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SW TOOLS

The document is a General Intake Sheet and Social Welfare Development Indicators Matrix designed for collecting information about individuals and families for social welfare assessments. It includes sections for general information, family composition, problems presented, initial assessments, recommendations, and a score sheet for evaluating economic sufficiency and social adequacy. The score sheet assesses various indicators related to health, nutrition, housing, education, and family awareness of social issues to determine the level of well-being of the household.

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Almairah Benito
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3 views

SW TOOLS

The document is a General Intake Sheet and Social Welfare Development Indicators Matrix designed for collecting information about individuals and families for social welfare assessments. It includes sections for general information, family composition, problems presented, initial assessments, recommendations, and a score sheet for evaluating economic sufficiency and social adequacy. The score sheet assesses various indicators related to health, nutrition, housing, education, and family awareness of social issues to determine the level of well-being of the household.

Uploaded by

Almairah Benito
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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GENERAL INTAKE SHEET

Date:

I. GENERAL INFORMATION
Name: Age: Sex:
Address: Religion: Tribe:
Date of Birth: Place of Birth:
Contact Number: Educational Attainment:

II. FAMILY COMPOSITION

Name Age Sex Civil Relationship Educational Occupation


Status Attainment

PROBLEM PRESENTED:

INITIAL ASSESMENT:

RECOMMENDATION:

Client’s Name and Signature

Interviewers Name and Signature


Social Welfare Development Indicators Matrix
Score Sheet
Name of the Household Head:
Name of the Respondent:
Age:___________Relation to the Household Head:
Signature of the Respondent:

Entry Date:
Components and Indicators Actual Score Points Total
A B C
I. ECONOMIC SUFFICIENCY
A. Employable skills (Occupation skills of family
members aged 18 yrs. or over
A1.
A2.
A3.
A4.
A5.
B. Employment (Working status of family
members aged 18 yrs. or over)
B1.
B2.
B3.
B4.
B5.
C. Income
Family monthly per capita in the past six
months
D. Social Security
Membership or access of family to formal
financial institutions
II. SOCIAL ADEQUENCY
HEALTH
1. Health Condition and availment of Health
Services
a. availment of family members of
accessible health services in the past six
months
b. health conditions of the family members
2. Nutrition
a. numbers of meals taken a day
b. household members take well-balanced
meal
c. nutritional status of children aged 5 years
or below
3. Water and Sanitation
a. access to safe drinking water
b. access to sanitary toilet facilities
c. practice properly garbage disposal
d. practice self-care/personal hygiene
HOUSING
1. House Structure
a. construction materials of the roof
b. construction materials of the outer walls
2. Tenure status of Housing unit
3. Lighting Facilities of the house
EDUCATION
1. Function literacy of family members aged 10
yrs.
or over
1.1
1.2
1.3
1.4
1.5
2. School enrolment/attendance of children aged
3-7 yrs. in formal/informal school
2.1
2.2
2.3
2.4
2.5
ROLE PERFORMANCE OF THE FAMILY
1. Involvement of family member in family
activities
2. Ability of parents/guardian to discern
problems in the family and arrive at solutions
3. Participation of family members in legitimate
or widely recognized people’s
organizations/association or support group
FAMILY AWARENESS OF RELEVANT
SOCIAL ISSUES
1. Awareness of the rights of children
2. Awareness of gender-based violence
3. Awareness of disaster risk reduction and
management

SUMMATIVE RESULT
LEVEL OF WELL BEING OF HOUSEHOLD HEAD
Components Scales Remarks
ECONOMIC
SOFFICIENCY
SOCIAL ADEQUENCY
Family’s level of well-
being

Accomplished by:
Name and Signature
Cut-off Scores
Level of well-being Cut-off
Level 3 2.83 – 3.00 Self Sufficient Level
Level 2 1.83 – 2.82 Subsistence Level
Level 1 1.00 – 1.82 Survival Level
Social Welfare Development Indicators Matrix
Score Sheet
Note: This is a modified and simplified SDWI form patterned from DSWD
Pantawid SWDI form. This is exclusively used for educational purposes
and for the academe format to be used by the Social Work Students of
LCCI.

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