HOUSEHOLD IDENTIFICATION:

City/Municipality: Dagupan City

Barangay: Pantal
Street Name: Pantal East

Interviewer Household Household identification number

Elaine Briosos 1 1805

3 N/a

4 16

Mikaela Cabrito 1 1853

2 1920

3 1955

4 2250

5 2250

6 2250
7 2230
 Rhomabelle Esquerra 1 210

2 174

Angelika de Vera 1 109

2 2133

3 26

FAMILY STRUCTURE
Type of Family Structure Family Deciscion-Maker Religion
7 2 1
2 2 1
4 3 1
4 2 1
4 2 1
4 1 1
4 3 1
1 2 1
1 2 1
7 1 1
4 3 1
4 3 1
4 3 1
 4 1 1
4 4 5

ENVI
Space for gardening Source of drinking water Drinking water storage
1 2 4
1 2 4
1 2 4
1 2 4
1 2 4
1 2 4
1 2 4
1 2 5
1 2 4
2 2 4
2 2 4
2 2 4
2 2 4
2 2 4
2 6 4
Name of the Respondent Name of the Household Head Name (Last name, First name)
Marina Ragma Marina Ragma Ragma, Marina
Alipuyo, Angel
Ma. Lita Ferrer Ma. Lita Ferrer Ferrer, Ma. Lita
Ferrer, Lalaine
Ferrer, Jefferson
Ferrer, Lestelou
Ferrer, Jeremiah
Dominador Magalong Dominador Magalong Magalong, Dominador
Magalong, Venus
Magalong, April Ann
Magalong, Kristine
Lolita Ferrer Lolito Ferrer Ferrer, Lolito
Ferrer, Lolita
Ferrer, John Kenneth
Ferrer, John Paul
Ferrer, Angel
Nora Abella Nora Abella Abella, Nora
Abella, Ramon
Abella, Renelyn
Winielyn Villaruz Glenn Villaruz Villaruz, Glenn
Villaruz, Winielyn
Villaruz, Mark
Villaruz, Joshua
Villaruz, Karl
Percival Rauras Enrico Rauras Rauras, Enrica
Rauras, Percival
Rauras, Karen
Rauras, RJ
Sofia Navarro Solidad dela Cruz dela, Cruz, Solidad
Navarro, Sofia
Navarro, Danilo
Navarro, Jefferson
Padilla, Marion
Merianne Aqui Anna Aqui Aqui, Merianne
Gidagan, Jericho
Gidagan, Mark
Gidagan, Jefferson
Virgilio Andongo Virgilio Andongo Andongo, Virgilio
Leticia Flores Leticia Flores Flores, Leticia
Flores, Jimmy
Flores, James
 Flores, Joseph
Flores, Jayson
Jacky Racho Vincent Racho Racho, Vincent
Racho, Jacky
Racho, Hanna
Racho, Ana
Alan Perez Alan Perez Perez, Alan
Perez, Ruth Ann
Perez, Kibrullan
Perez, Levy Ann
Eligio Abad Eligio Abad Abad, Eligio
Abad, Nida
Abad, Elmer
Abad, Edwin
Abad, Neli
Abad, Elen
Alexis Diga Alexis Diga Diga, Alexis
Diga, Merlita
Diga, Bernardo
Diga, Digna
Rino Biltran Segundo Biltran Biltran, Segundo
Biltran, Rino

SOCIO-ECONOMIC PROFILE
Ownership status of the house Ownership status of the lot Type of dwelling unit/structure
3 3 2
2 3 2
3 3 2
3 3 2
3 5 1
3 4 1
3 5 1
3 5 1
3 5 1
3 5 1
1 4 2
1 1 1
3 3 1
 3 3 2
3 5 1

