iWaSH Data Forms and Requirements (FINAL)

DATA REQUIREMENTS Available Year
ASSESSMENT/STATUS OF DATA COLLECTION Growth Rate in %

REGION: VII e = Eulers Number
MUNICIPALITY: Sample
Number of Barangays: 100
Local iWaSH Council
Current
CLASSIFICATION Land Area Population
NAME OF BARANGAYS
2015
(Rural / Urban) (Ha)
Barangay 1
Barangay 2
Barangay 3
Barangay 4
Barangay 5
Barangay 6
Barangay 7
Barangay 8
Barangay 9
Barangay 10
Barangay 11
Barangay 12
Barangay 13
Barangay 14
Barangay 15
Barangay 16
Barangay 17
Barangay 18
Barangay 19
Barangay 20
Barangay 21
Barangay 22
Barangay 23
Barangay 24
Barangay 25
Barangay 26
Barangay 27
Barangay 28
Barangay 29
Barangay 30
Barangay 31
Barangay 32
Barangay 33
Barangay 34
Barangay 35
Barangay 36
Barangay 37
Barangay 38
Barangay 39
Barangay 40
Barangay 41
Barangay 42
Barangay 43
Barangay 44
Barangay 45
Barangay 46
Barangay 47
Barangay 48
Barangay 49
Barangay 50
Barangay 51
Barangay 52
Barangay 53
Barangay 54
Barangay 55
Barangay 56
Barangay 57
Barangay 58
Barangay 59
Barangay 60
Barangay 61
Barangay 62
Barangay 63
Barangay 64
Barangay 65
Barangay 66
Barangay 67
Barangay 68
Barangay 69
Barangay 70
Barangay 71
Barangay 72
Barangay 73
Barangay 74
Barangay 75
Barangay 76
Barangay 77
Barangay 78
Barangay 79
Barangay 80
Barangay 81
Barangay 82
Barangay 83
Barangay 84
Barangay 85
Barangay 86
Barangay 87
Barangay 88
Barangay 89
Barangay 90
Barangay 91
Barangay 92
Barangay 93
Barangay 94
Barangay 95
Barangay 96
Barangay 97
Barangay 98
Barangay 99
Barangay 100
Available Year 2015
Growth Rate in % 1.68%
e = Eulers Number 2.71828182
POPULATION DATA
Current
Projected Population Projected Househ
Household
2020 2022 2025 2030 2015 2020

Socio-Economic Profile
Projected Households
Average
Household
Income Above poverty Below poverty
2022 2025 2030
line line
Num
% Indigenous Level 1
Ethnic Group
People of the
(Specify)
Population
Private % Public %
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
HOUSEHOLD Access Applying the HRBA
Number of SERVED HH
Level 2 % TOOL Level 3 % TOOL

TOOL
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
0 - 0 - 0
WATER SUPPLY
pplying the HRBA
Number of UNDERSERVED HH
Total Level 1 % Level 2 % Level 3 %
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
0% - -
Water Source (specify)
Quality of Type of Yield of

Total % Location
Source Source Source
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
STATUS
NAME OF WATER
ORGANIZATION
MANAGING THE BUB/ADM No. of
Average WATER SYSTEM Household
COMPLETI FUNCTION
Distance to Served or
ON ALITY
Service Area to be
Served
WATER PROJECT/S
STATUS STATUS
KALAHI
SALINTUBIG No. of (DSWD)
COMPLETIO FUNCTIONA Household COMPLETI
N LITY Served or to ON
be Served
STATUS STATUS
Served
No. of OTHERS No. of
Household Household Household
FUNCTION COMPLETI FUNCTION
Served or Served or s w/
ALITY ON ALITY
to be to be Sanitary
Served Served Toilets
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HOUSEHOLDS ACCESS (APPLYING HRBA Principle)
Served Underserved
Households
w/ Shared
% TOOL % % Total
Unsanitary Toilets
Toilets
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
0 - - -
SCHOOLS ACCESS (A
iple)
Number of Schools: Total Number of
Unserved Students
OD or W/O Public Private Public Private

