SOCIAL WELFARE INDICATOR

Questionnaire Sheet
I. INFORMATION
Name:
Address:
Age:
Sex:
Occupation:
Educational Attainment:
II. ECONOMIC SUFFICIENCY
Head of the household employed or
1
with a regular job 1 Unemployed 2 On and off / Seasonal 3 Regular/Permanent
Job

Other members of the household 18

2 years old and above employed or 1 Unemployed 2 On and off / Seasonal 3 Regular/Permanent
Job
with regular job

Household member Household members

Adult members possess with skills but no with skills and
professional/technical/occupational Household member
3
skills duly recognized by appropiate 1 have no skills 2 certification from 3 certification from
recognized by recognized by
authorities appropiate authorities appropiate authorities

Household monthly per capita Income more that 50%

4 income above municipal poverty 1 Income below poverty
threshold 2 - 100% above poverty 3 More that 101% above
poverty threshold
threshold threshold

GSIS, SSS, other private insurance,

5
savings and loans association 1 Not a member of any
insurance 2 Airregular
member but
payment 3 Amember
regular contributing

III. SOCIAL ADEQUACY

Household members avail of health

1
services 1 Do not avail health
services 2 Sometimes avail
health services 3 Always avail health
services

Drinking water from Partial Access to safe Access to safe drinking

2 Household uses safe drinking water 1 unguaranteed sources 2 drinking water 3 water and connected
(rain, river, well etc) (Commercial Sources) to a trusted source

Household members take three

3
meals a day 1 Members only eat 1
meal a day 2 Members only eat 2
meals a day 3 Members only eat 3
meals a day
Household members take well-
4
balanced meals 1 One
only
balanced meal
2 Two meal balanced
per day 3 Three balanced meal
per day
Nutritional status of children below
5
6 years old 1 Very low 2 Below Normal 3 Normal

6 Household uses tiolet 1 No toilet facilitiy 2 With toilet but no

sanitary (open pit) 3 With sanitary toilet
 Proper garbage
Household practices proper garbage
7
disposal 1 No proper disposal 2 Disposal with No
segregation 3 disposal with
segregation

Housing Structure sturdy and

8
durable 1 Salvage Materials 2 Light Materials 3 Combined sturdy and
durable materials

Location of residence is safe and

9
secure 1 Not safe and secure 2 Vulnerable to harm
and displacement 3 Safe and secure
Uses commercially Uses electricity, LPG or
Household uses regular and safe
10
lighting facility 1 Uses home made
lamps/candle 2 produced kerosene 3 other similary ligting
and gas facility
Household members 10 and above
11 can read, write and do simple 1 Members cannot read Members or some
or write or count 2 have difficulties 3 Members are able to
read, write and count
calculaions

Household members of school age

Enrolled but unable to
are in formal and informal
12
school. 1 Not enrolled 2 continue this school 3 Enrolled and
continously in school
year

Household members are regularly Occasional

13 involved in family activities 1 Not engaged in Family involvement in family
activities 2 3 Regularly engaged in
family activity
activities

Household member not involved in

incidence of neglect, abuse, With incidence but
14
exploitation and violence in the 1 With incidents but not reported and resolved
reported 2 3 No
this
incidences within
year
this year
home and in the community

Household member participate at

15
least one community activities 1 No community
participation 2 Inactively Participation 3 Actively Participation
in the community