CORE QUESTION FOR DRINKING WATER
1. What is the main source of drinking water for members of your household?
Pipe Water
Piped/faucet into dwelling.
Piped/faucet into compound, yard, or plot.
Piped/faucet to neighbor.
Public tap/standpipe
Borehole/water pumps
Water from spring
Rainwater collection
Delivered water
Tanker-truck
Water kiosk/station
Package Water
Bottled water.
Surface water (river, stream, dam, lake, pond, canal, irrigation channel)
Other (specify): __________________________
2. What is the main source of water used by members of your household for other
purposes, such as cooking and hand washing? (Only Applies if the answer in 1 is
Package Water)
Pipe Water
Piped/faucet into dwelling.
Piped/faucet into compound, yard, or plot.
Piped/faucet to neighbor.
Public tap/standpipe
Borehole/water pumps
Water from spring
Rainwater collection
Delivered water
Tanker-truck
Water kiosk/station
Package Water
Bottled water.
Surface water (river, stream, dam, lake, pond, canal, irrigation channel)
Other (specify): __________________________
3. Where is that water collected from? (Skip if the answer in Q1 and 2 is Piped/faucet
into dwelling and piped/faucet into compound, yard, or plot.)
In own dwelling/house
In own yard / plot
Elsewhere
4. In the last month, has there been any time when your household did not have enough
drinking water when needed?
Yes, at least once
No, always sufficient
Don’t know
CORE QUESTION FOR SANITATION
1. What kind of toilet facility do members of your household usually use?
Flush / pour flush
Flush to piped sewer system
Flush to septic tank
Flush to pit latrine
Flush to open drain
Flush to don’t know where
Dry pit latrines
Pit latrine with slab
Pit latrine without slab / Open pit
Composting toilets
Twin pit with slab
Twin pit without slab
Other composting toilets
Bucket
Container based sanitation
Hanging toilet / hanging latrine
No facility / Bush / Field
Other (specify): ________________
2. Do you share this facility/toilet with others who are not members of your household?
Yes
No
3. Where is this toilet facility located?
In own dwelling
In own yard / plot
Elsewhere
4. Has your (pit latrine or septic tank) ever been emptied?
(Only applies to latrines, septic tanks, composting toilets, and twin pits)
Yes emptied
Never emptied
Don’t know
5. The last time it was emptied, where were the contents emptied to? (If you don’t have
answer in 4 skip)
Removed by service provider
to a treatment plant
buried in a covered pit to don’t know where.
Emptied by household
buried in a covered pit.
to uncovered pit, open ground, water body or elsewhere.
Other (specify)
Don’t know
CORE QUESTIONS FOR HYGIENE
1. Where members of your household most often wash their hands?
Fixed facility (sink/tap)
In dwelling
In yard/plot
Mobile object
(bucket/jug/kettle)
No handwashing place in dwelling/yard/plot
Other reason (specify): _______________
2. Availability of water at the place for handwashing.
Water is available.
Water is not available.
3. Availability of soap or detergent at the place for handwashing.
Soap or detergent available
Soap or detergent not available
4. What kind of soap did you and your household use in washing your hand.
Bar or Liquid soap
Detergent (Powder / Liquid / Paste)
Ash / Mud / Sand
