Forms

Household

ID	QUESTION	TYPE	OPTIONS
1	Woreda	CASCADE	-
2	Kebele	CASCADE	-
3	Village	TEXT	-
4	Name Of Respondent	TEXT	-
5	Household Size	NUMBER	-
6	Main Source Of Drinking Water	TEXT	-
7	Water Service Level	OPTION	Basic
			Limited
			Surface water
			Unimproved
8	Specific Location Of Water Collection	OPTION	Elsewhere
			In own dwelling
			In own yard / plot
9	Time To Collect Water	OPTION	Less than 30 minutes
			More than 30 minutes
10	Times In Last Month When Drinking Water Quantity Was Insufficient	OPTION	Don't know
			No, always sufficient
			Yes, at least once
11	Sanitation Service Level	OPTION	Basic
			Limited
			Safely managed
			Unimproved
12	Type Of Toilet Facility	OPTION	Bucket
			Pit latrine with slab
			Pit latrine without slab/open pit
			There is no latrine
			Toilet that flush/pour to flush piped sewer system
			Toilet that flush/pour to pit latrine
			Twinpit offset latrine
			Ventilated improved pit latrine (vip)
13	Facility Is Shared With Others Outside Of The Household	OPTION	No
			Yes
14	Location Of Sanitation Facility	OPTION	Elsewhere
			In own dwelling
			In own plot/yard
15	Emptying Of On-Site Sanitation Facilities	OPTION	Don't know
			No, never emptied
			Yes, but don't know when
16	Hygiene Service Level	OPTION	Basic
			Limited
			No facility
17	Type Of Handwashing Facility Used Most Often	OPTION	Fixed facility observed in dwelling
			Fixed facility observed in plot/yard
			Mobile object observed (bucket, jug, kettle)
			No handwashing place available in dwelling/plot/yard
			No permission to see
18	Water Available At Handwashing Facility	OPTION	Water is available
			Water is not available
19	Soap Is Available	OPTION	Ash/mud/sand is present
			No, not present
			Yes, soap or detergent are present

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Health Facilities

ID	QUESTION	TYPE	OPTIONS
1	Woreda	CASCADE	-
2	Kebele	CASCADE	-
3	Name Of Health Facility	TEXT	-
4	Latitude	DECIMAL	-
5	Longitude	DECIMAL	-
6	Type Of Healthy Facility	OPTION	Health post
			Other
7	Description Of Water Supply In Health Facilities	OPTION	No water supply in premises
			Pipeline connections
			Protected wells
			Rain water harvesting
8	Water	OPTION	Basic
			Limited
			No service
9	Latrine Description	OPTION	No latrine
			Simple pit latrine
			Vip
10	Sanitation	OPTION	Limited
			No service
			Usable
11	Physically Separate Latrines For Male Female Patients	OPTION	No
12	Facilitated Access For Disabled	OPTION	No
13	Latrine Condition	OPTION	Clean, used
			Dirty but used
			Filthy ,unused
14	Is There Hand Washing Facility With In 5M Of The Toilet	OPTION	No facility
15	Hygiene	OPTION	No service
16	Is Hand Washing Facility Operating I.E With Water	OPTION	Yes
17	Is Soap Available At Each Hand Washing Stand	OPTION	No
18	Is There A Toilet For Staff	OPTION	No

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School

ID	QUESTION	TYPE	OPTIONS
1	Woreda	CASCADE	-
2	Kebele	CASCADE	-
3	School Name	TEXT	-
4	Latitude	DECIMAL	-
5	Longitude	DECIMAL	-
6	School Type	OPTION	High school 9-10
			Primary(1-4)
			Primary(1-8)
7	Male Pupils	NUMBER	-
8	Female Pupils	DECIMAL	-
9	Reason For Inventory	OPTION	New scheme
			Repair
10	Water Supply Source	OPTION	No water scheme
			No water supply in premises
			Pipeline connection
			Shallow well fitted with pump
11	Water	OPTION	Basic
			Limited
			No service
12	Year Commisioned	DECIMAL	-
13	Functionality Status Of Water Supply	OPTION	Functional
			Non functional - mechanical
14	Yield	DECIMAL	-
15	Type Of Latrine	OPTION	No latrine
			Simple pit latrine
16	Sanitation	OPTION	Limited
			No service
17	Latrine For Boys And Girls Separate	OPTION	No
			Yes
18	Number Of Boy Pupils	NUMBER	-
19	Number Of Girl Pupils	DECIMAL	-
20	Are There Latrines For Disabled?	OPTION	No
			Yes
21	Latrine Condition	OPTION	Clean, used
			Dirty but used
			No latrine
22	Hygiene Service Level	OPTION	No service
23	Presence Of Handwashingfacility	OPTION	No
			Yes
24	Hand Washing In Use	OPTION	No
25	Availability Of Soap	OPTION	No
26	Urinal Present Girls	OPTION	No
			Yes
27	Urinal Present Boys	OPTION	No
			Yes
28	Separate Latrine For Tolitet Staff	OPTION	No
			Yes

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Water Points

ID	QUESTION	TYPE	OPTIONS
1	Woreda	CASCADE	-
2	Kebele	CASCADE	-
3	Village	TEXT	-
4	Site Name	TEXT	-
5	Latitude	DECIMAL	-
6	Longitude	DECIMAL	-
7	Water Source Type 1	OPTION	Deep well with distribution
			Hand dug well fitted with pump or windlass
			Protected spring
			Shallow well fitted with hand pump
8	Water Source Type	OPTION	Deep wel
			Hand dug well
			Protected spring
			Shallow well
			Spring
9	Functionality Status	OPTION	Functional
			No data
			Non functional
			Not functional
10	Souce Of Energy	OPTION	Diesel
			Electricity and grid
			Gravity
			Manual operation
			Other
			Solar
11	Estimated Number Of Users	OPTION	Don't know
12	Hand Pump Type	OPTION	Afridev
			Indian mark ii
			Submersible
13	Organisation That Installed The Water Pump	OPTION	Cda
			Government
			Kale hiwot
14	Year Commisioned	DECIMAL	-
15	Reason For Inventory	OPTION	Extension
			Inspection
			National wash inventory
			New scheme
			Repair
16	Functional Taps In The Scheme	DECIMAL	-
17	Number Of Non Functionaltaps In The Scheme	DECIMAL	-
18	Depth	DECIMAL	-
19	Yield	DECIMAL	-

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CLTS

ID	QUESTION	TYPE	OPTIONS
1	Woreda	CASCADE	-
2	Kebele	CASCADE	-
3	Village	TEXT	-
4	Latitude	DECIMAL	-
5	Longitude	DECIMAL	-
6	No. Of Hhs	DECIMAL	-
7	Initial Number Latrines	DECIMAL	-
8	Final Number Of Latrines	DECIMAL	-
9	Date Triggered	TEXT	-
10	Odf Status	OPTION	Declared
			Triggered
			Verified
11	Date Of Declared	DECIMAL	-
12	Date Of Verification	TEXT	-
13	Implementing Partner	OPTION	Amref
			Amref & local gov't
14	Remarks	OPTION	Phase i
			Phase ii
15	Time To Complete (Days)	OPTION	Sum only numbers showing/count of numbers showing
16	Progress Time	OPTION	Current day - date triggered date
			Current day' - date triggered

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