School of Business and Economics

University of San Carlos Downtown Campus

P. del Rosario St., Cebu City, 6000
Name: ____________________________________
Age: ______ Gender:
_________
Address: ____________________________________________________________________
Educational Attainment: ______________________ Occupation:
__________________
DEMOGRAPHICS:
How many family units make up the household prior to the Yolanda
incident? _____
Is this a single headed household? If yes, what is the gender of the
family head?
Yes __________
No
Please specify the ages and number of your direct household
members?
Under 1 yr M ____
F ____
1-5 yrs
M ____
F ____
6-12 yrs
M ____
F ____
13-18 yrs M ____
F ____
19-39 yrs M ____
F ____
40-60 yrs M ____
F ____
Over 60 yrs M ____
F ____
Are there any pregnant/lactating women, persons with disability and
persons with chronic illness in the household prior to the Yolanda
incident? If yes, how many?
Yes __________
No
BEFORE THE TYPHOON:
When did you hear about the super typhoon Yolanda hitting your area?
_____ 2 weeks ahead or more
_____ 7-13 days ahead
_____ 3-6 days ahead
_____ 1-2 days ahead
_____ on the day of the typhoon
How did you hear about it?
_____ Internet
_____ Television
_____ Radio
_____ Printed Media
_____ Word of mouth
_____ Others (please specify) ___________

What were your preparations for the typhoon? (Please fill the space
with the number of days or meals.
_____ Fixed Roofs
_____ Strengthen House/Infrastructure
_____ Stored Food good for _______ days or _______meals
_____ Stored Water good for _______ days or _______meals
_____ Prepared Emergency Kits and Medicine
_____ Prepared Batteries and Gas good for _______ days
_____ Cut trees
_____ Others (please specify) _________________________________________

Were you living on a flood prone area?

_____ Yes
_____ No

Did you do a preventive evacuation? If yes, where?

_____ Yes _________________________________________________________
_____ No

Have you experience any other disaster that you considered life
threatening, other than Yolanda? What was it?
_____ Yes ________________________________________________________
_____ No

Did you have any contingency plan? If yes, what was it?
_____ Yes ________________________________________________________
_____ No

What type of dwelling was the household resident in before typhoon

Yolanda?
_____ Hut
_____ Concrete and Masonry
_____ Timber
_____ Timber and Concrete (2
storey)
_____ Timber and Concrete
_____ Concrete and Masonry
(2 storey)

What was your land tenure status?

_____ Own house and lot
_____ Own house but rent lot
_____ Rent house/room including lot _____ Own house, rent free lot w/
consent
_____ Own house, rent free lot w/o consent
_____ Rent free house
and lot w/ consent
_____ Rent free house and lot w/o consent _____ Ancestral Domain land

DURING THE INCIDENT:

Was your dwelling flooded?

_____ Yes

Please assess the damage created by the typhoon to the dwelling.

_____ Totally destroyed
_____ Major damage
_____ Partially damaged
_____ No damage

Were you able to salvage any materials?

_____ Timber
_____ Roof Materials
_____ Fixings
____________Others

Did you lose access to the ff:

_____ Television
_____ Landline
_____ Internet

_____ No

_____ None

_____ Mobile Phone

_____ Radio

Did the typhoon destroy your source of living?

_____ Yes
_____ No

Did you lose any member of the family that belonged to your
household? If yes, how many? _____ Yes
_____ No

What other properties did you lose? Please enumerate.

____________________________________________________________________
____________________________________________________________________

AFTER THE TYPHOON:

Was the food that you were eating after the typhoon prepared and
served safely?
_____ Yes
_____ No

Did you experience hunger after the typhoon?

_____ Yes, for how many days? __________ No

How soon did you get access to the ff:

_____ Television
_____ Mobile Phone
_____ Landline
_____ Radio
_____ Internet

Can you give an estimate of the properties that were destroyed by the
Typhoon Yolanda?
_____ 500, 000 and more
_____ 200, 000 - 499, 999
_____ 100, 000 - 199, 999
_____ 99, 999 and less

How soon did you receive goods (water and food) from families and
friends?
________________ N/A _____

How soon did you receive goods (water and food) from the
government?
________________ N/A _____

How soon did you receive goods (water and food) from volunteers and
private group?
_______________
N/A _____

How often did you receive goods (water and food) from families and
friends?
_______________
N/A_____

How often did you receive goods (water and food) from the
government?
________________ N/A _____

How often did you receive goods (water and food) from volunteers and
private group?
________________ N/A _____
Other than water and food, did you receive any other help from
families and friends? If yes please enumerate.
_____ Yes ___________________________
_____ No

Other than water and food, did you receive any other help from the
government? If yes please enumerate.
_____ Yes ___________________________ _____ No

Other than water and food, did you receive any other help from
volunteers and private group? If yes please enumerate.
_____ Yes ___________________________ _____ No

Did you receive any remittance support from family members working
in a less/not affected area in the Philippines or those working abroad?
How long did it last?
_____ Yes __________
_____ No
_____ N/A

Did anyone in the household suffer from any of the ff diseases:

_____ Diarrhea
_____ Fever

_____ Cold and Cough

_____ Others (please specify)
____________________________________________

Din anyone in the household experienced gender-based violence?

_____ Yes
_____ No

Was anything stolen or taken from you or your home without your
permissions?
_____ Yes
_____ No
What was it? ___________________

How many times did you have to relocate?

_____ Five times or more
_____ Four times
_____ Three times
_____ Twice
_____ Once
_____ Still living in the same
house

Were you able to fix your house?

_____ Permanently
_____ Temporarily

_____ No

Did any of you surpass the criteria for registering post traumatic
disorder (PTSD)?
_____ Yes
_____ No

COMPARATIVE QUESTIONS:
What were the primary, secondary, and tertiary sources of income for
your household before and after Yolanda? Please check all that applies.
Before
After
Crop agriculture (own production)
Agricultural worker (non-own production)
Livestock poultry production
Fishing
Transportation (private driver, taxi driver, bus
driver)
Skilled manual labor (mason, carpenter,
tailor)
Unskilled daily wage laborer
Small business or trade (transport, store
owner, etc)
Public sector / Government employee
Remittance from family members
Assistance/aid from the government (4Ps)
Assistance/aid from NGOs
Private salaried job

No income

Does your household income cover the familys basic needs before and
after Yolanda?
Completely
Sufficiently
Partially
Not at all
Before
After

What is the main source of drinking water before and after Yolanda?
Before
After
Piped water (town water supply- house
connection)
Public tap/public fountain (town water supply)
Tube well / borehole (manual)
Piped water from protected spring (mini
water supply system)
Piped water from protected dug wee (mini
water supply system)
Protected spring (manual)
Protected dug well (manual)
Rain water collection
Unprotected spring (manual)
Unprotected dug well (manual)
Small water vendor
Tanker truck (private sector)
Bottled water
Surface water (river, pond, lake)
Others

What type of toilet did you use before and after the typhoon?
Before
Flush toilet (on-site/off-site sanitation)
Pit latrine (on-site sanitation)
VIP latrine (on-site sanitation)
Pour flush toilet (on-site sanitation)
Open defecation
Community toilet

After

What are the resources that is abundant or that can be reproduced in

your society before and after Yolanda?
Before
After
Rice, Corn and the like
Root Crops
Fish

Poultry, Swine and Cattle

Processed Food
Others/Specifications______________________________________________________

Please enumerate your skills.

________________________________________________

What are your suggestions for possible livelihood in your area/locality

that would help you cope up with your daily living?
___________________________________________
________________________________________________________________________