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Qn VATW Lk WAw LwUiWE WWW M - (PDF, 101 mb) - USAID

Qn VATW Lk WAw LwUiWE WWW M - (PDF, 101 mb) - USAID

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HEALTH EDUCATION AND SANITATION PROMOTION IN RURAL PIPED WATER PROJECTS FORM HESP 5<br />

VILLAGE INSPECTION TALLY SHEET<br />

Village Inspected by Date<br />

SANITATION ENVIRONMENTAL CLEANLINESS"<br />

Latrines 00000 00000 00000 00000 00000 00000 Dwelling 00000 00000 00000 00000 00000 00000*<br />

00000 00000 00000 00000 00000 00000 . Houses 00000 00000 00000 00000 00000 00000<br />

00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000<br />

OO00000 00000 00000 00000 00000 00000 ooooo 0000 ooooo ooooo0 00000<br />

Unsatisfactory 00000 00000 OOOO 00000 00000 00000 Unsatisfactory 0 0000 00000 0OO00 0000 00000<br />

.Latrines 00000 00000 00000 000o0 00000 00000 Dwelling 00000 00000 00000 00000 00000 00000<br />

00000 00000 00000 00000 00000 0000 Houses 00000 00000 00000 00000 00000 0000<br />

Latrines Under 00000 00000 00000 00000 0000 00OOO F-- Infested 0 00 0 000000 00000OO O<br />

Construction 00000 00000 00000 00000 00000 00000 El Dwelling 00000 0000 00000 00000 00000 00000<br />

L.<br />

Bath Houses 00000 00000 00000 00000 00000 00000<br />

00000 00000 00000 O00OO 00000 00000<br />

00000000000000 0000 00000000000<br />

00000 0000 00000 00000 00000 0000<br />

l<br />

Houses 00000 000<br />

Types of Infestations:-<br />

0 0000 0000 00000 00000 E<br />

General cleanliness of village:­<br />

Satisfactory [ _i<br />

Refuse Pits 000000000000000000000000000000<br />

00000 00000 0000OOC OO00000 U1]<br />

nstifatoy<br />

000000000 00000 00000 0000000000<br />

00000 00000 00000 00000 00000 00000 HOUSEHOLDS 00000 00000 00000 00000 00000 00000<br />

Dish Racks OOO 0000OOOOOOOOOO 0000 00000 00000 00000 00000 0000 00 000<br />

00000000OO000O00000000000000 00000000000000000000 00000 00000<br />

00000 00000 00000 0000000000 00000_0_0000000____00000<br />

OOO O 0000 000000000 00000 00000 PERCENTAGES<br />

WATER SUPPLY WTR P Taps with Taps With Households Households with<br />

: El<br />

No. of Taps ~j Satisfactory<br />

Drainage LJ Laundry Slabs L with Latrines<br />

Refuse Pits<br />

Households with<br />

Drinking<br />

Households<br />

Water 00000 00000 00000 00000<br />

with<br />

00000 Bath Houses Dish Racks<br />

Pots-Inspected 00000 00000 00000 0000 00 00000 0<br />

Unsatisfactory 00000 00000 OCOOO00000 O0000 00000 No. of VHC Me<strong>mb</strong>ers accompanying on inspection tour<br />

Drnaisfatr 00000 00000 00000 00000 00000 00000<br />

Drinking Water 00000 00000 L<br />

00000 00000 00000 00000 . Diseases reported as special problem in village:-<br />

Other Protected Water Sources (No. and type):­<br />

l

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