Enumerator
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Name of Enumerator
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Phone Number
INDICATORS
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LGA
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Ward
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Name of Community
- Gafang
- Lyoh Gyel
- Sot
- Tahei
- Tanchol
- Rahwol Kak
- Raku Sot
- Rankyeng
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Sub-sector
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Respondent role in the family
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Phone Number of the Head of Household
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Gender
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Number of persons in the household
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Occupation of Household
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Type of water source
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Means of water supply
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Where is the water source located?
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How long does it take to go there, get water, and come back?
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Where do you defecate?
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What is the state of the toilet facility?
- Private/Shared improved facility
- Private/Shared unimproved facility
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What is the type of facility (toilet/latrine) in the HH?
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Does the pan have a return cover or water separator?
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Does the latrine have a cover?
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Is there a superstructure (toilet building)?
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Is the superstructure well ventilated?
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Does the superstructure have installed doors, windows, and a roof? (Select all applicable)
- has a window
- has a door
- has a roof
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Does the toilet facility hygienically separate waste?
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Does the toilet facility have containment?
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Is there a slab covering the containment (pit)?
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Does it have a manhole for evacuation when filled up?
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Is the toilet facility clean?
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Does the toilet facility itself have any issue?
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Take pictures of the toilet facility
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Picture_URL
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Does the facility have a handwashing station?
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Is there water at the station?
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Is there soap at the station?
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Take pictures of the handwashing station.
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Picture_URL
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GPS of survey location
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Take picture
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Add location
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Take picture
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Add location
