Project Mindanao Screener 11_29 FINAL Group Number

RESPONDENT INFORMATION
GROUP
NAME OF RESPONDENT: ACTUAL AGE:
NO.:
COMPLETE ADDRESS:
SCHOOL: YR. LEVEL/COURSE:
OCCUPATION: HOME TEL. NO:
POSITION & DEPARTMENT: MOBILE PHONE NUMBER:
COMPANY ADDRESS: OFFICE TEL. NO.:
DATE: E-MAIL ADDRESS:
RECRUITER:

SUMMARY OF RESPONDENT PROFILE

Gender Age Marital Status SEC Work Status
Self-employed/ Business
Female 1 13-22 yo 1 Single 1 C1 1 1 Student 5
Owner
Male 2 23-35 yo 2 Married 2 C2 2 Full time wage/salary earner 2 Not in the labor force 6
Unemployed/in
36-50 yo 3 Separated 3 D 3 Part time wage/salary earner 3 7
between jobs
Widowed 4 Voluntary worker 4 Full time homemaker 8

SOCIO – DEMOGRAPHICS
FACILITIES AT HOME
1 Plumbing* 10 DVD Player 21 Air conditioner
2 Electricity* 11 Internet (specify type _______) 22 Electric fan
3 TV*: B&W (#____); Colored (#____) 12 Landline telephone 23 Water dispenser
If colored (specify number of units): 13 Refrigerator/freezer* 24 Washing machine
CRT/
LCD Plasma 14 Microwave oven 25 Installed water heater
Regular
4 Cable TV/Satellite TV services 15 Range with oven 26 Gas stove/range
5 Radio/radio cassette* 16 Rice cooker 27 Motorcycle (Units _______)
6 Stereo/Component (Units _____) 17 Pressure cooker 28 Car* (Units __________)
(Year and Model
7 VCR/VHS/ Video Laser Disc Player 18 Turbo broiler
___________)
Smartphone
8 CD Player 19 Juicer/Food processor 29
(Units_________)
9 VCD Player 20 Gaming consoles (eg PS1 or 2, PSP, X-Box, etc.) 97 Refused
(*) Must have for AB SEC HHs
EDUCATIONAL ATTAINMENT HOUSE OWNERSHIP: TOTAL HOUSEHOLD INCOME
RESP HH HEAD Owned 1 P 3,001 – P 8,000 1
No formal education 1 1 Mortgaged 2 P 8,001 – P 15,000 2
Some elementary 2 2 Rented 3 P 15,001 – P 30,000 3
Elementary graduate 3 3 Neither owned nor P 30,001 – P 50,000 4
4
Some high school 4 4 rented P 50,001 – P 75,000 5
High school graduate 5 5 Others, specify P 75,001 – P 100,000 6
xx
Some vocational 6 6 ____________ P 100,001 – P 120,000 7
Some college 7 7 P 120,001 – P 250,000 8
College graduate 8 8 IF RENTED: (MONTHLY P 250,001 – P 500,000 9
Some post graduate 9 9 RENTAL) P 500,001 & up 10
Post graduate 10 10 Less than P1,000 1 Refused 99
Refused 99 99 P1,001 – P2,999 2 Other sources of income:
P3,000 – P4,999 3
P5,000 – P7,999 4
P8,000 and above 5
DK/Refused 99
School of Respondent:
ACTUAL NO. OF HH MEMBERS:
School of Household Head: ACTUAL NO. OF HH HELPERS:

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Project Mindanao Screener 11_29 FINAL Group Number

SCREENING THE RESPONDENTS FOR QUALIFICATION

Before we begin, I just have a few questions to ask.

Bago tayo magsimula, may ilang katanungan lang po ako sa inyo.

1. May I know if you or any member of your family or close friends work in any of these industries?
Maaari ko po bang malaman kung kayo ba o sinumang miyembro sa inyong pamilya o kaibigan ay nagtatrabaho sa mga
sumusunod na industriya?

One engaged in conducting surveys or a market research company (e.g. Nielsen, TNS, etc.)
1
Kumpanya na gumagawa ng survey o market research (hal. Nielsen, TNS, atbp.)
One engaged in making advertisements and promotions (e.g. McCann, Publicis, Leo
Burnett, etc.)
2  TERMINATE
Kumpanya na gumagawa ng advertisements at promotions (hal. McCann, Publicis, Leo
Burnett, atbp.)
A television or radio station or media, newspaper, magazine (e.g. ABS-CBN, GMA, etc.)
3
Network ng TV o radyo o media, pahayagan, magazine (hal. ABS-CBN, GMA, atbp.)
None of the above 99  PROCEED

2. Have you ever attended a focus group discussion in the past 6 months?
Nakalahok na po ba kayo sa isang focus group discussion sa nakaraang 6 na buwan?

