Family Profile Survey

Family Profile Survey/Situational Analysis
Household No. Name of Household/Family Members:
Name of Household Head: Birthday Birthday

Purok/Sitio: 1) 7)
Barangay: 2) 8)
Municipality: 3) 9)
4) 10)
5) 11)
6) 12)
Total No. of Population: 2021 2022 2023 2024
Total No. of Household:
Total No. Of Household Surveyed:
Total No. Of Families Surveyed:
Total No. Of Women who are:
a.) Pregnant
b.) Nursing (mixed, bottle, breastfeeding) (0-23 months)
c.) Lactating (purely breastfeeding) (0-23 months)
Total No. Of Infants: Purely Breastfeeding (0-6 months)
Total No. Of 0-23 months old preschoolers
Total No. Of child given complementary feeding or other foods than
breast milk (6-23 months)
Total number of preschool population aged (0-59 months old)
Total number of preschoolers weighed and measured
Percent of OPT Plus Coverage
Total number of preschoolers
Boys:
Girls:
Total number of children with cleft palate
NUTRITIONAL Status of Preschooler
Total weigh for age (0-59 months)
a. Number of Normal
b. Number of Underweight (UW)
c. Number of Severely underweight (SUW)
d. Number of Overweight (OW)
Total Length/Height for age (0-59)
A. Number of Normal (N)
B. Number of Stunted (St)
C. Number of Severely Stunted (SSt)
D. Number of Tall
Total Weight for Length/Height (0-59 months)
A. Number of Normal
B. Number of Wasted (W)
C. Number of Severely Wasted (SW)
D. Number of Overweight (OW)
E. Number of Obese (Ob)
Number of Preschoolers Immunized
A. BCG
B. HEPA-B VACCINE
C. DPT- Hepa B- HIB ( Pentavalent Vaccine)
D. Oral Polio Vaccine
E. Roatavirus Vaccine
F. Measles
G. Measles- Mumps- Rubella Vaccine
H. Hpvc 13 (Pneumonia, conjugate vaccine)
Number of Household with:
A. Pail System Toilets
B. Open pit toilets
C. Closed pit toilets
D. Water sealed toilets (shared)
E. Water sealed toilets (owned)
F. No toilets
Number of Household getting water from:
A. Pipe/Faucet/Pressure Pump
B. Deep Well (60 ft above)
C. Shallow well (10 ft below)
D. Open dug well (balon, bobon, atabay)
E. Spring/river/stream
F. Rain
G. Peddler
H. Purified/bottle water
I. Community water system (tangke)
Number of Household with:
A. Vegetable garden (5-7 varieties)
B. Livestock
C. Poultry
D. Fishpond/fishnnet
Number of household with credit assistance (pautang)
A. Handicraft (native products)
B. Livelihood (cow, carabao)
C. Others:
Method of garbage disposal
A. Dumping
B. Compost pit
C. Burying
D. Collected by trucks
Number of household according to type of dwelling units
A. Concrete
B. Semi-concrete
C. Wood
D. Makeshift/barong-barong
a. Along the river banks
b. Under the bridge
c. Top of the mountain
Total number household with:
A. Blind drainage
B. Open drainage
Total number of children
A. Daycare
B. Kinder
C. Primary grade (1-4)
D. Elementary (5-6)
E. High school (7-10)
F. Senior high school (11-12)
G. College
H. Out of school youth
Total number of person with disability (PWD)
Registered:
NOT Registered PWD:
Total number of Senior Citizen
Registered:
NOT registered senior citizen:
Total number of out of school youth
Registered:
NOT registered Out of School Youth:
Total number of Philhealth Member
Philhealth Member:
Not Philhealth Member:
Total number of 4P’s Beneficiary (Barangay Data)
Total No. Of families with UW and SUW preschoolers
Total No. Of Families with wasted and severely wasted school children
Total No. Of Families using fortified foods (sangkap pinoy)
Total No. Of households using iodized salt
Total No. Of store selling fortified foods
Total No. Of Families practicing family planning
Total No. Of women with reproductive age (WRA) (15-49 yrs. Old)
Total No. Of skills training conducted in barangay
Total No. Of Sari-sari store (barangay data)
Total No. Of Botika sa barangay (barangay data)
Total No. Of eateries/carenderia (barangay data)
Total No. Of existing community garden (barangay data)
Total No. Of Peer counselor (barangay data)
Total No. Of Pabasa session (barangay data)
Total No. Of breastfeeding stations/corners/center (barangay data)
A. Health center/BHS
B. RHU
C. Terminal
D. Market
E. Schools
F. Barangay Hall
G. Others (Please Specify:)
Number of Smokers:
A. 12-17 years old
B. 18-21 years old
C. 22-25 years old
D. 60 and above
Total No. Of Daycare Centers
A. Private
B. Public
Total No. Of Elementary Schools
A. Private
B. Public
Total No. Of Secondary Schools
A. Private
B. Public
Total No. Of College Schools
A. Private
B. Public
Total No. Of Barangay Health Stations
Total No. Of Barangay Health worker (BHW)
Total no. Of Barangay Nutrition Scholar (BNS)
Total No. Of IPS
MALE
FEMALE
Total No. Of Non- IPS
MALE
FEMALE
Total No. Of Public Market
Total No. Of Transport Terminal
Total No. Of Registered Voters (18 years old and above)
_______________________________ ______________________
Name and Signature Date
Prepared by:__________________________________
Date: ______________________________________

Family Profile Survey

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Family Profile Survey

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Family Profile Survey/Situational Analysis

Household No. Name of Household/Family Members:

Name of Household Head: Birthday Birthday

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