NCM 122n/ COPAR RLE

Guidelines in filling up the Survey

forms & in tabulating the Data
 1. Interviewee should also be
included in the list of family members
 2. Members are only applicable to
those who are at present residing
with the family, and this will include
relatives and helpers.
3. Marital Status
 a. Single (S)- a person who is not and has never been
married
 b. Married (M)- a person living with another as a couple
married by legal rite/s.
 c. Common-law (CL)- a person living with another as a
couple not married by legal rite/s.
 d. Widowed (W)- a person whose spouse is dead and who
has not remarried
 e. Separated/ Divorced (Sep)- a person legally separated
from his/her spouse because of marital discord or similar
reason/s. a person whose bond of marriage has been
dissolved and can therefore re-marry.
4. Age distribution- Erickson’s Stages of Development
 a. Birth to 18 months- infancy
 b. 18 months to 3 years- early childhood
 c. 3-5 years- late childhood
 d. 6-12 years (11 years and 11 months)-
school age
 e. 12-18 ( 17 years and 11 months)-school
age
 f. 18-35 years ( 34 years and 11 months)-
young
adulthood
 g. 35-65 years- adulthood
 h. 65 years to death- maturity
DOH:
 10-24 years- young
person
 25-59- adults
 60 & up- older person
5. Types of work
 a. Full-time work- Employment that is based upon a
contract of employment for a standard hours engagement
( generally between 35- 40 hours per week)
 b. Part-time work- Work performed by any employee
who is engaged for a no. of hours, fixed or varied, but are
fewer than those specified as standard hours in the
relevant award.
 c. Casual work- A casual worker is someone hired by an
employer on an hourly or daily basis. Casual workers
should be employed to perform work of a short-term,
irregular or seasonal nature, either working full time or
part time hours.
 d. Temporary/contract work- Temporary employees are
often employed for a specific time period to complete a
particular project or to replace employee absent on leave.
 e. Self employment
 f. Classification can also be:
- Farmer
- Housekeeper
- DH
- Employee
- etc…
 6. Highest Educational Attainment- Refers only to the
highest level completed in the regular and formal system
of education, i.e. elementary, high school and collegiate
education. Excluded are attendance in nursery and
kindergarten schools and in purely vocational courses
such as dressmaking or carpentry. Enter only the last
level of education completed and the one the person is in
at the time of assessment.
 a. For the Elementary level, write G-1 to G-6 (Grade 1-

