CBMS FORM 2 VN 11201401

PSA Approval No: DILG-1540-02

Expires on 31 October 2016

Barangay Profile Questionnaire

Year _____
NOTE: The respondent for this questionnaire should be the Chairperson or the Secretary of the Barangay
Name of Respondent:
Position:
Date:
Time Started:
Time Ended:
Name of Enumerator:
Signature of Enumerator:

I.

Physical and Demographic Characteristics

(1)

Province:

(2)

City / Municipality:

(3)

Barangay:

(4)

Classification:

(5)

Number of Puroks/ Sitios:

(6)

Land Area:

1 Rural

2 Urban

(7) General Description and Characteristics

of the Barangay:
1 Yes 2 No
Total Area (in sq. km.)

Residential

1 Plains

Commercial

2 Upland

Industrial

3 Mountainous

Agricultural

4 Coastal

Mineral

5 Others, specify

Timberland
Special Classes
Total Land Area
(8)

(9)

(enter code)

Boundaries:
East

West

North

South

Major Sources of Livelihood:

Barangay ID__________

Demographic Reference:
(10) Population:

Male:

(enter number)

Female:

(enter number)

Total:

(enter number)

Households:

(enter number)

Families:

(enter number)

Male:

(enter number)

Female:

(enter number)

Total:

(enter number)

Reference period:
Source of data:

(11) Number of Households/Families

Reference period:
Source of data:

(12) Registered Voters:

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. Utility Worker

(enter number)

h. Others, specify ___________

(enter number)

(e.g. Midwife)
Reference period:
(14) Nutritional Status of Children 05 Years Old:
Total
Above normal
Normal
Below normal (moderate)
Below normal (severe)
Total

Female

Male
(enter number)
(enter number)
(enter number)
(enter number)
(enter number)

Reference period:
Source of data:

CBMS Form 2

Page 2

Barangay ID__________
II. Service Institutions and Infrastructure
(15)

Facility

Is the facility
present in the
barangay?
1 Yes (GO TO 16)

IF YES IN (15)
(16)

(17)

How many facilities are present in the

barangay? List the name/s of facilities in the
space provided.

2 No (GO TO 20)

Health Facility

IF NO IN (15)
(18)

(19)

(20)

Does the facility Does the facility

What is the
Geopoint
have access to have access to
distance from
safe drinking
sanitary toilets?
the barangay
water?
hall to the
1 Yes 2 No
Latitude Longitude
nearest facility
1 Yes 2 No
(in km)?

(16B)

(16A)

a. Barangay Health Center

1.
b. Hospitals
2.
1.
c. Maternity Clinic
2.
1.

d. Child Clinic

2.
1.
e. Maternity and Child Clinic
2.
1.
f. Private Medical Clinic
2.
g. Botika ng Barangay

1.

h. Botika ng Bayan

1.
1.

i. Private Drugstores
2.
1.
j. Others, specify ________
2.

Educational Facility

(15)

(16A)

(16B)

(16C) Levels
offered (e.g.,
Grade 14)

(17)

(18)

(19)

(20)

1.
a. Day Care Centers
2.
1.
b. Preschool
2.
1.
c. Elementary
2.
1.
d. Secondary
2.
1.
e. Vocational
2.
1.
f. College/University
2.
1.
g. Others, specify ___________
2.

CBMS Form 2

Page 3

Barangay ID__________

(15)

Facility and Input Dealer

Service Facility

IF YES IN (15)
(16)

Is the facility
present in the
barangay?

