PIVE Field Survey | UC-1 (Resident) - Disaster Preparedness

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Data Privacy Statement

SafeTravelPH Mobility Innovations Organization Inc. under the name of SafeTravelPH recognizes its responsibilities under the Data Privacy Act of 2012 (Republic Act No. 10173) with respect to the data they collect, record, organize, use, and consolidate from partners and participants. The personal data obtained will be used for the Organization and project purposes only.

By proceeding to this form, you agree that you are giving consent to the SafeTravelPH to collect, process, store, and eventually dispose of the personal data you provide in this application form for legitimate and lawful purposes relating to the project of Poverty Indicator and Vulnerability Estimator (PIVE) Tool of LocationMind and SafeTravelPH.
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STPH UserId
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Facebook Userid
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Guest UserId
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Type a question
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Surveyee/Resident Code(Example: XYZ-Month-###; ESS-09-01)
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Do you have the updated contact information of the local barangay if needed for quick response or emergency situations?* This field is required.
YESNO
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Total number of household members that are i) below 5 years old, ii) more than 65 years old, iii) with disability.* This field is required.
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Do you expect a family member(s) to arrive later tomorrow or the next day during or right after the period of heavy rains/flooding?* This field is required.
YESNO
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What is your family's preferred evacuation place?* This field is required.
School
Relatives House
Evacuation Center
Multipurpose building/gym
Public Hospital
Open Spaces
No plan
Other
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What is your main transportation mode to government facilities or commercial areas?* This field is required.
Please Select
Please Select
Personal car
Personal tricycle
Personal motorcycle
Biking
Walking
Jeepney
Tricycle
Taxi
Bus
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How confident are you that your house is physically ready for potential emergencies caused by heavy rains, flooding, or landslides?* This field is required.(Please slide the emoticon to give your rating of physical preparedness of your house)
Roofing/walls for heavy rains
Flooring/elevation for flooding
Roofing/walls for landslides
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Row 1, Column 0Row 1, Column 1Row 1, Column 2Row 1, Column 3Row 1, Column 4
Row 2, Column 0Row 2, Column 1Row 2, Column 2Row 2, Column 3Row 2, Column 4
Roofing/walls for heavy rains
Flooring/elevation for flooding
Roofing/walls for landslides
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Row 1, Column 0Row 1, Column 1Row 1, Column 2Row 1, Column 3Row 1, Column 4
Row 2, Column 0Row 2, Column 1Row 2, Column 2Row 2, Column 3Row 2, Column 4
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Rate the availability of food in your household for the next 48 hours.* This field is required.
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2
3
4
5
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When was your current house built?
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If your home has had major damage in recent years, when did it happen?
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If your home has had major renovations or improvements, when did it happen?
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Do you have any other comments or suggestions?DO NOT USE any apostrophe (') or quotation marks (")
Huge
Large
Normal
Small
Ok
Ok
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We will get your current location when we submit this form, do you agree?* This field is required.This is needed in case emergency happens and we need to know your whereabouts
Should be Empty: