Basic Survey Data

• Inspector
  BS.I.1: Name of the Person filling the form

  BS.I.2: Position of the person filling the form?
• School
  BS.S.1: What is the name of the School Head?

  BS.S.3: What is the Head Teacher's Mobile Number

  BS.S.4: Take photo of the water source

  Take Geolocation (automatic)

Core WASH Data

• Water

  CW.W.1: What is the source of water for the school?

  Source	Currently Available	Used for Drinking
  Piped water supply	Yes No	Yes No
  Protected well/spring	Yes No	Yes No
  Unprotected well/spring	Yes No	Yes No
  Rainwater	Yes No	Yes No
  Bottled water	Yes No	Yes No
  Tanker/Truck or cart	Yes No	Yes No
  Surfaced water (Lake,River,Stream)	Yes No	Yes No
  No water source

• Sanitation
  Choose your option Flush / Pour-flush toilets Pit latrines with slab Composting toilets Pit latrines without slab Hanging latrines Bucket latrines No toilets or latrines CW.S.1: What type of student toilets/latrines are at the school? (check one - most common)

  CW.S.2: How many toilets/latrines are at the school? (insert number)

  	Girls’ only toilets	Boys’ only toilets	Common use only toilets
  Total Number
  Number that are usable (accessible, functional, private)

• Hygiene
  Yes No CW.H.1: Are there handwashing facilities at the school?

  Yes, water and soap Water only Soap only Neither water or soap CW.H.2: Are both soap and water currently available at the handwashing facilities?

Supplemental WASH Data

• Water
  Piped water into school building (reticulated - treated) Piped water into school building (reticulated - untreated) Piped to school compound/yard.plot outside (reticulated - untreated) Public tap or standpipe (reticulated - treated) Public tap or standpipe (reticulated - untreated) Covered well (protected) Uncovered well (unprotected) Rainwater Harvesting collection (Tank) Cart with small tank/drum Surface water (river, stream, dam, lake, pond, canal, irrigation channel) Bottled water No water available at the school SW.W.1: What is the main water source of Drinking water for the school?

  Drinking Hand washing Bathing Cleaning Cooking Flushing toilets SW.W.2: what purpose is the main water source of water used for?

  (1) Question below only showing if user responded any of the following to the question "What is the main water source of Drinking water for the school?" above:

  • Public tap or standpipe (reticulated - treated)
  • Public tap or standpipe (reticulated - untreated)
  • Covered well (protected)
  • Uncovered well (unprotected)
  • Rainwater Harvesting collection (Tank)
  • Surface water (river, stream, dam, lake, pond, canal, irrigation channel)

  Yes No SW.W.3: Is the main water source located on school premises?

  (4) Questions below only showing if user responded Yes to previous question "Is the main water source located on school premises?"

  SW.W.4: If yes, how many taps or water points are there?

  <2 years 2–5 years 5–10 years 10–20 years >20 years When was the main water source originally completed?

  in what year was the main water supply completed?

  Yes No Don't know Has the main water source have any major rehabilitation?

  (1) Question below only showing if user responded any Yes to previous question above "Has the main water source have any major rehabilitation?"

  <2 years 2–5 years 5–10 years 10–20 years >20 years Never When was the last time the main water source have major rehabilitation?

  (3) Questions below only showing if user responded any of the following to the question "What is the main water source of Drinking water for the school?" above:

  • Piped water into school building (reticulated - treated)
  • Piped water into school building (reticulated - untreated)
  • Piped to school compound/yard.plot outside (reticulated - untreated)
  • Public tap or standpipe (reticulated - treated)
  • Public tap or standpipe (reticulated - untreated)
  • Covered well (protected)
  • Uncovered well (unprotected)
  • Rainwater Harvesting collection (Tank)
  • Surface water (river, stream, dam, lake, pond, canal, irrigation channel)

  Own independent water supply Part of the village/community water supply Is the main water source shared with others?

  Yes No Don't know Can water be accessed by all students without teacher assistance?

  Water is available all the time, every day Water is available most days Water isn't available at certain times of the day or year Water is rarely available or only some days Does the water source provide a continuous supply of water?

  (2) Questions below only showing if user responded any of the following to the question "Does the water source provide a continuous supply of water?" above:

  • Water isn't available at certain times of the day or year
  • Water is rarely available or only some days

  Water supply source not available (source dries up, not enough water for everyone) Leakage from taps and pipes Not properly constructed (design, workmanship, incomplete project) System damaged (weather accident, vandalism, theft) Unclear responsibilities for operation and maintenance If rarely available, what is the reason?

