Questionnaire Text

Questionnaire form view entire document:  text  image

What is the distance from home to the nearest


H17. Source of water

[] 1 On premises
[] 2 Less than half mile
[] 3 Half mile and less than one mile
[] 4 One mile and less than five miles
[] 5 Five miles and above

Questionnaire instructions view entire document:  text  image

Section 2 - Housing facilities


H15 - H17 Distance from home to the nearest facility


H17 -- Source of water
182. Ask: "What is the distance from your house to the nearest source of water?" You may have to ask for the location of the source in certain cases in order to visualize the distance and get as accurate an answer as possible. Record the appropriate code provided in the column H17.


Section 2: Housing facilities


What is the distance from home to the nearest:

H17 Source of water

[] 1 On premises
[] 2 Less than 1/2 mile
[] 3 1/2 mile and less than 1 mile
[] 4 1 mile and less than 5 miles
[] 5 5 miles and above