Mindanao State University

Marawi City
College of Public Affairs
DEPARTMENT OF COMMUNITY DEVELOPMENT
Paperless Sectoral Survey Instrument

1. Type of Disadvantage Group <dropdown> c. Live-in/Common Law

a) Women d. Separated/ Divorced
b) Farmers e. Widow/ Widower
c) Fisherfolks 9. If married Muslim male, number of wives
d) Out School Youth <number>
e) Elderly 10. Total number of Children (to all wives)
f) PWD <number>
g) Drivers 11. Educational attainment <drop box>
h) Solo Parents a. No formal Schooling
i) Indigenous People b. Arabic Only
j) Vendors c. Elementary Level
k) Houseband d. Elementary Graduate
l) Massage Therapists e. High School level
(you can add additional options if needed) f. High School Graduate
I. Membership to CBOs and Reasons for g. Technical/Vocational
Non-Membership (common to all sectors) h. College Level
1. Are you a member of an existing CBOs? i. College Graduate
<multiple choice> j. Graduate & Post Graduate Level
a. Yes III. Economic Information (common to all
b. No sectors)
2. If yes, what is the name of the 12. Previous Employment (Pre-Pandemic)
Organization? <short answer> <short answer>
3. If yes, position in the organization <short 13. Present Employment/ Alternative
answer> Source of Income <short answer>
4. If yes, length of membership (months) 14. Nature of Employment <choices>
<number> a. Permanent
5. If no, reasons for non-membership b. Contractual/ Casual
<long answer> c. MOA
II. General Information (common to all d. Freelance
sectors) e. Others
1. Purok/ Land Mark <short answer> 15. Business (If engaged in business, what
2. Length of Stay in the barangay months type of business are you engaged into?
(month) <multiple choice> <short answer>
a. Since Birth 16. Others, please specify <short answer>
b. Others ______ (number of months) 17. Estimated amount of monthly income
3. Name of Respondent <short answer> derived from major occupation?
4. Age <number> <number>
5. Religion <short answer> 18. Do you have extra income source?
6. Sex Affiliation <multiple choice> (Choices)
a. Male a. Yes
b. Female b. None
7. Ethnic Affiliation <short answer> 19. If yes, what extra income sources do
8. Civil Status <drop down> you have? <short answer>
a. Single
b. Married
 20. How much estimated monthly income 26. Source of Information about Community
you earned from your extra income Quarantine guidelines?
source/s? <number> a. Television
IV. Health Status (common to all sectors) b. Radio
21. Classification of Priority Sector c. Facebook & Other social media
<choices> d. Internet other than choice ‘c’
a. Priority Eligible A e. Newspaper & Printed Sources
b. Priority Eligible B f. Word of Mouth/ Balita sa
c. Priority Eligible C Kapibahay/ Chismis
A1 Workers in Frontline Health Services 27. Level of Awareness to Covid19 and its
A2 All Senior Citizens symptoms? <star rating>
A3 Persons with Comorbidities 1 star – Lack of Awareness
A4 Frontline Personnel in Essential Sectors, 2 star – Low Level of Awareness
including Uniformed Personnel 3 star – Medium Level of Awareness
A5 Indigent Population 4 star – High Level of Awareness
B1 Teachers, Social Workers 5 star – Completely Awareness
B2 Other Government Workers Other 28. Do you know what are the things to do
Essential Workers when experiencing Covid Symptoms?
B4 Socio-Demographic Groups at <star rating>
significantly higher risk other than senior 1 star – Lack of Awareness
citizens and poor population based on the 2 star – Low Level of Awareness
NHTS-PR 3 star – Medium Level of Awareness
B5 OFW 4 star – High Level of Awareness
B6 Other Remaining Workers 5 star – Completely Awareness
C Rest of the Filipino Population not 29. Would you like to avail the free Covid19
otherwise included in the above groups vaccines by the government? <choices>
a. Yes
22. With/Without comorbidity? <choices> b. No
a. With comorbidity c. Not yet/ Undecided
b. Without comorbidity 30. If ‘not yet’ or ‘undecided’, state the
23. If with comorbidity, type of comorbidity? reasons why? <long answers>
<short answer> 31. Is the coronavirus pandemic affecting
24. Source of Information about Covid19? our mental health? <choices>
<checkbox> a. Yes
a. Television b. No
b. Radio c. Undecided
c. Facebook & Other social media 32. If yes, Effects of Pandemic to mental
d. Internet other than choice ‘c’ health <choices>
e. Newspaper & Printed Sources a. Anxiety
f. Word of Mouth/ Balita sa b. Depression
Kapibahay/ Chismis c. Others, specify ______
25. Source of Information about Covid19 33. During the twelve months, was a
Vaccine efficacy? <checkbox> member of your household became
a. Television sick? <choices>
b. Radio a. Yes
c. Facebook & Other social media b. None
d. Internet other than choice ‘c’ 34. If yes, what illness suffered from? <short
e. Newspaper & Printed Sources answer>
f. Word of Mouth/ Balita sa 35. Where did you go to avail medical
Kapibahay/ Chismis treatment? <dropdown>
a. Self-Medication