  Yes No Don't know Does it provide enough water for the needs of the school, including water for drinking, hand washing, and food preparation?

  (2) Question below only showing if user responded No to previous question above "Does it provide enough water for the needs of the school, including water for drinking, hand washing, and food preparation?"

  Bring water from home Buy bottled water Don't drink water Drink from unsafe source What do children do when drinking water is not available at the school?

  Yes No Don't know Do you treat water for drinking?

  (1) Question below only showing if user responded any Yes to previous question above "Do you treat water for drinking?"

  Boiling Use of filter Let stand and settle down Chlorinated (chlorine, bleach) SODIS In what ways do you treat water for drinking?

  (2) Question below only showing if user responded any No to previous question above "Do you treat water for drinking?"

  Water quality is OK No storage capacity for drinking water Don't know where to access/buy chlorination tablets/solution No money to buy chlorine tablets/solution Don't like the taste of chlorine What is the reason/s for not treating water?

  Yes, alternate source available at school No, student must bring water from home Does the school have an alternate or backup drinking water source that students use when water is not available?

  (1) Question below only showing if user responded any Yes to previous question above "Does the school have an alternate or backup drinking water source that students use when water is not available?"

  Piped water into school building (reticulated - treated) Piped water into school building (reticulated - untreated) Piped to school compound/yard.plot outside (reticulated - untreated) Public tap or standpipe (reticulated - treated) Public tap or standpipe (reticulated - untreated) Covered well (protected) Uncovered well (unprotected) Rainwater Harvesting collection (Tank) Cart with small tank/drum Surface water (river, stream, dam, lake, pond, canal, irrigation channel) Bottled water No water available at the school If yes, what is the alternate drinking water source?

  (2) Question below only showing if user responded any of the following to the question "If yes, what is the alternate drinking water source?" above:

  • Piped water into school building (reticulated - treated)
  • Piped water into school building (reticulated - untreated)
  • Piped to school compound/yard.plot outside (reticulated - untreated)
  • Public tap or standpipe (reticulated - treated)
  • Public tap or standpipe (reticulated - untreated)
  • Covered well (protected)
  • Uncovered well (unprotected)
  • Rainwater Harvesting collection (Tank)
  • Surface water (river, stream, dam, lake, pond, canal, irrigation channel)

  Yes No Is the alternate or back up water source located in the school ground?

  1 2 3 4 5 >5 How many times has the water supply had major rehabilitation?

  Take photo of school (Front - whole compound with the school sign)

• Sanitation
  Yes No SW.S.1: Are there toilets/latrines at the school?

  Yes No SW.S.2. Do all functional toilets have lighting (includes natural light or alternative sources)?

  Yes No Do all functional toilets have adequate ventilation?

  (1) Questions below only showing if user responded Yes to previous question "Are there toilets/latrines at the school?"

  Flush / Pour-flush toilets Pit latrines with slab Composting toilets Pit latrines without slab Hanging latrines Bucket latrines No toilets or latrines What kind of toilet facilities are used at the school?

  (1) Question below only showing if user responded any of the following to the question "What kind of toilet facilities are used at the school?" above:

  • Flush / Pour-flush toilets
  • Pit latrines with slab
  • Composting toilets
  • Pit latrines without slab
  • Hanging latrines
  • Bucket latrines

  Concrete Timber Traditional materials What materials are the toilets (pan and Slab) made from?

  (1) Question below only showing if user responded any of the following to the question "What kind of toilet facilities are used at the school?" above:

  • Flush / Pour-flush toilets
  • Pit latrines with slab
  • Composting toilets
  • Pit latrines without slab
  • Hanging latrines
  • Bucket latrines

  Concrete Timber Traditional materials What materials is the toilet structures made from?

  (2) Questions below only showing if user responded Yes to previous question "Are there toilets/latrines at the school?"

  No, own school toilets Yes, toilets are shared with another school Are the toilet facilities share with others?

  All Some None Are the toilet facilities accessible to children with disabilities?

  (1) Questions below only showing if user responded All|Some to previous question "Are the toilet facilities accessible to children with disabilities?"

  Please take a photo of the facility that is accessible to children with disabilities.

  (1) Questions below only showing if user responded Yes to previous question "Are there toilets/latrines at the school?"