Yes 1  TERMINATE
No 2  PROCEED

3. Have you ever participated in a research study/ survey in the past 6 months?
Nakasali na po ba kayo sa isang pag-aaral o survey sa nakaraang 6 na buwan?

Yes 1  TERMINATE
No 2  PROCEED

4. How old are you in your most recent birthday?

Ilang taon kayo noong inyong nagdaang kaarawan?

Actual Age: Below 13 1  TERMINATE

13-22 yo 2
23-35 yo 3  PROCEED
36-50 yo 4
__________
Above 50 5  TERMINATE

5. May I know what religious denomination do you belong to?

Maaari ko po bang malaman kung ano ang iyong kinabibilangang relihiyon?

Born Again 1
Catholic 2
Iglesia ni Cristo 3
 PROCEED
Muslim 4
Other Christian denomination: (specify)
( )
_________________
Others: (specify)
( )  TERMINATE
_________________
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Project Mindanao Screener 11_29 FINAL Group Number

NOTE TO RECRUITER:
6. Please record the respondent’s current city of residence.

Butuan City 1
Cagayan de Oro 2
Davao City 3
General Santos City 4

7. May I know for how long have you been living here in (mention location in Q6)? (INDICATE IF IN YEARS OR MONTHS)
Maaari ko po bang malaman kung gaano na kayo katagal naninirahan dito sa (mention location in Q6)?

Record Actual:
(Indicate inclusive Less than 12 months 1  TERMINATE
years)

12 months or more 2  PROCEED

______________

8. And may I know how likely or not are you to stay here in (mention location in Q6) in the next 12 months?
At maaari ko po bang malaman kung gaano ka-malamang o hindi na kayo ay manatili dito sa (mention location in Q6) sa
susunod na 12 buwan?

Very likely to stay in the next 12 months

4
Talagang malamang na manatili sa susunod na 12 buwan
 PROCEED
Somewhat likely to stay in the next 12 months
3
Medyo malamang na manatili sa susunod na 12 buwan
Somewhat not likely to stay in the next 12 months
2
Medyo hindi malamang na manatili sa susunod na 12 buwan
 TERMINATE
Not likely to stay in the next 12 months at all
1
Talagang hindi malamang na manatili sa susunod na 12 buwan

NOTE TO INTERVIEWER: Record answers for Q9 and Q10 on the grid provided on the next page.

9. Talking about products and services, which of the following products and services do you usually buy/avail of in recent
months? Which else? Anything else? MULTIPLE ANSWERS ALLOWED.
Kung pag-uusapan ang mga produkto at serbisyo, maaari ko po bang malaman kung alin sa mga sumusunod na produkto
o serbisyo ang inyong binibili nitong mga nakaraang buwan? Alin pa po? Mayroon pa po bang iba?

[ASK PER PRODUCT/SERVICE MENTIONED IN Q9]

10. When it comes to the purchase of products and services that you mentioned, may I know which of these do you buy
personally for yourself or for your own consumption? Which else? Anything else? MULTIPLE ANSWERS ALLOWED.
Kung pag-uusapan ang mga produkto o serbisyo na inyong binibili, maari ko po bang malaman kung alin dito ang binibili
ninyo para sa inyong sarili o para sa inyong sariling konsumo? Alin pa po? Mayroon pa po bang iba?

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Project Mindanao Screener 11_29 FINAL Group Number

Q9. Q10.
USUALLY AVAILED FOR
PRODUCTS/SERVICES
AVAILED SELF/ PERSONAL
CONSUMPTION
Alcoholic beverages 1 1
Apparel and footwear 2 2
Banking/Finance 3 3
Food-related products 4 4
Gadgets/Technology 5 5
Health and wellness 6 6
Home appliances 7 7
Home vehicles 8 8
Non-alcoholic beverages 9 9
Non-food household products 10 10
Personal care 11 11
Pharmaceuticals 12 12
Others: (Indicate)
( ) ( )
___________________________

SUMMARY
SESSION SESSION
GROUP CITY SEC RELIGION GENDER AGE
DATE * TIME *
1 Christian/ Male/ Teens/newly-grownups (13-22yo) 12 Dec 1:00 pm
Davao CD
2 Catholic Female Adults (36-50 YO) 12 Dec 5:00 pm

*tentative, for final

approval