University of Southern Mindanao

College of Engineering and Computing

DEPARTMENT OF CIVIL ENGINEERING
Kabacan, North Cotabato, Philippines

Questionnaire

This questionnaire aims to collect social and economic data related to

the household. These data will be used to study their effects on the number of

trips (i.e. work trips, education trips, shopping trips, recreational trip, and so on)

that the household makes and to develop a mathematical model that connects

these socioeconomic data with the number of trips made by the household.

This model can benefit urban transportation planning of Tacurong City.

Thanks for Your Cooperation

Researcher: Jerrilyn Louise S. Lunasco

 SECTION 1. HOUSEHOLD INFORMATION INTERVIEW FORM

Traffic Zone (Purok ): _______________________ Survey Date: _____________

Household No: ____________

Q1. Is the respondent head of the household (HoH)?

Yes ____
No ____ Relationship to HoH: ________

Q2. Gender of the HoH: Male _____ Female ____

Q3. Number of Household Members: ______

Q4. Household Ownership Owned ____ Rent ____

Q5. Average Monthly Income (PHP): Below 5,000 ______

5,001-10,000 ______
10,001-15,000 ______
15,001-20,000 ______
Above 20,000 ______

Q7. No. of Licensed Drivers:_______

Q9. Number of Vehicles Owned: ______

Q10.Years of Residency

Less than a year ______

2 to 5 years ______
5 to 10 years ______
10 years and up ______
 SECTION 2. HOUSEHOLD MEMBERS INFORMATION FORM

Traffic Zone (Purok): __________________ Survey Date: _____________

Household No: _________

1. Household Members
1
HHD Name of Household Members Age Gender 1HHD - Household Designation
2Mode – (1) Private owned Vehicles, (2) Busses, (3)
1 _________________________ _____ _____ Jeepneys, (4) Tricycles, (5) Multicabs, (6) Van, (0)
2 _________________________ _____ _____ Others and (N) None

3 _________________________ _____ _____

4 _________________________ _____ _____
5 _________________________ _____ _____
6 _________________________ _____ _____
7 _________________________ _____ _____
8 _________________________ _____ _____
9 _________________________ _____ _____
10 _________________________ _____ _____

2. Household Members with Job

1HHD 2Mode
Occupation Workplace Monthly
Income (PHP)

______ ____________ __________ ________ _____

______ ____________ __________ ________ _____
______ ____________ __________ ________ _____
______ ____________ __________ ________ _____
______ ____________ __________ ________ _____
______ ____________ __________ ________ _____

3. Household Members that are Students

2
HHD Level of Education School Age Gender Mode
______ _______________ ____________ ____ _______ _____
______ _______________ ____________ ____ _______ _____
______ _______________ ____________ ____ _______ _____
______ _______________ ____________ ____ _______ _____
______ _______________ ____________ ____ _______ _____
______ _______________ ____________ ____ _______ _____