Questionnaire Text

Questionnaire form view entire document: text image

a) What is the source of water for this dwelling?

[] 1 Well or spring
[] 2 Cistern (aljibe)
[] 3 River, stream
[] 4 Public system
Other (specify) ____

Questionnaire instructions view entire document: text image

Question 5. Water service.

Reach each of the following questions and the possible answers; make an X in the corresponding box. If it is a source of water which is not listed, annotate the name of the source on the line for "other."

Keep in mind the following definitions:

[A depiction of question 5a and b, to the right of the preceding text is omitted here.]

A. The source of water is:

Well or spring: If the inhabitants of the dwelling obtain their water from under the ground.

Tank: If the inhabitants of the dwelling obtain their water from rain water collected in the tank.

River or Stream: If the inhabitants of the dwelling obtain their water from a river or stream.

Public Network: If the inhabitants of the dwelling obtain their water from a system of pipes. For example: "Corposana," "Senasa."

Other: If the water supply is of a different form than the preceding examples. For example: water truck.

[A drawing of a stream, well, and faucet is omitted here.]

[P. 27]

b) The place of the water supply is:

Inside the dwelling: When the well, tank, or pipes are situated inside one of the rooms; in the kitchen or in the hallway of the dwelling.

Outside the dwelling but in the yard: when the place of water provision is in the yard of the dwelling.

Outside the yard: when the inhabitants of the dwelling have to leave the limits of the dwelling to obtain water. Water truck is also included in this category.

[A drawing of a sink, water truck, and yard pump, with persons using each, is omitted here.]