ENVIRONMENTAL HEALTH
Food Storage Drainage System Toilet Facilities
1 2 4
3 3 5
3 1 5
3 2 5
3 2 5
3 2 5
3 2 5
3 2 6
3 2 5
3 2 5
2 2 5
2 2 4
3 2 5
3 2 5
4 2 5
Relation to household head Age Gender
1 76 y/o 2
5 8 y/o 2
1 52 y/o 2
3 29 y/o 2
3 27 y/o 1
3 24 y/o 1
3 16 y/o 1
1 62 y/o 1
2 62 y/o 2
3 33 y/o 2
3 25 y/o 2
1 65 y/o 1
2 52 y/o 2
3 25 y/o 1
3 23 y/o 1
3 10 y/o 2
1 53 y/o 2
2 62 y/o 1
3 26 y/o 2
1 40 y/o 1
2 39 y/o 2
3 10 y/o 1
3 8 y/o 1
3 3 y/o 1
1 69 y/o 2
2 67 y/o 1
3 33 y/o 2
3 30 y/o 1
1 80 y/o 2
3 58 y/o 2
3 62 y/o 1
5 27 y/o 1
7 29 y/o 1
3 23 y/o 2
8 24 y/o 1
5 3 yrs and 9 mos 1
5 1 yr 6 mos 1
1 61 y/o 1
1 58 y/o 2
2 58 y/o 1
3 25 y/o 1
 3 23 y/o 1
3 24 y/o 1
1 32 y/o 1
2 33 y/o 2
3 3 y/o 2
3 10 y/o 2
1 27 y/o 1
2 29 y/o 2
3 7 y/o 1
3 3 y/o 2
1 65 y/o 1
2 55 y/o 2
3 31 y/o 1
3 30 y/o 1
3 28 y/o 2
3 20 y/o 2
1 56 y/o 1
4 88 y/o 2
4 1
3 2
1 61 y/o 1
3 32 y/o 1

Electricity Supply Type of cooking fuel

2 3
4 5 Household 5
4 5
4 5
4 5
4 5
4 5
4 5
4 5
4 5
4 1, 3
4 3,4
4 4
 4 5
4 3

Garbage Disposal Garbage Segregation Number of Children

1 1 8
1 1 4
1 2 2
1 1 3
1 1 1
1 2 3
1 2 1
1 1 1
1 1 1
1 1 2
1 1 3
1 1 2
1 1 2
1 1 5
1 2 3
Civil Status (18 y/o and above) Highest Level of school attended Current Employment
3 1 9
- 1 -
3 3 - 1st Year College 4
1 3 - Commerce 2
1 3 - Nursing 2
1 3 - Accountancy 2
- 3 - 2nd year -
2 3 2 - Part time teacher
2 3 5
1 3 9
1 3 1 - Volunteer Nurse
2 2 10
2 2 3
1 2 2
1 2 9
- 1 - Grade 5 -
2 1 - Grade 1 9
2 3 10
1 2 3
2 3 8
2 3 9
5 - -
5 - -
5 - -
2 5 10
2 3 10
1 3 1
1 3 1
3 3 10
2 3 4
2 3 4
1 3 1
1 5 9
1 2 9
1 2 3
5 - -
5 - -
2 2 10
2 1 9
2 1 1
1 1 3
 1 1 3
1 1 4
2 2 3
2 2 9
- 0 -
1 1 -
2 3 9
2 3 9
- 1 -
- 0 -
2 2 4
2 3 - Undergrad 9
1 2 - Undergrad 2
1 4 1
1 3 2
1 3 - Undergrad 9
1 1 9
3 9
2
1 2 2
4 1 10
4 1 10

Children Immunization
Name Age BCG
Jefferson Gidagan 1 yr 6 mos /
 FAMILY HEALTH ORGANIZATION
Still Birth Number of deceased children Common illness in the family
0 1 - Unknown 2, 6, 7
0 0 2
1 (Not Registered) 0 2
0 0 2
0 0 2
0 0 2
0 0
0 0 3
0 0 1
2 0 4
0 0 2
0 0 1,2
0 0 2
2 1- Cause? 3
2 7 - Cause? 0
OPV DPT HEPA B MMR
/ / / /
ATION
Family Planning Acceptor Methods Used Health Resources Availed
x x Other - Herbal, Self Med
x x 2
x x 2
x x 2
2 x 1
2 x 1
2 x 2
2 x 2
1 6 4
2 x 1
2 x 1
1 6 3,4
1 6 2
x x 2
x x 4