Republic of the Philippines

CAVITE STATE UNIVERSITY

Don Severino de las Alas Campus
Indang, Cavite

To the respondents,

We, the researcher's request your kind participation by responding to the attached sets of the survey
questionnaire to generate the data very much needed to achieve the objectives of the study entitled:
DEMOGRAPHIC PROFILE, LEVEL OF STRESS AND FACTORS AFFECTING THE STRESS
OF SELECTED INMATES IN CAVITE PROVINCIAL as
partial fulfillment of the requirements for CRIM26: Criminological Research and Statistics.

Rest assured that any information and/or data shared will only be used for the purpose of the study and
will kept in utmost confidentiality.

Thank you very much for your cooperation and rest assured that this study will go along in sustaining the
development of the program offers in the Criminal Justice Department.

Sincerely yours,
Daryll Espiritu
Researcher

Francis Ace Jarata

Researcher

Shiena B. Lejano
Researcher
Title of the Study: Demographic Profile, Stress Level and Factors Affecting the stress of
Selected Inmates in Cavite Provincial Jail
Researcher: Daryll Espiitu
Francis Ace Jarata
Shiena Lejano

SURVEY QUESTIONNAIRE
A. Profile of the Participants (Inmates)

Name:_____________________________________________________
Age:_____ years old
Gender: ( )Male ( ) Female
Civil Status: ( ) Single ( ) Married ( ) Widow/Widower ( ) Separated/Divorced
Length of Stay:______________

B. Measuring Stress Level of Selected Inmates in Cavite Provincial Jail

Direction: Put a check in the box that best describe your answer ( Lagyan ng tsek ang kahon na
naglalarawan sa iyong sagot).

(1)Strongly Disagree (2)Disagree ) (3)Neutral (4)Agree (5)Strongly Agree

Example (Halimbawa):

1)Strongly (2)Disagre (3)Neutral (4)Agree (5)Strongl

Disagree e ( Walang (Sumasang y Agree
( Lubos ( Hindi pinapanigan -ayon) (Lubos na
na di sumasang- ) sumasang-
sumasang ayon) ayon)
-ayon)
1. I'm able to
practise my /
religion in this
prison
2. I feel self-
harmed in this /
prison
Begin Here(Magsimula dito) :

Part 1: Environmental factors

(1)Strongl (2)Disagree (3)Neutral (4)Agree (5)Strongly

y Disagree ( Hindi ( Walang (Sumasang- Agree
( Lubos na sumasang- pinapanigan ayon) (Lubos na
di ayon) ) sumasang-
sumasang- ayon)
ayon)
1. I always experience
disturbing noise
inside the jail
(Nakakaranas ako ng
palagiang
nakakabulabog na
ingay sa loob ng
bilangguan)
2. I sleep comfortably
inside the cell
(Nakakatulog ako ng
maayos sa loob ng
selda)
3. I am given adequate
opportunities to keep
myself clean and
decent (Binibigyan
ako ng sapat na
oportunidad na
maging malinis at
desente sa
pangangatawan)
4. The cell that I am
belong is quite
crowded ( Ang aking
kinabibilangan na
selda ay masikip)
5. The cell that I am
belong is well
ventilated ( Ang aking
kinabibilangan na
selda ay may maayos
na bentilasyon)
6. I received complete
meals in a day
(Nakakatanggap ako
ng kumpletong rasyon
ng pagkain araw-
araw)
7. I heard and
 experience inequality
inside the prison
(Nakararanas at
nakaririnig ako ng di
pagkakapantay-
pantay sa loob ng
bilangguan)
8. My relationship
between staffs in this
prison are good.
( Maayos ang aking
relasyon sa mga
tauhan sa loob ng
bilangguan)
9. I never experience to
sleep peacefully
inside the prison
( Hindi ko naranasan
na matulog ng tahimik
sa loob ng
bilangguan)
10. The cell that I am
belong is clean ( Ang
selda na aking
kinabibilangan ay
malinis)
11. My health is
monitored by our
resident doctor/nurse
( Ang aking
kalusugan ay
palagiang
nasusubaybayan ng
nakatalagang doktor
at nars)
12. Some of the treatment
I receive in this prison
is degrading ( Ang
ilan sa pag trato sa
loob ng bilangguan ay
naka bababa ng
pagkatao)
13. I am not having
privacy in this cell
(Wala akong
pribadong buhay dito)
14. I afraid of catching
communicable disease
( Nangangamba ako
na madapuan ng
 nakahahawang sakit)
15. I experience hard task
inside the jail
( Nakararanas ako ng
mabibigat na trabaho
sa loob ng
bilangguan)

Part 2: Emotional Factors

(1)Strongl (2)Disagree (3)Neutral (4)Agree (5)Strongly

y Disagree ( Hindi ( Walang (Sumasang- Agree
( Lubos na sumasang- pinapanigan ayon) (Lubos na
di ayon) ) sumasang-
sumasang- ayon)
ayon)
1. My family is regularly
visiting me. ( Palagi
akong binibisita ng
aking pamilya )
2. I received good
treatment inside the
jail (Nakatatanggap
ako ng mabuting
pagtrato sa loob ng
bilangguan)
3. I missed my life
outside the jail.
( Nasasabik ako sa
buhay ko sa labas ng
kulingan )
4. I fear for my physical
safety inside the jail
(Natatakot ako sa
pisikal kong
kaligtasan sa loob ng
bilangguan)
5. I experience
threat/bullying inside
the jail. ( Nakararanas
ako ng pag babanta at
pananakot sa loob ng
bilangguan)
6. I feel scared most of
the time in this prison.
( Madalas akong
nakararamdam ng
takot sa loob ng
bilangguan)
7. I have thought about
suicide in this prison
( Naisipan ko ng
magpakamatay sa
bilangguan)
8. I have problems
sleeping at night
( ( Nahihirapan ako sa
pagtulog tuwing gabi)
9. I felt extremely alone
(Nakararamdam ako
ng labis na pag-iisa)
10. I am not able to use a
phone to call my
friends and family
( Hindi ako maaaring
gumamit ng telepono
para tumawag sa
aking kaibigan at
pamilya)
11. I am not being treated
as a human being in
here (Hindi ako
tinatrato ng tama sa
bilangguan)
12. I feel tense in this
prison
( Nakararamdam ako
ng tensyon sa
bilangguang ito)
13. I feel that I am treated
with respect by staff
in this prison
( Ramdam ko ang
respeto sa akin ng
mga tauhan sa
bilangguang ito)
14. I feel stuck in this
system (Pakiramdam
ko ay natigil na ako
ssa ganitong sistema)
15. I trust the officer in
this prison
( Pinagkakatiwalaan
ko ang mga tauhan sa
bilangguang ito)