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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 ____________________________