Questionnaire Text

Questionnaire form view entire document:  text  image
I. Housing characteristics
Distance to water source [For each of the different sources of water.]
[] On premises
[] Less than 500 m
[] Between 500 m and 1 km
[] More than 1 km
Questionnaire instructions view entire document:  text  image
Section G: Housing characteristics
Responses to questions 21 to 25 and 27 to 29 are pre-coded. Tick the box for the correct response.

Question 28: Water for drinking and cooking
The question asks for information on: main water source, distance to that water source, and indirectly also whether water source is safe or not. The response alternatives are:

1. Piped water, inside or outside
2. Well/borehole, protected
3. Well/borehole, unprotected
4. River/stream/dam
5. Rain water from tank/jar
6. Other

If the main source of water varies during the year, record the source that supplies the largest quantity of water.