
e. incest rape
f. Other crimes against persons ________

Crimes against property
a. robbery/ theft
b. other crimes against property ________
Other crimes
a. substance abuse
b. human trafficking/ illegal recruitment
c. prostitution
d. sexual harrasment
e. economic abuse
f. Other types of crimes, _____________


V. Government Land and Resettlement
55.    Is there a government-owned land in the barangay that is available for resettlement?
       1 Yes                                2 No (go to 57)                                        (enter code)
56.    What is the total size of land that can be used for resettlement?
       1 Less than 1 hectare                  3           3.1 - 5 hectares                         (enter code)
       2 1-3 hectares                         4           More than 5 hectares
57.    Is the barangay willing to acquire land to be used for resettlement?
       1 Yes                                2 No                                                   (enter code)


CBMS Form 2 (GRB)                                                                                                  Page 6
                                                                                                               Barangay ID _____




    VI.Gender and Development Planning

   58.      Does your barangay have a Gender and Development (GAD) Plan?
            1 Yes (Request for a copy of GAD plan)                2 No                               (enter code)

   59.      Does your barangay have a Gender and Development (GAD) budget?

            1 Yes                                                 2 No                               (enter code)

   60.      Who is the GAD focal person/ GAD focal point for your barangay?




    VII. Barangay Equipment
   Does the barangay have the following equipment ?

                   Equipment           Is it present in the How many of these are       Present condition of
                                           barangay ?       present?                       equipment/s
                                     1 Yes (GO to 63)                               1 functional
                                     2 No                                           2 malfuctional but reparable
                                                                                    3 beyond repair
                     (61)                        (62)              (63)                              (64)
   a. Typewriter

   b. Personal Computers

   c. Two way radio
      (base and mobile)
   d. Public announcement
     (PA) unit
   e. Service vehicle

   f. Fire truck

   g. Others (specify)




CBMS-GRB Form 2                                                                                                           Page 7

								
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