SURVEY QUESTIONNAIRE

NEEDS ASSESSMENT OF SELECTED BARANGAYS IN DUMINGAG, ZAMBOANGA

DEL SUR AS TABANGE PROGRAM PROSPECT BENEFICIARY

Name: ______________________________________Date: _______________

Address:________________________________________________________
Direction: May I request you to answer the following questions as honest as you can.
Mark check () of your answer among the options given below.

Part I. Socio-demographic profile of the Respondents

1. Age
( ) 15-25 yrs. old ( ) 26-35 yrs. old
( ) 36-45 yrs. old ( ) 46-55 yrs. old
( ) 56 yrs. old and above
2. Gender
( ) Male ( ) Female
3. Civil Status
( ) single ( ) married
( ) widow ( ) others,______
4. Educational Attainment
( ) no schooling ( ) college level
( ) elementary level ( ) college graduate
( ) elementary graduate
( ) high school level ( ) others, ____________
( ) high school graduate
5. Religious Affiliation
( ) Catholic ( ) INC ( ) Alliance ( ) SDA
( ) UCCP ( ) Others, _________
6. Number of Siblings
( )1-2 ( )3-4 ( ) 5- 6 ( ) 7 above
7. Number of years residing in current address
( ) less than 1 year ( ) 1-3
( ) 4-6 ( ) 7-9
( ) 10 above ( ) others,_____________________________
8. Are you a member of organization?
( ) Yes ( ) No
9. If yes, what organization you belong?
( ) farmer’s association ( ) DUSA
( ) farmer’s cooperative ( ) MOSA
( ) religious organization ( ) others,_______________
10. Other sources of income aside from farming
( ) sari-sari store ( ) handicraft
( ) daily wage/contract labor ( ) hunting
( ) government employee ( ) others,____________
( ) carpentry
11. Land ownership
( ) owner ( ) tenant ( ) lessee
12. Size of land tilled
( ) 1 hectare below ( ) 1.1-2 ha. ( ) 2.1 – 3 ha.
( ) 3.1 – 4 ha. ( ) 4.1 – 5 ha.
13. Average household annual income from all sources
( ) below 10,000
( ) 10,001-20,000
( ) 20,001-30,000
( ) 30,001-40,000
( ) 40,001-50,000
 ( ) 50,001 and above

Part II. FARMING PRACTICES ADOPTED

14. Crops cultivated
( ) corn ( ) rice ( ) cassava ( )banana
( ) taro ( ) pigeon pea ( ) peanut ( )adlay ( ) others__
15. Types of crop
( ) native ( ) hybrid
16. Purpose of production:
( ) own consumption only ( ) consumption and business
( ) business
17. Animal/s raised
( ) chicken ( ) goat ( ) swine ( ) cattle ( ) others,_________
18. Types of animals
( ) native ( ) purebred ( ) mixed
19. Purpose of production:
( ) own consumption only ( ) consumption and business
( ) business
20. Method of land preparation
( ) slash and burn
( ) application of herbicide
( ) machineries
( ) others,_____________
21. Topography of land cultivated
( ) hilly ( ) rolling ( ) flat
22. Types of soil
( ) loamy ( ) clayey ( ) sandy ( ) others, ___________
23. Tools used in cultivation
( ) bolo ( ) sharp bolo ( ) spade ( ) harrow ( ) animal drawn plow
( ) others,___________________
24. Did you use fertilizer?
( ) Yes ( ) No
25. Types of fertilizer used
( ) organic ( ) inorganic
( ) combination
26. Have you encountered pests & diseases in your crops and animals raised?
( ) yes ( ) no
27. If yes, what pests and diseases you have identified?
Crop Animals
( ) tungro ( ) cholera
( ) corn borer ( ) sora
( ) rice bug ( ) diarhea
( ) pod and fruit borer ( ) liver fluke
( ) aphids ( ) fowl fox
( ) others ( ) new castle disease
( ) others,_____
28. Preventive measures used
( ) cultural (binukid) ( ) fogging
( ) vaccines ( ) others,_____
( ) smudging
29. Control Measures
( ) immunization
( ) vaccination
( ) spraying of organic chemicals
( ) spraying of synthetic chemicals
( ) others,_______
PART III. PROBLEMS ENCOUNTERED