  Yes, girls and boys have separate toilets Some toilets are separate, some are shared by boys and girls No, girls and boys share the same toilets Are there separate toilets for boys and girls

  (1) Questions below only showing if user responded Yes to previous question "Are there toilets/latrines at the school?"

  What is the total number of toilets for students

  (4) Questions below only showing if user responded any of the following to previous question "Are there separate toilets for boys and girls"

  • Yes, girls and boys have separate toilets
  • Some toilets are separate, some are shared by boys and girls

  How many toilet exclusively for the girls?

  All Some None Are girls individual toilet compartments lockable from the inside?

  How many toilets exclusively for girls are not functioning on the day of the visit?

  Yes No Does the school have cleansing material available for personal hygiene?

  Yes, disposable Yes, reusable No Does the school provide pads for girls/disposable or reusable for free or safe?

  (1) Questions below only showing if user responded No to previous question "Does the school have cleansing material available for personal hygiene?"

  Water Water and soap Tissue, toilet paper brought from home Tissue, toilet paper available at school Leaves or organic material Nothing Don't know What do female students use to clean for personal hygiene?

  (2) Questions below only showing if user responded No to previous question "If yes, does the school provide pads for girls/disposable or reusable for free or safe?"

  Yes No Would it be useful that the school can provide sanitary pads?

  Yes No Can you tell if girls are expected to come to school when menstruating?

  (1) Questions below only showing if user responded any of the following to previous question "Are there separate toilets for boys and girls"

  • Yes, girls and boys have separate toilets
  • Some toilets are separate, some are shared by boys and girls

  All (containers) All (plastic bags) Some (containers) Some (plastic bags) Some (containers and plastic bags) None Do girls individual toilet include a container or plastic bag for disposing of napkins and/or disposable pads?

  (1) Questions below only showing if user responded any of the following to previous question "Do girls individual toilet include a container or plastic bag for disposing of napkins and/or disposable pads?"

  • All (containers)
  • Some (containers)
  • Some (containers and plastic bags)

  Has a lid Is easily washable Is disposable/made from organcic materials such as leaves Has a handle for carrying Open container Describe the container for napkin disposal?

  (1) Questions below only showing if user responded any of the following to previous question "Are there separate toilets for boys and girls"

  • Yes, girls and boys have separate toilets
  • Some toilets are separate, some are shared by boys and girls

  Yes No Don't know Does the school have a room for changing and washing pads for girls?

  (1) Questions below only showing if user responded Yes|No to previous question "Can you tell if girls are expected to come to school when menstruating?"

  What can your school do to make it easier for girls to be in school during menstruation?

  (1) Questions below only showing if user responded any of the following to previous question "Are there separate toilets for boys and girls"

  • Yes, girls and boys have separate toilets
  • Some toilets are separate, some are shared by boys and girls

  How many toilets exclusively are for the boys?

  (1) Questions below only showing if user responded any of the following to previous question "Are there separate toilets for boys and girls"

  • Yes, girls and boys have separate toilets
  • Some toilets are separate, some are shared by boys and girls

  How many toilets exclusively for boys are not functioning on the day of the visit?

  (2) Questions below only showing if user responded Yes|No to previous question "Are there toilets/latrines at the school?"

  Open defecate inside the school compound Open defecate outside the school grounds Go home and use toilet Use school toilets anyway Don't know What do children do when toilets are not functioning?

  Yes No Do teachers have their own toilet facilities separate from students?

  (1) Questions below only showing if user responded Yes to previous question "Do teachers have their own toilet facilities separate from students?"

  Yes, teacher toilets are separate for males and females Some, toilets are shared and some are separate No, teacher toilets are not separate and are shared Are these teacher toilets separate for male and females?

  (4) Questions below only showing if user responded any of the following to previous question "Are these teacher toilets separate for male and females?"

  • Yes, teacher toilets are separate for males and females
  • Some, toilets are shared and some are separate

  How many toilets exclusively for female staff?

  How many of the exclusive female teacher toilets are functioning on the day of the visit?

  How many toilets exclusively for male staff?

  How many of the exclusive male teacher toilets are functioning on the day of the visit?

  (1) Questions below only showing if user responded Yes to previous question "Are there toilets/latrines at the school?"

  Yes No Are toilets cleaned on a regular basis?

  (1) Questions below only showing if user responded No to previous question "Are toilets cleaned on a regular basis?"

