Fill | Polls by Makopa

a. Province *

b. City/ Municipality *

c. Zone *

d. Barangay *

e. Purok/ Sitio *

f. Street *

g. House Number *

II. Househould Identification Number *

III. Coordinates *

Latitude

Longitude

IV. Name of Respondent *

V. Date of Interview *

VI. Time Started *

VII. Time Finished *

VIII. Name and Signature of Enumerator *

IX. Name and Signature of Field Coordinator *

1. In what type of building does the household reside? *

2. How many bedrooms does the unit have

3. What type of construction material are the roof made of? *

4. What type of construction material are the outer walls made of? *

(5) How many household members are overseas workers? *

(6) How many nuclear families are there in the household? *

(7) Is any member of the household pregnant? *

(8) Is any member of the household a solo parent? *

(9) Is any member of the household disabled? *

Choose 1

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