Serial number
Start time
PSU number
Researcher name
How would you categorize this sampling area?
What is it about the sampling area that has led you to select the answer to ques
Single residential dwelling, not connected
Single residential dwellings which are connected, with limited or no passage bet
Apartment blocks
Mix of residential dwellings which are both connected and not connected
Mix residential dwellings (all types) and commercial property
primarily industrial or commercial
Other (specify)
Majority of households of the sampling area suffer/not suffer from over-crowding
Surfaced (e.g. Tarmac/cencrete), well maintained, vehicles can travel across the
Surfaced (e.g. Tarmac/cencrete), not maintained, it can be difficult for vehicle
Loose/compacted surface (e.g. stones/gravel), well maintained, vehicles can trav
Loose/compacted surface (e.g. stones/gravel), not maintained, it can be difficul
Natural or narrow track or path with no vehicular access
Narrow paths/passage ways with no vehicular access
Open disposal- standing water visible
Open disposal to a river/pond or other body of water
Open disposal to drains
Piped to drains or soak pit
No evidence of grey water in the area
Covered drains, free flowing
Open drains, free flowing
Covered drains but blocked
Open drains but blocked
Natural drainage
No drainage
Evidence of open defecation
Evidence of fecal material in the drains, on the roadway and/or near to dwelling
No evidence of human excreta in the vicinity
Open dumping at a common dump site (no burning)
Open dumping at a common dump site (burning)
General open dumping and burning
Evidence of irregular waste collection
Evidence of regular waste collection (no accumulation apparent)
No evidence of solid waste
What is the level of air pollution in the sampling area compared to the average
Landslide area
Low lying land or marsh
Floodplain or flood prone area
River bank
Garbage mountain/pile
Industrial pollution area
Powerline
Road fly over/ underpass
Unauthorised area
Police station
Street lighting- working
Street lighting- not working
Public standpipe
Public toilet
Health facility
Public meeting area
Sports, field, play ground
Green/ open space
School
Day care centre
Public transport- non/limited service
Public transport- adequate/good service
Temple or other faith facility
Any further observations e.g. Unusual features or circumstances, construction ac
Time finished to complete the observation form
Did you need additional time in the PSU in order to complete this form, if so pl
How consistent was the sampling area with regard to the characteristics you were
Did you have to ask any local people anything in order to help you complete the
Are there key charateristics of the sampling area which are not captured by the
Was there anything in the form that did not make sense?
What suggestions would you make for improving the form/data collected?
Are there any other comments/suggestions you would like to make?