  Budget for staff Shortage of water Shortage of cleaning supplies Difficulty mobilizing the students None What are the main challenges in keeping toilets clean?

  (5) Questions below only showing if user responded any of the following to previous question "What kind of toilet facilities are used at the school?"

  • Flush toilet (using cistern and pan) to sewer
  • Flush (using cister and pan) to septic tank
  • Flush to pit (water seal/pour flush)
  • Ventilated improved latrines (VIP)
  • Pit latrines with slab (concrete and/or timber)
  • Pit latrine without slab/open pit
  • Composting toilet

  Yes No Is emptying and disposing of the sludge from the septic tank or pit done?

  Yes No Is the school ground free from rubbish?

  Yes No Are rubbish bins present in the school grounds?

  Yes No Is the school practicing rubbish segregation/composting?

  Incinerate Collection service Throw/pile outside (within or out of school compound) Bury No disposal Don't know How does the school dispose of rubbish and sanitary pads?
• Hygiene
  Yes No SW.H.1: Does the school have a place to wash hands?

  (2) Questions below only showing if user responded Yes to previous question "Does the school have a place to wash hands?"

  SW.H.2: If yes, how many hand washing facilities are functioning?

  All Most Some None Is there a place to wash hands inside, or directly outside, each toilet block?

  (1) Questions below only showing if user responded any of the following to previous question "Is there a place to wash hands inside, or directly outside, each toilet block?"

  • All
  • Most
  • Some

  Running water from a piped system or tank (faucet and sink/stand tap/rainwater tank and faucet/bucket and spigot) hand poured water system (bucket or ladle) Basin/bucket (hand washing done in the water and is not running or poured) What kind of hand washing facilities does the school have?

  How many group handwashing facilities are available in your school?

  Yes No Is group hand washing practiced in the school?

  (1) Questions below only showing if user responded Yes to previous question "Is group hand washing practiced in the school?"

  Yes, all classes Yes, some classes No Is group hand washing practiced daily?

  (1) Questions below only showing if user responded No to previous question "Is group hand washing practiced daily?"

  Soap not available Shortage of water no group facility Not enough time Not considered useful/priority Children are not interested/don't like it teachers don't like it Not thought of it Don't know What are the barriers to practice of group hand washing?

  (1) Questions below only showing if user responded any of the following to previous question "Is there a place to wash hands inside, or directly outside, each toilet block?"

  • All
  • Most
  • Some

  Yes No 90. Is hand washing done with soap?

  (1) Questions below only showing if user responded No to previous question "90. Is hand washing done with soap?"

  Ash Lemon Coconut husk Sand If no, what other material is used to wash hands?

  (1) Questions below only showing if user responded No to previous question "Is group hand washing practiced daily?"

  • Yes, all classes
  • Yes, some classes

  Yes No Do teachers supervise hand washing with soap at critical times such as after visiting toilet and before meals?

  (1) Questions below only showing if user responded Yes to previous question "90. Is hand washing done with soap?"

  Yes all have water and soap Some have water and soap None had water and soap available Use other materials Please assess if water and soap are available for hand washing at the hand washing facility (Observation)

  (2) Questions below only showing if user responded Yes to previous question "Does the school have a place to wash hands?"

  All Most Some None Please assess if the hand washing facilities are accessible to children with disabilities and the youngest children at the school (Observation)

  Yes, all classes Yes, some classes No Is group tooth brushing practiced daily?

  (1) Questions below only showing if user responded Yes to previous question "Is group tooth brushing practiced daily?"

  Toothbrushes not available/children don't have any Toothpaste not available Shortage of water No group wash facility what are the barriers to practicing tooth brushing daily?
• Operation and Maintenance
  All Most Some None SW.OM.1: Do you think the school water and sanitation facilities are successfully maintained and repaired when required?

  Yes No Don't know SW.OM.2: Does the school have a school improvement plan?

  (1) Questions below only showing if user responded Yes to previous question "Does the school have a school improvement plan?"

  Yes No Is WASH, solid waste management included in the School Improvement Plan

  Yes No Sometimes Don't know Does the school have an active school management committee?

  Yes, active Yes, but not active No Does the school have any student WASH clubs?

  Yes No Are members of the school community supportive in the operation of the school such as the maintenance of environment for learning, WASH facilities and provision of soap?

  (3) Questions below only showing if user responded Yes to previous question "Are members of the school community supportive in the operation of the school such as the maintenance of environment for learning, WASH facilities and provision of soap?"

