Surveypoint

Q01

STATE/U.T.

Q02

DISTRICT

Q03

TEHSIL/TOWN

Q04

VILLAGE NAME

Q05

Village Code

Q06

Type of Structure

Community Toilet

School

Anganwadi Centre

A01

Type of toilet, gender wise

Only male

Only female

Both male and female

A02

Number of seats in the toilet

A02_1

For male

A02_2

For female

A02_3

For both male and female

A03

Are there any separate rooms for bathing area in the toilet complex?

Yes

No

A04

If yes, how many?

A05

Opening hours for the toilet

24 hours

Only during day

Few specific hours

No specific time

A06

Is there a schedule available outside the toilet to notify the public about its timings?

Yes

No

B01

Where is the toilet constructed?

At a podium

At ground level

Below ground level

B02

Is there a pan fitted in the toilet?

Cement

Porcelain

Steel

Not present

Any other (please specify)

B03

What are the walls made of?

Mud

Bamboo

Bricks

Bricks/Stones joined with mud

Bricks/Stones joined with cement

Any other (please specify)

B04

Is there a roof in the toilet?

No roof

Thatched

Cemented

Asbestos sheet

Plastic sheet

Any other (please specify)

B05

Is there water available in the toilet

Yes

No

B06

What is the source of water in the toilet?

Container/Tumbler

Tap

Any other (please specify)

B07

Is there any water stagnated around the toilet?

Yes

No

B08

Was there a Handwashing facility present within the facility?

Yes

No

B09

Was there a Handwashing facility present outside, but nearby the facility?

Yes

No

B10

Were there doors in toilet?

Yes

No

B11

Do the doors of toilet close and lock from inside properly?

Yes

No

B12

Do the doors of toilet close and lock from outside properly?

Yes

No

B13

Were there dustbins inside the toilets?

Yes

No

B14

Were there dustbins outside the toilets?

Yes

No

B15

Is the garbage overflowing from dustbins?

Yes

No

B16

Was there water in the handwashing facility?

Yes

No

B17

What was the type of handwashing facility available?

Tippy tap/treadle tap

Covered water container with tap

Covered water container with ladle or dipper

Open water container with tap

Open water container with ladle or dipper

Others (Specify)

B18

Was there water for cleaning after defecation?

Yes

No

B19

Was there soap available?

Yes

No

B20

Is the toilet free of any unpleasant odor?

Yes

No

B21

Is the toilet seat/pan clean?

Yes

No

B22

Is the toilet seat in good repair?

Yes

No

B23

Does the toilet flush properly?

Yes

No

B24

Is the facility well lit?

Yes

No

B25

Was there a functional bulb/tubelight in the toilet?

Yes

No

C01

Do you see liquid waste running into open environment from the toilet?

Yes

No

C02

Do you see human waste running into open environment from the toilet?

Yes

No

C03

What is the drainage system near the toilet?

Underground

Covered Pucca

Open Pucca

Open Kutcha

No drain; waste flowing outside the toilet

Toilet Observation Template -Form Fill

STATE/U.T.

DISTRICT

TEHSIL/TOWN

VILLAGE NAME

Village Code

Type of Structure

Type of toilet, gender wise

Number of seats in the toilet var statement=document.write(localStorage.getItem('total'));

For male

For female

For both male and female

Are there any separate rooms for bathing area in the toilet complex?

If yes, how many?

Opening hours for the toilet

Is there a schedule available outside the toilet to notify the public about its timings?

Where is the toilet constructed?

Is there a pan fitted in the toilet?

What are the walls made of?

Is there a roof in the toilet?

Is there water available in the toilet

What is the source of water in the toilet?

Is there any water stagnated around the toilet?

Was there a Handwashing facility present within the facility?

Was there a Handwashing facility present outside, but nearby the facility?

Were there doors in toilet?

Do the doors of toilet close and lock from inside properly?

Do the doors of toilet close and lock from outside properly?

Were there dustbins inside the toilets?

Were there dustbins outside the toilets?

Is the garbage overflowing from dustbins?

Was there water in the handwashing facility?

What was the type of handwashing facility available?

Was there water for cleaning after defecation?

Was there soap available?

Is the toilet free of any unpleasant odor?

Is the toilet seat/pan clean?

Is the toilet seat in good repair?

Does the toilet flush properly?

Is the facility well lit?

Was there a functional bulb/tubelight in the toilet?

Do you see liquid waste running into open environment from the toilet?

Do you see human waste running into open environment from the toilet?

What is the drainage system near the toilet?

Number of seats in the toilet