% %
Toilets
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
SANITATIO
HOOLS ACCESS (APPLYING HRBA Principle)
Schools w/ Toilets
Public Private
For Males For Female Shared For Males For Female Shared Total
Toilets Toilets Number of
Health
Center
SANITATION FACILITIES
Barangay Hall Daycare Center Health Cen
For Males For Female Shared For Males For Female Shared For Males
Toilets Toilets
PUBLIC PLACES ACCESS (APPLYING HRBA Principle)
Health Center Public Market Public Terminal
For Female Shared For Males For Female Shared For Males For Female
Toilets Toilets
nciple)
ic Terminal Parks and Playground Evacuation Center/ Multi Purpose

Hall
Shared For Males For Female Shared For Males For Female Shared
Toilets Toilets Toilets
SOLID WASTE & LIQUID DI
HYGIENE FACILITIES
PRACTICE
Etc. Number of Hand washing

facilities
For Males For Female Shared Garbage collection
Toilets and disposal system
Public Private (Specify)
WASTE & LIQUID DISPOSAL
HEALTH DATA
PRACTICE
Water, Sanitation and Hygiene Related Diseases (Specify)
Drainage System
(Specify Type,
OPEN/CLOSE) Diarrhea Cholera Ammobiasis Hepatitis A
TA FINANCIAL DATA
ated Diseases (Specify)

Number of CIVIL
SOCIETY
Past Public Public-Private ORGANIZATION
Dengue Others Specify Investment Partnership
GAD Related
CCA/DRR (Specify Hazard Mitigation
Activities (Specify
the activities) Identified Conducted
the activities)
Inventory of Human Resources: (Health, Water, Sanitation and Hygiene Conc
Public health
Engineers/
Water Public Health
Municipal Doctor Nurses
Technicians promoters
Health Sanitary
Inspectors
Sanitation and Hygiene Concerns)
Barangay Barangay
Midwives Health Workers Nutrition
(BHW) Scholar (BNS)
Municipality of ______________________________
Land Area and Classification by Barangay

Classification Land Area
Barangay
(Rural / Urban) (Ha)
Barangay 1 0 0
Barangay 2 0 0
Barangay 3 0 0
Barangay 4 0 0
Barangay 5 0 0
Barangay 6 0 0
Barangay 7 0 0
Barangay 8 0 0
Barangay 9 0 0
Barangay 10 0 0
Barangay 11 0 0
Barangay 12 0 0
Barangay 13 0 0
Barangay 14 0 0
Barangay 15 0 0
Barangay 16 0 0
Barangay 17 0 0
Barangay 18 0 0
Barangay 19 0 0
Barangay 20 0 0
Barangay 21 0 0
Barangay 22 0 0
Barangay 23 0 0
Barangay 24 0 0
Barangay 25 0 0
Barangay 26 0 0
Barangay 27 0 0
Barangay 28 0 0
Barangay 29 0 0
Barangay 30 0 0
Barangay 31 0 0
Barangay 32 0 0
Barangay 33 0 0
Barangay 34 0 0
Barangay 35 0 0
Barangay 36 0 0
Barangay 37 0 0
Barangay 38 0 0
Barangay 39 0 0
Barangay 40 0 0
Barangay 41 0 0
Barangay 42 0 0
Barangay 43 0 0
Barangay 44 0 0
Barangay 45 0 0
Barangay 46 0 0
Barangay 47 0 0
Barangay 48 0 0
Barangay 49 0 0
Barangay 50 0 0
Barangay 51 0 0
Barangay 52 0 0
Barangay 53 0 0
Barangay 54 0 0
Barangay 55 0 0
Barangay 56 0 0
Barangay 57 0 0
Barangay 58 0 0
Barangay 59 0 0
Barangay 60 0 0
Barangay 61 0 0
Barangay 62 0 0
Barangay 63 0 0
Barangay 64 0 0
Barangay 65 0 0
Barangay 66 0 0
Barangay 67 0 0
Barangay 68 0 0
Barangay 69 0 0
Barangay 70 0 0
Barangay 71 0 0
Barangay 72 0 0
Barangay 73 0 0
Barangay 74 0 0
Barangay 75 0 0
Barangay 76 0 0
Barangay 77 0 0
Barangay 78 0 0
Barangay 79 0 0
Barangay 80 0 0
Barangay 81 0 0
Barangay 82 0 0
Barangay 83 0 0
Barangay 84 0 0
Barangay 85 0 0
Barangay 86 0 0
Barangay 87 0 0
Barangay 88 0 0
Barangay 89 0 0
Barangay 90 0 0
Barangay 91 0 0
Barangay 92 0 0
Barangay 93 0 0
Barangay 94 0 0
Barangay 95 0 0
Barangay 96 0 0
Barangay 97 0 0
Barangay 98 0 0
Barangay 99 0 0
Barangay 100 0 0
Municipality of ______________________________
Existing Level I Water Supply Facilities

