Thanks to visit codestin.com
Credit goes to www.scribd.com

Scribd
Upload
49 views2 pages

Mapping Survey Form

This document appears to be a geographic identification and household census form from the Isabela State University-Cauayan Campus in the Philippines. It collects information such as the barangay, household head name, hazard susceptibility, number of household members, construction materials used, and intended residence in 5 years. The form is used to gather data on housing and households for analysis and planning purposes.

Uploaded by

Jong Franco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
49 views2 pages

Mapping Survey Form

This document appears to be a geographic identification and household census form from the Isabela State University-Cauayan Campus in the Philippines. It collects information such as the barangay, household head name, hazard susceptibility, number of household members, construction materials used, and intended residence in 5 years. The form is used to gather data on housing and households for analysis and planning purposes.

Uploaded by

Jong Franco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

Republic of the Philippines

Province of Isabela
Commission on Higher Education
ISABELA STATE UNIVERSITY- CAUAYAN CAMPUS
College of Computing and Information Technology
San Fermin, Cauayan City, Isabela

GEOGRAPHIC IDENTIFICATION

PROVINCE ______________
CITY/MUNICIPALITY_________
BARANGAY _______________
HOUSE NUMBER___________
NAME OF HOUSEHOLD HEAD ___________________________________________
Last Name First Name Middle

INTERVIEW RECORD
HAZARD MAP DATA SUMMARY OF VISIT

Flood Susceptibility _______________ NUMBER OF VISITS MADE _____


Barangay Name _______________ NUMBER OF HOUSEHOLD
Building Class _______________ MEMBERS____
Building Type _______________ NUMBER OF MALES ____
Building Name _______________ NUMBER OF FEMALES ____
No Floors _______________
Estimated Value _______________ CODES FOR RESULT VISIT
Number of Households ______________
Number of Occupants ______________ 1. Completed
Time of Construction _______________ 2. Partly completed
Number of 15 below _______________ 3. Refused
Number of 60 above _______________ 4. Postponed
Number of People with Disabilities _____ 5. Household temporarily away/ no
Purok _______________ respondent around
_____________________________________ 6. Others, specify
NAME OF HOUSEHOLDS
1. Is the house vulnerable to:
2. Put Check (/) In The Blank
3. ________ Flood Prone Area
4. How many times in a year ______
5.
________ Landslide Prone Area
6.
How many times in a year _______
7.

HOUSEHOLD/HOUSING CENSUS QUESTIONS


Type of Building/house Construction Materials of the outer walls
Put Check (/) In The Blank Put Check (/) In The Blank

____ 1. Single House ____ 1. Concrete/Brick/Stone


____ 2. Duplex ____ 2. Wood
____ 3. Multi-unit residential ____ 3. Half Concrete/Brick/Stone and half
(three units or more) wood
____ 4. Commercial/Industrial/Agricultural ____ 4. Galvanize iron/aluminum
(office, factory, and others) ____ 5. Bamboo/Sawali/Cogon/Nipa
____ 5. Institutional living quarter ____ 6. Asbestos
(hotel, hospital and others) ____ 7. Glass
____ 8. Makeshift/salvage/improvised materials
____ 9. others, specify: ___________________

Residence five years from now


In what city/municipality those this household intends to reside after five years?

____ Same City


____ If another City/Municipality specify:
City/Municipality_______________________
Province ____________________________

You might also like