VI)
 b. For High school, HS-1 to HS-4 and
 c. For College education, C-1 to C-4, as the case maybe.
For degree holders, write the degree, e.g. BSE or BSN
 7. Religion
 a. Islam
 b. Christians
 1. Christian denominations
 1.1 Catholics
 1.2 Protestants
- Baptist
- etc
 8. Immunization Status
 a. Fully immunized child (FIC)- a child who
received one dose of BCG;
 3 doses of OPV; 3 doses of DPT; 3 doses of
HB and one dose of measles before a child’s first
birthday
 b. Complete- a child who received all required
vaccine based on his/her age
 c. Incomplete- a child who has incomplete
required vaccine based on his/ her age.
 d. none
9. Nutritional status
 a. Normal
 b. Underweight
 c. Overweight
10. Construction materials used for
house
 a. Light- refers to such materials as
bamboo, nipa, sawali, coconut
leaves or cardboard.
 b. Mixed- refers to a combination
of light materials, wood and/or
concrete.
 c. Strong- refers to a
predominantly concrete house
11. Number of rooms used for
sleeping- this refers to the
number of rooms in the house,
not necessarily private
bedrooms that are used as
sleeping area. Write the number.
12. Toilet facilities
 a. Overhung latrine- the toilet house
is constructed over a body of water
(Stream, lake or river) into which
excreta is allowed to fall freely
 b. Open pit privy- consists of a pit
covered by a platform with a hole. The
hole is not usually not covered. The
platform may, in its simplest form,
consists only of two pieces of wood or
bamboo.
 C. Closed pit privy- a pit privy in
which the hole over the platform or
toilet floor is provided with cover
 e. Bored- hole latrine- consists of a deep
(usually more than 10 feet) but relatively
narrow (Lee than 2 feet in diameter) hole
made with a boring equipment
 F. Water-sealed latrine- non- antipolo type
of toilet, bored-hole latrine or any pit privy
wherein water- sealed toilet bowl is placed
instead of the simple platform hole.
 G. Flush type- a toilet system where
waste is disposed by flushing water
through pipes (sewers) into a public
sewerage system or into an individual
disposal system like an individual septic
tank.
 H. Pail system- a pail or box is
used to receive the excreta and
disposed later when filled, this
includes the “balot” system wherein
excreta is wrapped in a piece of
paper or plastic and thrown later.
 i. Antipolo type- the toilet is elevated and the
shallow pit is extended upwards to the platform
(toilet floor) by means of a chute or pipe made
of clay, metal, aluminum or board
 13. Storage of water
a. large- contain 4 gallons or more
14. Drainage-
 a. Open- waste water flows through
a system of pipes (could be improvised
from bamboo) to an open pit or canal
 b. Blind –waste water flows
through a system of closed
pipes to an underground pit or
covered canal.
 c. None- water flows freely
from source to the ground or
thrown to the ground after
being used.
 15. waste disposal
a. hog feeding- garbage is
used as a hog fee
 b. open dumping- refuse and or garbage
is piled in a dumping place (w/or w/o
pit) with no covering
 C. Open burning- regularly piles
refuse/garbage piled in a dumping
place [w/ or w/o pit) with no soil
covering then burns them
 D. Burial pit- refuse/garbage is
placed in a pit and covered when
filled up. There is no intention to
dig it up later for use as fertilizer.
 E. composting- involves burying or
stacking of alternating layers of organic-
based refuse/garbage and “treated coil”
arranged so as to hasten rapid decay and
decomposition into compost. This organic
mixture can later be used as fertilizer.
 F. garbage collection-refuse/garbage
collected by garbage truck or any type of
garbage collection in the community.
REMINDERS:
Survey forms
• Submit with the list of households
surveyed in alphabetical order
• Arrange the forms per purok/sitio
• Number the forms based on its number in
the spot map
• Summarize the data using the guide below

No. Head of the Family Partner No. of children

 SPOT MAP/ COMMUNITY HEALTH DATA
SHEET(whole purok and per block)
• Individual households, locations and
distances from each other
• Physical characteristics of the community
such as:
- waterways ( river, etc…)
- land use (rice fields, etc)
- Public service infrastructure (bridges, etc)
- Non-residential structures (churches)
- Boundaries of the purok
- All types of water sources
 The community health datasheet is
like a spot map. It gives you an idea
about the health status of families
and guides community managers in
planning projects needed by the
community.

 The health indicators are provided

on the datasheet. The color coding
stand for health status or condition
of each household.
 The household datasheet. Individual
presentation of every household presented as
data matrices that contain information.
- health programs (columns)

-I Colors
P inFPthe cells
N (value-entry)
W GD T

Meaning of the colors:

 Red (Stop, danger)
 Yellow (needs improvement, caution)
 Green (go, safe)
 Blue (None, not applicable)
The health datasheet keep an eye on at least
seven(7) public health programs in the
households of a community. This programs
are the health indicators:
 Immunization
 Prenatal
 Family planning
 Nutrition
 Water
 Garbage disposal
 toilet
 Community health plan and GANNT chart

GANNT chart
• Visual representation of a project schedule
• A type of bar chart that shows the start and
finish dates of the different required
elements of the project
• Typically, tasks are shown on the vertical
axis, and the project time span on the
horizontal axis
• Each task has a corresponding bar that
shows the time span required for the task
• Developed by Henry Laurence Gannt, an
American mechanical engineer
 Example of GANNT chart:
ACTIVITIES Target date Needed resources Responsible persons

September October

22 23 24 16 17

Courtesy call

Conduct of Survey forms, pens, Community leaders,

survey weighing scale Students
 Community Health Plan Example:
Identified Problem Proposed solution Activities of students
(community &
students)
Intervention Persons involved Evaluation Parameters

Improper garbage • Information • Conduct of seminar • Community • 95% of the

disposal drive on proper on waste leaders community will
• 95% of the waste management • Students participate in the
population do not
segregation • Government
segregate their
waste • Provision of agencies
• Dumping of garbage cans
garbage is the • Establishment of
primary mode of business about
waste disposal recyclable
materials