Adjectival rating:
Very Serious –5
Serious -3
Less Serious -1

Problems Responses
5 3 1
1. high cost of inputs
2. seeds availability
3. lack of capital
4. human destruction and stealing
5. insufficient water supply
6. health and nutrition
7. low viability of planting materials
8. lack of interest
9. pest infestation
10. peace and security
11. food sustainability
12. financial support to school children
13. reading comprehension level
14. mathematical skills
15. others,___________

PART IV. NEEDS AND SERVICES DESIRED BY THE RESPONDENTS

1. What information and skills do you want to access?

Education and Health

____reading and writing literacy
____numeracy skills
____basic entrepreneurial skills
____basic housekeeping training
____health and nutrition literacy
____basics of parliamentary procedure
____Alternative medicine processing
____Food processing
____beauty care workshop and seminar
____others, please specify, __________

Information, Communication and Technology

____basic bookkeeping and record keeping
____basic computer operation
____innovative packaging design
____e-governance of the barangay
____others, please specify, __________

Peace and Order

____survival literacy
____emergency response training
____basic community services training
____security enhancement program
____policy dissemination and awareness
____others, please specify, __________
Sustainable Agriculture
____Diseases and pesticide management
____package technology transfer
____vegetable production
____plant propagation
____farm credit, farm insurance
____Piggery production
____Poultry Production
____Post harvest techniques
____vermicomposting
____organic farming
____soil analysis
____rubber nursery establishment
____rubber tapping
____others, please specify, ________

2. What other support services do you want to avail?

____ Vegetable seeds, specify______________
____ grafted seedlings (rambutan, durian, lanzones, mango)
____ budded rubber seedlings
____ coconut seedlings
____ banana suckers
____ other seedlings, specify, ____________
____ farm tools and equipment (sharp bolo, blunt bolo, knife, plow, digging bar)
____ other tools please specify, _____________
____ vaccine (anti-rabies)
____ credit & financial assistance
____ others, _________________________

PART V. PROFILE OF THE BARANGAY

3. Demographic Profile and Special Population

a) No. of households ________________________________

b) Average Household size ________________________________
c) No. of out-of-school youth ________________________________
d) No. of identified PWDs in the barangay ________________________________
e) No. of illiterate adults ________________________________
f) Age distribution ________________________________
g) Ethnic composition ________________________________
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4. Economic characteristics

a) Employment trend (no. of employed, unemployed and self-employed citizens)

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b) Is there a presence of business or industry in the place (e.g., grocery stores,

restaurants, shopping areas, businesses, etc.)? If so, please describe.
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 c) What livelihood does people have? Please enumerate.
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d) Describe the overall aesthetic characteristic of the barangay e.g. presence of

trees, arable lands, and other notable features.
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5. What are the common types of housing in the barangay?

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6. What medical or health care facility is present in the place? Please describe (public
or private designation, location, clientele, services offered)
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7. What educational facilities are present? (day care, elementary, high school, etc. and
specify if public or private designation, the location, school district boundaries, size,
student enrollment, age, condition of structures)
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8. What are the public works and services available in the barangay? Describe the
services available to residents, including law enforcement, emergency services (such
as fire protection and ambulance service), postal services, libraries, and public
assistance services; location of facility; jurisdiction of services; location of emergency
routes.
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9. Recreational Facilities: location and description of facilities (indoor vs. outdoor, public
park, community center, private facility, amenities available, etc.), availability (time of
year, hours of operation, membership eligibility, etc.), programs offered, condition of
structures/facilities, if applicable.
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10. Common disputes settled in the barangay:

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11. Is there a presence of aggression by a group or groups of people? How often does
this occur?
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12. What are the implemented barangay programs and activities? Please enumerate.

a)
b)
c)
d)
e)
f)
g)
h)
i)

13. What support services are availed by the residents from the government? Please
check.
( ) free medical check up
( ) free medicine
( ) free planting materials
( ) 4Ps
( ) trainings
( ) seeds subsidy
( ) animal dispersal
( )others,________