FAMILY ASSESSMENT GUIDE

CONSOLIDATED REPORT

Sitio:__________

I. Demographic Data:

A.Number of Households - 15

_____________________________________________________________________________________________
b. Family Data

Length of 1-5 years 6-10 years 11-15 years 16-20 years More than 21
residency years

4 2 2 0 7

C.Place of Origin

Bayyo 14

Others-Specify 1

D.Family Size

Family size 1-3 4-6 7-10 11-13 14 and more

10 4 0 0 0

E.Religion

Total

1.Roman 10 10
Catholic

2. Calvary 3 3
Baptist
Church

3. Anglican 1 1

4. Pentecost 1 1

F.Sex

Males 6

Females 8

G.Civil Status

Single 2

Married 10

Separated 0

Widowed 2
H.Educational Attainment

Elementary graduate 4

Elementary undergraduate 4

High school graduate 3

High School undergraduate 3

College graduate 0

College undergraduate 0

Post graduate/ 0
masterals/Doctorate

I.Occupation

Laborer 5

Farmer 5

Government employee 0

Business 0

Others 3

Driver 1

Carpenter 1

II.Type of Family Structure

Extended 2

Nuclear 8

Patriarchal 5

Matriarchal 1

Dominamt 5
Family member

A. ____________
B. ___________
C. ___________
D. ___________

CRITERIA

Observable conflicts between family N/A

members
Characteristic of communication N/A
Interaction patterns among members N/A
III.Family Dietary Habits

Breakfast (list the different meals that came

out of the interview)

A. Bread and coffee

1
B. Rice and processed foods
1
C. Rice and vegetables
9
D. Breakfast cereals
0
E. Others
8

Lunch

A. Rice and meat 3

B. Rice and vegetables 5

C. Combination of rice, veg and meat 6

D. Others 8

Dinner

A.Rice and meat 1

B.Rice and vegetables 5

C.Combination of rice, veg and meat 7

D.others 7

IV. Monthly Family Income Source

Husband 10

Wife 7

Both 0

Others 3

V.Monthly Family Income /month

Below ₱ 5,000 10

Above ₱5000-10,000 4

Above ₱10,000- 15,000 1

Above ₱15,000- 20,000 0

above ₱25,000-30,000.00 0
 above ₱ 30,000- 40, 000 0

above ₱40,000- 50,000 0

more than ₱50,000 0

VI. Family Health Status/ health History

Father 5

Mother 6

Children 5

VII.Felt Family needs (identify and rank according to priority)

1. Foods 11

2. Money 9

3. Work 6

4. Basic necessities 3

5. Medicine 3

6. Bills 2

7. Shelter 1

8. Education 1

9.

10.

VIII: Home and environment

A. Lot Yes NO
ownership
10 5

B. House 10 5
ownership

C. Housing Materials

Wood 2

Concrete 0

Mixed 12

Makeshift 0

D. Appliances owned by the family

Refrigerator 3

Washing machine 7

TV 5
 Microwave oven 1

Sala set 0

Rice Cooker 1

Blender 1

E. Type of Garbage Disposal

Collected 0

Waste Segregation 7

Feeding to animals 2

Open dumping 1

Burning 12

Burying 3

Throw in the river/sewer 0

Others 0

F. Type of waste disposal

Flush 13

Wrap and throw 1

Watwr sealed 0

Pit privy 0

Others-specify 0

G. Type of drainage system

Open 1

Close 14

H. Source of water supply

Owened 0

Bought 0

Shared 2

Others, specify 13

I. Drinking water storage

Refrigerated 2

Uncovered 0

Covered 15
J. Containers Used

Plastic 14

Bottles 15

Jars, clay pots 0

Others 0

K.Food storage / cooking facilities

Covered 15

Uncovered 0

Stove 0

Stove 15

refrigerator 1

Cabinet 1

Pots/pans 14
etc

K. Common household pests found at home

rats 5

cockroaches 11

L. Pets/ animals kept in the yard/ home

cats 6

dogs 9

Pig 7

Chicken 7

Duck 1

M. Accident hazards present?

Yes 1
Specify

No 14

IX. Health and health practices

A. Common illnesses encountered for the last 6 months and the treatment applied.

Common
Illnesses in
the last 6 mos

Cough and 9
 cold

Flu 3

Headache 1

Toothache 1

Stomach ache 1

Treatments
applied in the
last 6 mos

Home 4
Medications

OTC meds. 5

Herbal Med 1

B. Whom do you consult for health-related problems?

Manghihilot

midwife 8

doctor 5

albularyo 0

nurse 2

Health center 13

BHW 13

Others-specify 0

C. For problems other than health, whom do you consult?

Family members 14

Friends 3

priest 0

relatives 3

Barangay officials 0

Others, specify 0

D. Food Storage:

refrigerated 2

covered 13

uncovered 1

paminganan 0
X. Health Seeking Behaviors:

A. Common illness for the past 6 months, specify: ______________________

1. Cough and Cold 7

2. Flu 3

3. Stomach ache 1

4. Toothache 1

5. Headache 2

B. Where did you seek for health care?

Barangay health Center 12

Private Clinic 0

Hospital 2

Private

public 2

C. Nearest Health Center Facilities: Bayyo Baranggy General Clinic

D. Nearest Government Hospital: Bontoc General Hospital

E. Nearest recreational park: Bayyo Basketball Court

F. Nearest public school: Bayyo Elementary School

XI. Communication:

A. Health information source

Health care personnel 7

radio 4

television 6

phone 12

Newspaper/fliers/posters 0

XII. Family Planning:

A. Practicing family planning

Yes 2

No 1

B. Methods Used

Hormonal- pills, injectables, implants 0

Barriers- IUD, condoms, diaphragm, cervical 0

cap
 Natural – calendar, BBT, cervical mucus, 2
withdrawal

Surgical- Ligation, Vasectomy 0

C.Pre-natal check-up for pregnant women:

N/A N/A

C. Stress and relaxation activities

YES NO

Rest and sleep 15 0

Exercies 13 2

Relaxation activities 10 5
Specify

Stress mgt activities 11 3

Specify

XIII. Environment

1. Kind of neighborhood  Rural

 Sociable

2. Social and health facilities available  Bayyo Baranggy Health Station

3. Communication and transportation  Baranggy hall

facilities  PUJ
 Private vehicles
 Phone

XIV. Awareness of community organization

A. Awareness of existing organizations in the community

Yes 10

No 4

B. Organization/s that people know

Organization

Church COOP 1 Bayyo Youths 1

Ambayuwan 1 AWA Dagdag 1

 Couple for 1 Mami’s 2
Christ

Gen. Assembly 1 Bayyo Lagad 1

Brotherhood 1

CWL 1

Senior Org. 1

.
C. Membership to any of these organizations

Yes 6

No 6

D. Involvement to its activities

Attend meetings 7

planning 4

implementation 3

Give donations 0

evaluation 0

Others, specify 0

E. 5 formal and non-formal leaders of the community whom people think can lead people

1. Joseph Lacwin 3 11. Gloria Akkang 1

2. Mauricio Kitan 1 12. Clara Lokat 1

3. Jhonel Kitan 1 13. Celia Dakalan 1

4. Sally Peta 1 14. Fermin Agpas 1

5.Marselina 1 15. Israel Rubuan 1

Lacwin

6. William Gaston 2

7. Mary Bortokey 1

8.Conception 1
Bimmukod

9. Allen Bulaek 1

10. Caryu Nganno 1

.
XV. Ranking Health Problems of Families in the Barangay
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.