  Parents volunteers Teachers and staff SIP committee Children Indicate with the tick the members of the school community that supports the school in improving learning environment, repair WASH facilities tanks, tippy taps and toilets

  Non-existent Poor Satisfactory Good Great How would you rate the community involvement and participation in school activities?

  Fundraising School meetings (PTA) School clean up Reconstruction of classrooms Construction of toilets Construction of water source for the school What are some of the activities that the community participate in?

  (1) Questions below only showing if user responded No to previous question "Are members of the school community supportive in the operation of the school such as the maintenance of environment for learning, WASH facilities and provision of soap?"

  No interest Cannot afford to support Other interests take precedence Why do you think, communities do not support school activities?

  (1) Questions below only showing if user responded Yes to previous question "Are members of the school community supportive in the operation of the school such as the maintenance of environment for learning, WASH facilities and provision of soap?"

  Yes No Is there a budget or funding available for repairs and maintenance intended for WASH facilities?

  (2) Questions below only showing if user responded Yes to previous question "Is there a budget or funding available for repairs and maintenance intended for WASH facilities?"

  School Improvement Plan Committee Teachers School Committee Parents Department of Education Village Welfare Group Donors If yes, who provide the funding?

  Take a picture of the SIP which shows the inclusion of WASH Action Plan/Targets

  Maintenance staff Teachers Students Someone else Don't know Within the school, who is responsible for cleaning the toilet facilities? Check all that apply.

  (1) Questions below only showing if user responded Someone else to previous question "Within the school, who is responsible for cleaning the toilet facilities? Check all that apply."

  • Yes, all classes
  • Yes, some classes

  If someone else, specify

  Yes No Does the school have regular supply of cleaning materials?
• Curriculumn and School Activities
  Yes No SW.CSA.1: Is personal hygiene taught at the school or part of the curriculum?

  (2) Questions below only showing if user responded Yes to previous question "Is personal hygiene taught at the school or part of the curriculum?"

  Teachers Health workers Parents Pupils/WASH Clubs SW.CSA.2: If yes, by whom?

  Yes No Is menstruation related education taught at school?

  (2) Questions below only showing if user responded Yes to previous question "Is menstruation related education taught at school?"

  Information on biological reasons for menstruation How to manage menstrual hygiene As part of reproductive health What is taught?

  Female teachers only Both female and male teachers Health workers Pupils/WASH Clubs If yes, by whom?

  Yes No Don't know Does the school have WASH activities?

  (3) Questions below only showing if user responded Yes to previous question "Does the school have WASH activities?"

  Infrastructure construction Hygiene awareness WASH committee training If yes, what kind of activities?

  Drink safe water Use of toilets Hand washing Menstrual hygiene Don't know If yes, what was the theme of the WASH activity?

  Yes No Do children participate in the WASH activities?

  (2) Questions below only showing if user responded Yes to previous question "Do children participate in the cleaning of WASH facilities?"

  Cleaning toilets Refilling tippy taps Ensuring soap is availale at hand washing stations Help supervise hand washing activities Help supervise tooth brushing activities If yes, what activities do children participate in?

  Yes No Don't know Does the school have a roster for these activities?

  (1) Questions below only showing if user responded Yes to previous question "Does the school have a roster for these activities?"

  Cleaning toilets Refilling tippy taps Ensuring soap is availale at hand washing stations Help supervise hand washing activities Help supervise tooth brushing activities If yes, what activities have rosters?

  Yes No Are learning materials available for teaching WinS?

  Yes No Are the teachers oriented on WASH in Schools?
• School WASH Kits
  Yes No SW.SWK.1: Did the school receive a school WASH kit?

  (3) Questions below only showing if user responded Yes to previous question "Did the school receive a school WASH kit?"

  Posters Emergency hands Pocket guides Water bottles Soap Disposable pads Toothbrush Toothpaste Nail clipper SW.SWK.2: If yes, can you please name the items in the kit?

  WASH advocacy and learning materials (i.e. poster, sticker, flipchart, brochure, etc.) Water bottles Soap Disposable pads Toothbrush Toothpaste Nail clipper What materials in the WASH kit were the most useful?

  Yes No Have the materials within the kits, been used to create a WASH corner within each classroom?

  (1) Questions below only showing if user responded Yes to previous question "Have the materials within the kits, been used to create a WASH corner within each classroom?"

  Please take a photo of the WASH corner?