Level I - Private (or Individual Household) Level I - Public
Total No. of No. of Total No. of Total No. of Percent of Facilities Total No. of Total No. of Percent of Facilities Total No. of % of Total of
Barangay HH (Yr. No. of No. of Regularly No. of No. of
No. of Covered Level I - HH Served HH Served No. of Level I - HHs served HHs served Regularly HH Served HH Served
_____) Shallow Developed Shallow Developed
Deep Well Improved Private by Private by Private Treated (√) Deep Well Public by Public by Public Treated (√)
Well Spring Well Spring
Dug Well Facilities Facilities Facilities Facilities Facilities Facilities
Yes No Yes No
Barangay 1 0 0 0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0!
Municipality of ______________________________
Existing Level II Water Supply Facilities

Water Source With No. of
Barangay Total No. of HH Treatment Total No. of % of Total
(Yr. _____) Surface Facilities Public HH Served HH Served
Spring Well Faucet
Water (Yes/No)
Barangay 1 0 0 #DIV/0!
Municipality of ______________________________
Existing Level III Water Supply Facilities

Water Source With
Barangay Total No. of HH Treatment No. of HH % of HH Served
(Yr. _____) Surface Facilities Connections
Spring Well
Water (Yes/No)
Municipality of ______________________________
Population Categorically with Access to Water Supply

Water Service Coverage By Levels PERCENTAGE
Barangay No. of HH Level 1 TOTAL Level 1 TOTAL
Level 2 Level 3 Level 2 Level 3
Private Public Private Public
1 Barangay 1 - 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Municipality of ______________________________
Data on Proposed (Future) Water Source

Location
Estimated Estimated
Discharge Estimated Distance from Geographical Coordinates
Source Type* Elevation Proposed Remarks
(mamsl) Service Area Name of Barangay Longitude Latitude
(Liters/sec) (km)
(in deg/min/sec) (in deg/min/sec)
Notes: *Source Type: 1. Spring, 2 Deep Well (>20m deep bored well), 4. Shallow Well (<20m deep bored well), 5. Dug Well (shallow large diameter well), 6. Surface Water (creek),
7. Surface Water (river), 8. Surface Water (lake).
mamsl - meters above mean sea level
Municipality of ______________________________
Household Toilet Facility

Number of Household with Sanitary Toilets Number of Household with Unsanitary Toilets No. of HH
Total No. of HH % of HH Without
Without Toilets/
Barangay Toilets/ Open
(Yr. _____) Flush With Pour Flush W/ Open Pit/Pit Open
Defecation
VIP Total % Over-hung Total % Defecation
Septic Tank Septic Tank latrine
Barangay 1 0 0 #DIV/0! 0 #DIV/0!

