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IPHO - LDS HRH Comunity Profiling

Region: BARMM PERIOD COVERED


Province: LANAO DEL SUR
Municipality/City :
Barangay :
Signature above Name of Barangay Chairman
HRH in charge :
BHW:
Barangay Nutrition Scholar:
No.of Household in the Barangay :
No.of Household Profiled :
School in the Barangay:
Madrasa in the Barangay:
Name of Active MRL in the Brgy:
Contact Number of MRL

NEWBORN INFANT CHILD ADOLESCENT 60 YRS AND


29 days- 20-49 yrs old 50-59 yrs old ABOVE SUBTOTAL
0-28 days 11mos 1-4 yrs old 5-9 yrs old 10-19 yrs old
HOUSEHOLD MEMBER F F GRAND TOTAL
M F M F M F M F M M M F M F M F
Pregnant GRAVIDA / AOG Post Partum Non-Pregnant Pregnant GRAVIDA / AOG Post Partum Non-Pregnant

SUBTOTAL
GRAND TOTAL
To be accomplished during the visit to the HHs
No. Name of HH Heads
SE Status Type of Water Supply Status Located w/in
1-NHTS
(Family Name, First Name) (Place a √) HH w/ access to premises
2-Non-NHTS (3) basic safe water(Place a √)
Level I Level II √ - WS is Level I
Level III Others, specify
(point (communal (individual (for doubtful or II or III
source) faucet) connection) sources, X - if WS not Level
e.g. open dug I,II, III
(1) (2) (a) well, etc.) (4) (5)

10

Total
Validation/Random Sampling/Testing Status
Available Microbiological Validation Physico-Chemical Use
Test of safely-managed
24/7 (7) (8) Drinking-Water Services
(Place a √) Dates Results Date Results √ - if Col. 5 + 6
Validation √ - absence Testing √ + PNSDW
- within allowable 7 + 8 islimit

Done of E. coli Done X
for priority chemic – If Col 5 or 6
X - presence X – above the allowable
or 7 orPNSDW
8 is Xlimit
of E. coli for priority chemical (e.g. arsenic)

(6) (9)
Type of Sanitary Facility Type of Unsanitary Facility Status Open
Place a √ mark Place a √ mark Sanitary Defecation
(10) (11) Facility Place a √ mark
Pour/flush Pour flush Ventilated Pit Water-sealed Over hung Open Pit Without toilet√ - if any of Col if10yes and X if not
type with Toilet (VIP) Latrine toilet w/o latrine Latrine
septic tank connected to septic tank is checked
septic tank
AND to (c)
(a) sewerage
system
(b)

(12) (13)
Type of Safely Managed Sanitation Facility
Status on Using
(Applies only to a and c) Safely Managed
Place a √ Sanitation Facility
(14) √ - If any of Col 10 is √;
14.1 Toilet
14.2Not
Disposal /Treatment of Excreta/Sewage
If Col 14.1 is √ and if
shared
sewage/excret sewage/excret Col 14.2 a or b is √
a is safely a is collected,
disposed in transported,
situ treated and
disposed off-
(a) site
(b) (15)
Part 3. Solid Waste Management Part 4. Complete Sanitation Fac
Waste Management Status With access to
Solid Waste basic safe
Place a √ Management water supply
(16) Practice
Waste Backyard Recycling / Collected by Others Check (√) if Col. (If Part 1 Col. 4
Segregation Composting Reuse City/Municipal (Burning / 16A + 16B + 16C is √)
Collection and Burying) is √ OR Col. 16A
and 16D is √
Disposal (within household
compound; not a
System satisfactory method
of disposal)

a b c d e (17) (18)
mplete Sanitation Facilities Remarks
With sanitation Status of
facility Complete
sanitation
facilities
Place a √ if Cols
(If Part 2 Col. 12 17 + 18 + 19 is √
is √)
and X if not

(19) (20) (21)