ID
Start Time
PSU ID
Superviser/ Data Collector
PSU Categories
Explaination of PSU Type
Single Resident Not Connected
Single Resident Connected
Apartment Block
Mix residential (connect & not)
Mix residential (Commercial)
Industrial or Commercial
Other
Overcrowding
Surfaced - Well maintained
Surfaced - Not Maintained
Loose/Compacted surfaced - Well maintained
Loose/Compacted surfaced - Not maintained
Natural - Narrow Track
Narrow Path - Passage
Open disposal - Standing water
Open disposal to river
Open disposal to drains
Piped to drains
No grey water
Covered drain - Free flowing
Open drain - Free flowing
Cover drain - Blocked
Open drain - Blocked
Natural Drainage
No Drainage
Evidence of open defecation
Evidence of fecal material in drains
No evidence
Open dumping - No burning
Open Dumping - Burning
Open dumping & Burning
Irregular waste collection
Regular waste collection
No evidence of solid waste
Air pollution vs average
Landslide area
Low lying land
Floodplain
River bank
Garbage pile
Industrial pollution area
Railway right of way
Powerline
Road fly over
Unauthorised area
Police station
Street lighting - working
Street lighting - not working
Public standpipe
Public toilet
Health facility
Public meeting area
Sports field
Green/ Open space
School
Day care centre
Public transport - limited service
Public transport - good service
Temple or other religion areas
Further Observation
Time Finish
Need additional time to fill
Consistent of sampling area & characteristics
Ask local people to help filling
Characteristic not capture
Non-sense questions
Suggestions if have
Ohter comments