Annex H

IS Form No. 1

Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT
Caraga Regional Office
Butuan City

PROFILE OF DISPLACED WORKERS

(Informal Sector Workers)

Instructions
1. Accomplish this form when profiling displaced workers (informal sector) due to calamities of armed conflicts.
2. Respondent can be any member of the household with his/her lined number encircled.
3. If the last name is similar with the first member, it can be replaced with underline then the first name.
4. Please refer to the codes below for the 5th and 8th columns.

GENERAL INFORMATION

NAME OF RESPONDENT : ________________________________________________________________

ADDRESS 1 (Street/Barangay) : ________________________________________________________________
ADDRESS 2 (City/Municipality) : ________________________________________________________________
ADDRESS 3 (Province) : ________________________________________________________________
HOUSEHOLD CONTROL NO. : ________________________________________________________________

PROFILE OF DISPLACED INFORMAL SECTOR WORKERS AFFECTED BY _____________

Interventions Needed
Line
Household Member Sex Age as Type of Status of Skills Immediate Post-
Number
(with lost livelihood) 1 Male of Last Livelihood Livelihood (use (use code) Displacement
2 Female Birthday (use code) (use code) code) (use code)
(1) (8) (9)
(2) (3) (4) (5) (6) (7)
01
02
03
04
05
06
07
08
09
10
Code for Types of Livelihood (Col. 5) Code for Status of Livelihood (Col. 6) Code for Skills (Col. 7)
1 Crop Growing 1 Severely Affected/Damaged 1 Construction/Carpentry
2 Fishing 2 Slightly Affected/Damaged 2 Farming
3 Homebased Work Code for Intervention/s Needed (Col. 8) 3 Fishing
4 Livestock/Poultry Raising 1 Emergency Employment 4 Vulcanizing/Welding
5 Servicing 2 Others (please specify) 5 Cosmetology
6 Alternative Transporting Code for Post-Displacement Intervention/s 6 Tailoring/Dressmaking
7 Vending Needed (Col. 9) 7 Computer
8 Others (please specify) 1 Livelihood 8 Performing Arts
2 Training (Skills, Entrepreneurship) 9 Handicraft
3 Job Referral 10 Others (please specify)
4 Others (please specify)

CERTIFICATION

NAME OF RESPONDENT: ____________________________ Telephone Number/s: ________________

SIGNATURE: _____________________________

Interviewed by:
Name : _______________________________
Signature: ____________________________ Date Interviewed: _______________________

OP-07-007
Revision No.: 00
Date Issued: 1/08/14