Sl no
starting time of completing this observation form
sampling area reference number
supervisor name
category of the sampling area
Discription
categorisation is challenging or not and if yes then specify reason
Q_6_1_Single residential dwelling, not connected
Q_6_2_Single residential dwellings which are connected
Q_6_3_Apartment blocks
Q_6_4_Mix of residential dwellings which are both connected
Q_6_5_Mixed residential dwellings(all types) and commercial property
Q_6_6_Primarily industrial
suffer from over crowding
presence of overcrowding or not
Q_8_1_Surfaced well maintained
Q_8_2_Surfaced not maintained
Q_8_3_Loose/compacted surface well maintained
Q_8_4_Loose/compacted surface not maintained
Q_8_5_Natural or narrow track
Q_8_6_Narrow paths/passage way
Q_9_1_Open disposal
Q_9_2_Open disposal to a river
Q_9_3_Open disposal to drains
Q_9_4_Piped to drains
Q_9_5_No evidence of grey water
Q_10_1_Covered drains
Q_10_2_Open drains
Q_10_3_Covered drains but blocked
Q_10_4_Open drains but blocked
Q_10_5_Natural Drainage
10_6_No Drainage
Q_11_1_Evidence of open defecation
Q_11_2_Evidence of fecal material
Q_11_3_No evidence
Q_12_1_Open dumping at a common dump site (no burning)
Q_12_2_Open dumping at a common dump site (burning)
Q_12_3_General open dumping and burning
Q_12_4_Evidence of irregular waste collection
Q_12_5_Evidence of regular waste collection
Q_12_6_No evidence of solid waste
level of air pollution of sampling area compare to city
presence of air pollution or not
Q_14_Landslide area
Low lying land or marsh
Floodplain or flood prone area
River bank
Garbage mountain/pile
Industrial pollution area
Railway right of way
Powerline
Road fly over/underpass
Unauthorised area
Q_15_1_ Police station
Q_15_2_Street lighting – working
Q_15_3_ Street lighting - not working
Q_15_4_ Public standpipe
Q_15_5_ Public toilet
Q_15_6_ Health facility
Q_15_7_ Public meeting area
Q_15_8_ Sports field, play ground
Q_15_9_ Green/open space
Q_15_10_School
Q_15_11_Day care centre
Q_15_12_Public transport - none/limited service
Q_15_13_Public transport - adequate/good service
Q_15_14_Temple or other faith facility e.g. church, mosque etc
Q_16_ observations
time when completing this observation
require additional time or not
if require than estimate extra time
sampling area were cosistent with the characteristics that you observe, or not
if not consistent than specify
ask to local peopleto complete the form or not
if yes than specify reason and number of people
key characteristics of the sampling area were missing to capture or not
if yes then describe
was anything in the form that didn't make sense or not
is there any suggestions for improving the form
any other comments you like to make