(17)

IF NO IN (15)
(18)

(19)

(20)

What is the
Does the
Does the
How many facilities are present in the
Geopoint
distance from
barangay? List the name/s of facilities in facility have facility have
the barangay
access to
access to
the space provided.
hall to the
sanitary
safe drinking
Latitude Longitude nearest facility
1 Yes (GO TO 16)
toilets?
water?
(in km)?
1 Yes 2 No 1 Yes 2 No
2 No (GO TO 20)
(16B)

(16A)

a. Multipurpose Hall
b. Police Station
c. Women's/Crisis Center

1.
d. Bank

2.
e. Post Office
f. Market
g. Others, specify __________

Agricultural Facility

(16B)

(16A)
1.

a. Rice Mill
2.
b. Corn Mill

1.
2.

c. Feed Mill

1.
2.

d. Agricultural Produce Market

(bagsakan/bulungan)

1.
2.
1.

e. Others, specify ________

2.
Input Dealer
1.
a. Fertilizer Dealer
2.
1.
b. Pesticide Dealer
2.
1.
c. Seeds Dealer
2.
1.
d. Feeds Dealer
2.
1.
e. Others, specify __________
2.
Public Transport
(21) What types of public transportation are present in the barangay?

1-Yes

2-No

1 Bus
2 Taxi
3 Van/FX
4 Jeepney
5 Tricycle
6 Pedicab
7 Boat
8 Others, specify
CBMS Form 2

Page 4

Barangay ID __________

Road Network
IF YES IN (22)

(22)
Are any of the following roads/streets present in
the barangay?

1-Yes (GO TO 23)

2-No

(23)
What is the length of the road/street?
(IN KM)

(24)
What is the present condition of the
road/street?

(25)
Who is maintaining the
road/street?

(SEE CODES BELOW)

(SEE CODES BELOW)

a. Concrete (IF NO, GO TO 26)

b. Asphalt (IF NO, GO TO 27)
c. Gravel

(IF NO, GO TO 28)

d. Natural/Earth surface (IF NO, GO TO 28)

(24) Present condition of the road/street

(25) Maintained by

1. Good

1. Private

4. Municipality/City

2. Fair

2. National Government

5. Barangay

3. Poor

3. Province

6. Others, specify _______________

(26) 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)

(27) 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
(28) Is the barangay being served by a water
station/company ?

IF YES IN (28)
1-Yes (GO TO 29)
2-No

a Level II water system

b Level III water system

(29)

(30)

What is the name of the water

company?

How many
households are
being served?

(31)
Is the source located
in the barangay?
1 Yes (GO TO 32)
2 No (GO TO 33)

(32)
Geopoint
Latitude

Longitude

2
(33)

Are any of the following water facilities

present in the barangay?

IF YES IN (33)
(34)
1-Yes (GO TO 34)
2-No

How many
units/stations?
(Total)

(35)

(36)

Name

Is the facility
functioning?
1 Yes (GO TO 37)
2 No

(37)

(38)

How many
households are being
served?

Geopoint
Latitude

Longitude

1.

a. Deep Well (Level I)

2.
1.

b. Artesian Well (Level I)

2.
1.

c. Shallow Well (Level I)

2.
1.

d. Commercial Water Refill Stations

2.
1.

e. Others, specify

2.
Garbage/Waste Disposal System
IF YES IN (39)

(39)
(40)
Are any of the following community garbage
disposal facilities present in the barangay?
1 - Yes (GO TO 40)
2 - No

a. Open Dump Site

How many
units?
(Total)

IF NO IN (39)

(41)

(42)

(43)

(44)

Geopoint

Name

How many
households
are being
served?

What is the distance

from the barangay to
the nearest disposal
facility? (in km)

Latitude

Longitude

1.
2.

b. Sanitary Landfill

1.
2.

c. Compost Pits

1.
2.

d. Material Recovery Facility (MRF)

1.
2.

e. Others, specify

1.
2.

CBMS Form 2

Page 5

Barangay ID __________

Electricity Service
(45) What is the source of
electricity in the barangay?

IF YES IN (45)
(46)
(47)
(48)
1 - Yes
What is the name of the
Is there an electric
How many
(GO TO 46) company or association that
substation present
households are
2 - No
is providing or maintaining being served by the in the barangay?
the electricity supply?
source of electricity? 1 Yes (GO TO 49)

(49)
Geopoint
Latitude Longitude

2 No (GO TO 51)

1 Electric Company
2 Generator
3 Solar
4 Battery
5 Others, specify
6 None
IF NO IN (45.1)
(50)

What is the distance from the barangay to the nearest electrical station/company?
(in kilometers)

Credit Institutions
(51) Are there credit institutions
operating in the barangay?

