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SOCIAL-CENSUS-FORMFrom NCIP

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Mechielle Valles
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26 views4 pages

SOCIAL-CENSUS-FORMFrom NCIP

Uploaded by

Mechielle Valles
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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FORMULATION OF THE ANCESTRAL DOMAIN SUSTAINABLE DEVELOPMENT &

PROTECTION PLAN (ADSDPP)


SOCIAL CENSUS OF LISON VALLEY AD

Name of Respondent:
Relation to Household Head:
Address:

1) INCOME:
a) Average Family Income (monthly):

b) Sources of Income (check appropriate box):

Farming Hunting Government Employed

Business Others, specify:

c) Major Crops (check appropriate box):

Coconut Upland Rice Rice (lowland)

Corn Banana Root crops (Cassava,Camote,Gabi)

Others, specify:

d) Domesticated Animals (indicate the number of heads):

Carabao: Cattle/Cow: Horse:

Goat: Chicken: Duck:

Goose/Swan: Turkey: Pig:

Others, specify:

2) HOUSING:
a) Type of Housing (check appropriate box): c) Types of Materials Used:

Owned Light Materials

Rented Semi-permanent

b) Used for Cooking (check appropriate box): Permanent

Firewood Gasul

Charcoal Others, specify:

3) COMMUNICATION/INFORMATION, APPLIANCES& TRANSPORTATION:


a) Communication/Information Facilities (check appropriate box):

Cellphone Radio Television

Social Census for Lison Valley AD Page 1


ICOM Radio Telephone Telegram

Letters Agong Others, specify:

b) Appliances (check appropriate box):

Karaoke Refrigerator Washing Machine

Gas Range Videoke CD/DVD Player

CD/DVD Component Gas Stove Others, specify:

c) Vehicles Owned (check appropriate box):

Single Motorcycle Tricycle Multicab

Bicycle Car Truck

Others, specify:

4) WATER & SANITATION PRACTICES:


a) Source of Drinking Water (check appropriate box):

Water Pump Rain Shallow Well

Deep Well Spring River/Creek

Mineral Water Water System Others, specify:

b) Source of Water for General Use (check appropriate box):

Water Pump Rain Shallow Well

Deep Well Spring River/Creek

Water System Others, specify:

c) Toilet Type (check appropriate box):

Water-Sealed Antipolo Open Pit

Anywhere Others, specify:

d) Garbage Disposal (check appropriate box):

Compost Pit Burned Anywhere

Others, specify:

Social Census for Lison Valley AD Page 2


5) HEALTH
a) Health Practices (check appropriate box):

Regular check-up to the nearest health center

Regular check-up to a hospital

Traditional Method

Others, specify:

b) Where does the mother delivered her latest baby (check appropriate box)?

House Delivery Health Center Hospital

Others, specify:

c) If house delivery, who assist the mother (check appropriate box)?

Midwife Hilot (non-IP) Tribal Hilot

Both Midwife &Hilot (non-IP) Both Midwife & Tribal Hilot

Others, specify:

d) For the past two years, who among the members have been brought to the hospital?

Family Member Sickness (specify) How many times


hospitalized?

Father

Mother

Son

Daughter

Other Members, specify:

e) Common Diseases experienced by family members for the last two years (check
appropriate box):

Fever Colds Cough

Sore Throat Sore Eyes Skin Diseases

Social Census for Lison Valley AD Page 3


Anemia High Blood Dengue

Urinary Tract Infection Others, specify:

f) Who cures these common diseases (check appropriate box)?

Health Personnel

Traditional Tribal Healer Others, specify:

Interviewer:

Printed Name & Signature Date

Social Census for Lison Valley AD Page 4

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