Municipality of ______________________________
Data on School Toilet

Number of School Toilet Facilities
Total No. of HH Number of School/s Number of Student/s
Barangay Sanitary Unsanitary
(Yr. _____)
Public Private Public Private Public Private Public Private
Barangay 1 0
Barangay 2 0
Barangay 3 0
Barangay 4 0
Barangay 5 0
Barangay 6 0
Barangay 7 0
Barangay 8 0
Barangay 9 0
Barangay 10 0
Barangay 11 0
Barangay 12 0
Barangay 13 0
Barangay 14 0
Barangay 15 0
Barangay 16 0
Barangay 17 0
Barangay 18 0
Barangay 19 0
Barangay 20 0
Barangay 21 0
Barangay 22 0
Barangay 23 0
Barangay 24 0
Barangay 25 0
Barangay 26 0
Barangay 27 0
Barangay 28 0
Barangay 29 0
Barangay 30 0
Barangay 31 0
Barangay 32 0
Barangay 33 0
Barangay 34 0
Barangay 35 0
Barangay 36 0
Barangay 37 0
Barangay 38 0
Barangay 39 0
Barangay 40 0
Barangay 41 0
Barangay 42 0
Barangay 43 0
Barangay 44 0
Barangay 45 0
Barangay 46 0
Barangay 47 0
Barangay 48 0
Barangay 49 0
Barangay 50 0
Barangay 51 0
Barangay 52 0
Barangay 53 0
Barangay 54 0
Barangay 55 0
Barangay 56 0
Barangay 57 0
Barangay 58 0
Barangay 59 0
Barangay 60 0
Barangay 61 0
Barangay 62 0
Barangay 63 0
Barangay 64 0
Barangay 65 0
Barangay 66 0
Barangay 67 0
Barangay 68 0
Barangay 69 0
Barangay 70 0
Barangay 71 0
Barangay 72 0
Barangay 73 0
Barangay 74 0
Barangay 75 0
Barangay 76 0
Barangay 77 0
Barangay 78 0
Barangay 79 0
Barangay 80 0
Barangay 81 0
Barangay 82 0
Barangay 83 0
Barangay 84 0
Barangay 85 0
Barangay 86 0
Barangay 87 0
Barangay 88 0
Barangay 89 0
Barangay 90 0
Barangay 91 0
Barangay 92 0
Barangay 93 0
Barangay 94 0
Barangay 95 0
Barangay 96 0
Barangay 97 0
Barangay 98 0
Barangay 99 0
Barangay 100 0
Municipality of ______________________________
Data on Public Toilet Facility

Total Number of Public Facility Number of Public Sanitary Toilets Number of Public Unsanitary Toilets
Barangay Total No. of HH (Yr. Bus/ Bus/ Bus/
_____) Public Parks/Playgr Public Parks/Playgr Public Parks/Playgr
Jeepney Port Jeepney Port Jeepney Port
Market ounds Market ounds Market ounds
Terminal Terminal Terminal
Barangay 1 0
Barangay 2 0
Barangay 3 0
Barangay 4 0
Barangay 5 0
Barangay 6 0
Barangay 7 0
Barangay 8 0
Barangay 9 0
Barangay 10 0
Barangay 11 0
Barangay 12 0
Barangay 13 0
Barangay 14 0
Barangay 15 0
Barangay 16 0
Barangay 17 0
Barangay 18 0
Barangay 19 0
Barangay 20 0
Barangay 21 0
Barangay 22 0
Barangay 23 0
Barangay 24 0
Barangay 25 0
Barangay 26 0
Barangay 27 0
Barangay 28 0
Barangay 29 0
Barangay 30 0
Barangay 31 0
Barangay 32 0
Barangay 33 0
Barangay 34 0
Barangay 35 0
Barangay 36 0
Barangay 37 0
Barangay 38 0
Barangay 39 0
Barangay 40 0
Barangay 41 0
Barangay 42 0
Barangay 43 0
Barangay 44 0
Barangay 45 0
Barangay 46 0
Barangay 47 0
Barangay 48 0
Barangay 49 0
Barangay 50 0
Barangay 51 0
Barangay 52 0
Barangay 53 0
Barangay 54 0
Barangay 55 0
Barangay 56 0
Barangay 57 0
Barangay 58 0
Barangay 59 0
Barangay 60 0
Barangay 61 0
Barangay 62 0
Barangay 63 0
Barangay 64 0
Barangay 65 0
Barangay 66 0
Barangay 67 0
Barangay 68 0
Barangay 69 0
Barangay 70 0
Barangay 71 0
Barangay 72 0
Barangay 73 0
Barangay 74 0
Barangay 75 0
Barangay 76 0
Barangay 77 0
Barangay 78 0
Barangay 79 0
Barangay 80 0
Barangay 81 0
Barangay 82 0
Barangay 83 0
Barangay 84 0
Barangay 85 0
Barangay 86 0
Barangay 87 0
Barangay 88 0
Barangay 89 0
Barangay 90 0
Barangay 91 0
Barangay 92 0
Barangay 93 0
Barangay 94 0
Barangay 95 0
Barangay 96 0
Barangay 97 0
Barangay 98 0
Barangay 99 0
Barangay 100 0
Municipality of ______________________________
Data on Solid Waste Management Practices