IF YES IN (51)
(52)
What are the names of the credit institutions?

(53)
Contact person and details
(Office Address, Telephone, E-mail)

1 Yes (GO TO 52)

2 No (GO TO 54)

1
2
3
Registered Business Firms (based on latest records of the barangay)
(54)

How many business firms/establishments are registered in the barangay?

Reference period: _____

III. Significant Events in the Barangay During the Past 3 Years

(55) During the past 3 years, how many times did the event occur? Write the number in the box provided.
1 Typhoon
7 Tsunami
13 Armed Conflict
2 Flooding
8 Fire in Houses/Properties
14 Closure of Large Firm
3 Drought
9 Forest Fire
15 Closure of Many Small Firms
4 Earthquake
10 Epidemic
16 Mass Layoff
5 Volcanic Eruption
11 Pest Infestation
17 Opening of Large Firm
6 Landslide
12 Livestock/Poultry Diseases
18 Opening of Many Small Firms
IV. Disaster Risk Reduction and Preparedness
(56) Does the barangay have a written disaster risk reduction plan?
(57) Does the barangay have a disaster/emergency response team?

1-Yes 2-No
1-Yes 2-No

(58) Does the barangay have any of the following disaster/emergency response equipment? 1-Yes 2-No
1 Rubber Boats
2 Handheld Radios
3 Rain Gear (e.g., raincoats and boots)
4 Emergency/Service Vehicle
(59) Does the barangay have
designated evacuation
centers?

5 Flashlights
6 Medicines/First Aid Supplies
7 Life Vests
8 Megaphone

9 Others, please
specify __________

IF YES IN (59)
(60)
List the names of the evacuation centers

1 Yes (GO TO 60)

2 No (GO TO 62)

(61)
Geopoint
Latitude

Longitude

3
CBMS Form 2

Page 6

Barangay ID __________

V. Peace and Order

(62) Does the barangay have reported
cases on the following crimes during
the past 12 months?

1 - Yes
(GO TO 63)
2 - No

Crimes against Persons

IF YES IN (62)
(63) How many were the victims in the reported cases?
Male
Female
18 years
18 years
Total
017 years
017
Total
old &
Total
old &
old
years old
above
above

a. Murder/Homicide
b. Physical Injury
c. Rape
Crimes against Property
a. Theft
b. Robbery
Other Crimes
a. Prohibited Drug Use
b. Human Trafficking
c. Illegal Recruitment
d. Prostitution
e. Spousal/Partner Abuse
f. Sexual Harassment
g. Other types of crimes, specify

VI. Programs, Projects, and Activities (based on the barangay's Annual Investment Program during the past year)
(64)
What programs, projects, and activities
(PPAs) were implemented in the
barangay during the past year?

(65)
Provide a brief description of the
PPA.

(66)
How much was allotted for the
PPA?

(67)
How many benefited
from the PPA during
the past year?
(Indicate unit)

a.
b.
c.
d.
e.
f.
g.
h.

VII. Budget, Revenue, and Expenditure

(68) How much was the barangay's budget, revenue, and expenditure during the past 3 years?
Year

Budget

Revenue

Expenditure

1
2
3

VIII. Spotmap
(Attach a duly accomplished spotmap of the barangay before submitting this form to the supervisor.)
(69) When was the spotmap prepared? (MM/DD/YY) _______________________
(70) Does the spotmap contain the locations of the following?: 1- Yes 2-No 3-Not Applicable
1. Creeks, Rivers, Waterfalls
2. Road Networks, Bridges,
Railroads
3. Purok Boundaries

4. Barangay Boundaries
5. Schools
6. Hospitals, Clinics
7. Barangay Health Center

8. Barangay Hall,
Multipurpose Hall
9. Church, Chapel
10. Public Market

Note: For mobile data capture system, answer only the items 70.1 to 70.4, and indicate 3-Not Applicable for items 70.5 to 70.10

CBMS Form 2

Page 7