THIS RESEARCH TOOL IS USE TO CONDUCT SURVEY ON AWARENESS OF COMMON COMMUNICABLE DISEASES

1. LEVEL OF AWARENESS OF COMMUNICABLE DISEASE CHECKLIST
Part 1 - Profile of Respondents:
1. Age: _________
2. Sex: ( ) Male ( ) Female
3. Educational Attainment: Please put a check (√) mark on a given option below
( ) – Post-Graduate ( ) – High School Undergrad
( ) – College Graduate ( ) – Elementary Graduate
( ) – College Undergrad ( ) – Elementary Undergrad
( ) – High School Graduate
Part 2- Level of Awareness of Communicable Diseases:
1. Please read each item carefully and decide honestly to what extent you have
knowledge about common communicable diseases.
2. Put a check (√) marks under the given common communicable diseases that you
believe it fit-in to the description given.
3. Leave the box blank or unmark if it does not fit to the description given or you
are not sure.
Gonococcal Diseases (STD)
Chicken Pox
Infectious Diarrhea / Food poisoning
HIV/AIDS
PneumoniaTuberculosis/
Hepatits A Viral
Dengue
Malaria
Hepatitis B Viral
Typhoid fever
Mode of Transmission
Which specific communicable
diseases that fits in the description
about the mode of transmissions
below?
1. Hands of infected person soiled with their
own lesion discharges (semen or vaginal
discharges)
2. Respiratory droplets or objects
contaminated with discharges
3. Sexual activity, hands of infected persons
soiled with their own discharges

2. 4. Water or food contaminated with feces
5. Inhale or contact of droplets expelled
from the sick during sneezing, coughing,
spitting and speaking,
6. Through ingestion of contaminated food
or water, or use of contaminated eating
utensils
7. Touching of mucous membranes of the
mouth, nose and the eyes, etc with hands
contaminated with infective agents
8. Through blood transfusion, tattooing, ear
piercing or sexual intercourse
9. From the pregnant mother to the fetus
10. Contact with infected areas of vagina of
infected mother during birth
11. Carried out through mosquito bites.
12. Food or water contaminated with feces, or
urine from infected person
Hepatits A Viral
Dengue
Gonococcal Diseases (STD)
Chicken Pox
Infectious Diarrhea / Food poisoning
HIV/AIDS
PneumoniaTuberculosis/
Hepatitis B Viral
Malaria
Typhoid fever
Signs and Symptoms of
Communicable Diseases
Which specific communicable diseases
have a positive signs and symptoms
given in every item?
1. There is a presence of very high fever
2. The period of high communicability of
the disease is during when the rashes
dried out.
3. There is present of profuse night
sweating.
4. There is pain in urination and
inflammation in the scrotum (man) and/
or urethral/vaginal tract (woman)

3. 5. There is presence of jaundice
(yellowish discoloration) of the sclera
and skin
6. Presence of cough, sputum discharges
7. The opportunistic infections will appear
for many years when immune system is
severely compromise
8. Fever will occur and persist when
infection progress without early
medical intervention
9. There is diarrhea and abdominal pain.
10. Dehydration develop when late or no
medical intervention associated with
low-moderate fever
11. There is presence of blistered rashes
12. Fine rashes will appear after many days
of high fever
Gonococcal Diseases (STD)
Chicken Pox
Infectious Diarrhea / Food poisoning
HIV/AIDS
Hepatits A Viral
Dengue
Malaria
PneumoniaTuberculosis/
Hepatitis B Viral
Typhoid fever
Prevention & Control of
Communicable Diseases
Which specific communicable diseases
applicable to the preventive and control
measures given every item?
1. Use condom during sexual intercourse
2. Practice hand washing.

4. 3. Disinfection or Chlorinate drinking
water
4. Kill breeding sites
5. Isolation from family members and
separate personal belongings including
kitchen utensils.
6. Avoid eating elsewhere if unsure of
sanitary practice in cooking food
7. Avoid multiple sexual partners
8. Have yourself vaccinated
9. Maintain clean environment and
personal hygiene.
10. Eat nutritious variety kind of food
11. Cook food appropriately and reheat
food in right temperature
12. Avoid pin piercing, tattoo, or exchange
any hypodermic needles