For LGU Garbage Collection
Number of Households Practicing:
Total No. of HH Service
Barangay Remarks
(Yr. _____) LGU With MRF? Ave. Cost
Burning Composting Collection (Yes/No) (Php/HH/mo.)
Barangay 1 0
Barangay 2 0
Barangay 3 0
Barangay 4 0
Barangay 5 0
Barangay 6 0
Barangay 7 0
Barangay 8 0
Barangay 9 0
Barangay 10 0
Barangay 11 0
Barangay 12 0
Barangay 13 0
Barangay 14 0
Barangay 15 0
Barangay 16 0
Barangay 17 0
Barangay 18 0
Barangay 19 0
Barangay 20 0
Barangay 21 0
Barangay 22 0
Barangay 23 0
Barangay 24 0
Barangay 25 0
Barangay 26 0
Barangay 27 0
Barangay 28 0
Barangay 29 0
Barangay 30 0
Barangay 31 0
Barangay 32 0
Barangay 33 0
Barangay 34 0
Barangay 35 0
Barangay 36 0
Barangay 37 0
Barangay 38 0
Barangay 39 0
Barangay 40 0
Barangay 41 0
Barangay 42 0
Barangay 43 0
Barangay 44 0
Barangay 45 0
Barangay 46 0
Barangay 47 0
Barangay 48 0
Barangay 49 0
Barangay 50 0
Barangay 51 0
Barangay 52 0
Barangay 53 0
Barangay 54 0
Barangay 55 0
Barangay 56 0
Barangay 57 0
Barangay 58 0
Barangay 59 0
Barangay 60 0
Barangay 61 0
Barangay 62 0
Barangay 63 0
Barangay 64 0
Barangay 65 0
Barangay 66 0
Barangay 67 0
Barangay 68 0
Barangay 69 0
Barangay 70 0
Barangay 71 0
Barangay 72 0
Barangay 73 0
Barangay 74 0
Barangay 75 0
Barangay 76 0
Barangay 77 0
Barangay 78 0
Barangay 79 0
Barangay 80 0
Barangay 81 0
Barangay 82 0
Barangay 83 0
Barangay 84 0
Barangay 85 0
Barangay 86 0
Barangay 87 0
Barangay 88 0
Barangay 89 0
Barangay 90 0
Barangay 91 0
Barangay 92 0
Barangay 93 0
Barangay 94 0
Barangay 95 0
Barangay 96 0
Barangay 97 0
Barangay 98 0
Barangay 99 0
Barangay 100 0
Municipality of ______________________________
Data on Drainage Facility

Length (In Linear Meters) Outfall/Discharge Point
Barangay Pipe Concrete Earth Creek/ Remarks
Lake Open Land Sea
Culvert Lined (Unlined) River
Barangay 1
Barangay 2
Barangay 3
Barangay 4
Barangay 5
Barangay 6
Barangay 7
Barangay 8
Barangay 9
Barangay 10
Barangay 11
Barangay 12
Barangay 13
Barangay 14
Barangay 15
Barangay 16
Barangay 17
Barangay 18
Barangay 19
Barangay 20
Barangay 21
Barangay 22
Barangay 23
Barangay 24
Barangay 25
Barangay 26
Barangay 27
Barangay 28
Barangay 29
Barangay 30
Barangay 31
Barangay 32
Barangay 33
Barangay 34
Barangay 35
Barangay 36
Barangay 37
Barangay 38
Barangay 39
Barangay 40
Barangay 41
Barangay 42
Barangay 43
Barangay 44
Barangay 45
Barangay 46
Barangay 47
Barangay 48
Barangay 49
Barangay 50
Barangay 51
Barangay 52
Barangay 53
Barangay 54
Barangay 55
Barangay 56
Barangay 57
Barangay 58
Barangay 59
Barangay 60
Barangay 61
Barangay 62
Barangay 63
Barangay 64
Barangay 65
Barangay 66
Barangay 67
Barangay 68
Barangay 69
Barangay 70
Barangay 71
Barangay 72
Barangay 73
Barangay 74
Barangay 75
Barangay 76
Barangay 77
Barangay 78
Barangay 79
Barangay 80
Barangay 81
Barangay 82
Barangay 83
Barangay 84
Barangay 85
Barangay 86
Barangay 87
Barangay 88
Barangay 89
Barangay 90
Barangay 91
Barangay 92
Barangay 93
Barangay 94
Barangay 95
Barangay 96
Barangay 97
Barangay 98
Barangay 99
Barangay 100
Municipality of ______________________________
Data on Morbidity and Mortality

Water Annual Incidence per 1,000 People
Name of Diseases Related Infant
Diseases Morbidity Mortality
Mortlity
1 Diarhea X
2 Pneumonias
3 Bronchitis/Bronchiolitis
4 Influenza
5 Measles
6 TB Respiratory
7 TB Meningitis
8 TB Other forms
9 Diseases of the Heart
10 Hypertension
11 Malignant Neoplasms
12 Chickenpox X
13 Dengue Fever X
14 Malaria X
15 Cholera X
16 Typhoid and Paratypoid X
17 Viral Hepatitis X
18 Rabies (Human)
19 Diphteria X
20 Tetanus Neonatorum
21 AIDS/HIV Infection
22 Leprosy X
23 Schistosomiasis X
24 Filariasis
25 Meningitis/Encephalitis X
26 Leptospirosis
27 Poisoning
28 Meningococcemia
29 Skin Diseases
30 Scabies X
31 Dysentery X
32 Intestinal Parasites X
33 Conjunctivities X
Note: X represent as water related diseases
Source:
Municipality of ______________________________
FINANCIAL DATA
1. INCOME PROFILE
Total Local Total Tax Total Non-Tax
Year Total Income IRA
Sources Revenue Revenue
2016
2015
2014
2013
2012
2. INCOME EXPENDITURES
Education, Social
Health,
Culture & Security
Total General Public Nutrition & Economic Other
Year Sports/ /Social Debt Service
Expenditures Services Population Services Purposes
Manpower Services &
Control
Development Welfare
2016
2015
2014
2013
2012
3. INFORMATION ON EXISTING LOANS

End of
Loan Purpose of Amount of Annual Grace Period Repayment Funding
Repayment Interest Rate
Details Existing Loan Existing Loan Amortization (Years) Period Institution
Period

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DATA REQUIREMENTS Available Year

ASSESSMENT/STATUS OF DATA COLLECTION Growth Rate in %

2020 2022 2025 2030 2015 2020

Level 2 % TOOL Level 3 % TOOL

Total Level 1 % Level 2 % Level 3 %

Quality of Type of Yield of

OD or W/O Public Private Public Private

Barangay Hall Daycare Center Health Cen

Health Center Public Market Public Terminal

ic Terminal Parks and Playground Evacuation Center/ Multi Purpose

Etc. Number of Hand washing

Water, Sanitation and Hygiene Related Diseases (Specify)

ated Diseases (Specify)

Land Area and Classification by Barangay

Existing Level I Water Supply Facilities

Existing Level II Water Supply Facilities

Existing Level III Water Supply Facilities

Population Categorically with Access to Water Supply

Data on Proposed (Future) Water Source

Household Toilet Facility

Barangay 1 0 0 #DIV/0! 0 #DIV/0!

Data on School Toilet

Data on Public Toilet Facility

Data on Solid Waste Management Practices

Data on Drainage Facility

Data on Morbidity and Mortality

3. INFORMATION ON EXISTING LOANS

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