survey Baseline

Baseline Household Survey (Pre-intervention)
GS Project ID - GS12963
Full version (Carbon + SDG modules).
For Gold Standard Methodology 429 (Safe Drinking Water Supply).

Enumerator guidance: Ask questions exactly as written. Tick one box unless it says “tick all that apply”. If the respondent does not know, tick “Don’t know / Not sure”. Record numbers only where requested. For monitoring, “before the project” refers to the situation before the borehole was installed/rehabilitated.

Step 1 of 12

Section 1: Photos and consent

1.1 Consent to participate in this survey (tick one) *

Yes No (end survey)

1.2 Consent to take photos (tick one) *

Yes No (continue survey)

1.3 Respondent photo (if consented, otherwise skip) *

TAKE PHOTO TOOL - NOT MANDATORY

1.4 Household/premises photo (if consented, otherwise skip) *

TAKE PHOTO TOOL - NOT MANDATORY

1.5 Main current drinking water source photo (if available) *

TAKE PHOTO TOOL - NOT MANDATORY

1.6 GPS coordinates of premises captured by enumerator *

GPS TOOL - NOT MANDATORY (recommended, but contingent on internet connection)

Section 2: Survey identification and location

2.1 Date of interview *

2.2 Enumerator ID and name *

EKUG1015 - Nambi Babra EKUG1014 - Kirabo Juliet EKUG1013 - Kampi Shamim EKUG1012 - Namaganda Babra EKUG1011 - Naibere Angella EKUG1004 - Mwamiyaidhi Hasifa EKUG1010 - Ademun Angella EKUG1009 - Namukasa Hope Janet EKUG1002 - Musobya Emmanuel EKUG1008 - Kikabi Aziz EKUG1003 - Immaculate Bam Tendo EKUG1001 - Ssebidde Ammex

2.3 Region / District / Sub-county / Parish / Village *

Jinja Kamuli Luuka Buyende Other (specify)

2.4 Sub County *

2.5 Parish, Village *

2.6 Premises type (tick one) *

Household School Religious building Community centre Other (specify)

2.7 If there is a potential planned project, what is assigned borehole number? (if no project is planned, leave this blank) *

2.8 If there is a potential planned project, what is the distance to this planned project? *

Less than 500m (Less than 6 minutes walk) Between 500m and 1km (Between 6 minutes and 12 minutes walk) More than 1km (more than 12 minute walk) Not applicable

Section 3: Respondent and household/premises profile

3.1 Respondent name *

3.2 Respondent phone number (optional)

3.3 Respondent role (tick one) *

Head of household Spouse/partner Adult household member Staff (school/clinic/community building) Other (specify)

3.4 Respondent sex (tick one) *

Female Male Prefer not to say

3.5 Respondent age group (tick one) *

18–24 25–34 35–44 45–54 55+

3.6 Total number of people who normally live/use this premises (number) [SDWS 25 HNp,y] *

3.7 Of these people, how many are under the age of 5? *

3.8 How many people usually drink water from the project borehole? (number) [supports SDG 6 Py and SDWS 26] *

Section 4: Drinking water sources and access (baseline)

4.1 Current main source of drinking water most days (tick one) *

Unprotected borehole/spring River/stream Lake/pond Rainwater Protected borehole/spring Piped water/tap Vendor water Other (specify) Don’t know / Not sure

4.2 Second most used drinking water source (tick one) *

No second source Unprotected borehole/spring River/stream Lake/pond Rainwater Protected borehole/spring Piped water/tap Vendor water Other (specify) Don’t know / Not sure

4.3 Do you use your main drinking water source all year round? (tick one) *

Yes No Only rainy season Only dry season Don’t know / Not sure

4.4 Do you experience shortages from your main drinking water source? (tick one) *

Yes No Don’t know / Not sure

4.5 Main challenges when collecting drinking water (tick all that apply) *

Difficult terrain Distance too far Long waiting times Water quality concerns Frequent breakdowns at water point High cost No challenges Other (specify)

4.6 Do you think the current water availability meets your household’s needs? (tick one) *

Yes No Don’t know / Not sure

Section 5: Water collection time and main collector (SDG 5 baseline)

5.1 Who mainly collects drinking water for this premises? (tick one) [SDG 5 support] *

Adult woman Adult man Girl under 18 Boy under 18 Shared equally Paid water carrier Other (specify) Don’t know / Not sure

5.2 On a typical day, how much total time does your household spend collecting drinking water (walking, waiting, filling, returning) from all sources? (tick one) [SDG5 Tb,y] *

Less than 15 minutes 15–30 minutes 31–60 minutes 61–90 minutes More than 90 minutes Don’t know / Not sure

Section 6: Drinking water quantity for drinking (SDWS 24)

6.1 On a typical day, how much drinking water does each person drink? (tick one) [SDWS 24 QPWp] *

Less than 1 litre 1–2 litres 2–3 litres 3–4 litres 4–5 litres More than 5 litres Don’t know / Not sure

Section 7: Treatment and boiling behaviour (baseline)

7.1 Do you treat drinking water before drinking it? (tick one) *

Yes, always Yes, sometimes No, never Don’t know / Not sure

7.2 Main method used to make drinking water safe (tick one) *

Boiling Chlorine Filter Solar disinfection Let it settle only Buy treated water Other (specify) Not applicable (no treatment) Don’t know / Not sure

7.3 Do you boil drinking water for safety? (tick one) [SDG3 Pb,boil] *

Always Often Sometimes Rarely Never Don’t know / Not sure

7.4 Which statement best describes your usual drinking water? (tick one) [SDWS 12 Cb concept] *

We drink safe water without boiling We usually boil before drinking We usually use a non-boiling method We do not treat drinking water Don’t know / Not sure

Section 7a: Stove/device and fuel used for boiling drinking water (SDWS 6, 8, 11)

7a.1 What type(s) of stoves do you use for cooking or boiling water? (tick all that apply) [context / SDWS 6] *

Traditional three-stone fire Improved cookstove Gas stove (LPG) Electric stove/kettle Charcoal stove Other (specify) Don’t know / Not sure

7a.2 How many stoves/cooking devices does your household have in total? (number) *

7a.3 If you boil drinking water, which stove/device do you mainly use? (tick one) [SDWS 11 shares] *

Three stone fire (open fire) Improved cookstove Charcoal stove LPG gas stove Electric kettle/stove Other (specify) Not applicable (do not boil) Don’t know / Not sure

7a.4 If you boil drinking water, which fuel do you mainly use? (tick one) [SDWS 8 shares] *

Firewood Charcoal LPG Electricity Agricultural residues Other (specify) Not applicable (do not boil) Don’t know / Not sure

7a.5 7a.5 Is the wood used for boiling water bought or is it collected (found, chopped or obtained in another way). *

nothing is bought (0%) majority is bought (75%) half is bought (50%) small part bought(25%) nothing bought (0%) Not applicable (do not boil) Don’t know / Not sure

7a.6 Of the collected wood, how much is found (picked up from the ground) and how much is chopped by cutting down plants or trees. *

all is chopped (100%) majority chopped (75%) half chopped (50%) small part chopped (25%) nothing chopped (0%) Not applicable (do not boil) Don’t know / Not sure

7a.7 If you also chop, do you chop trees on own ground? *

Yes, always Yes, most of the time Yes, occasionally / sometimes Yes, but barely No, never Don’t know / Not sure

Section 7b: Water boiling practice and efficiency (cross-checks)

8.1 8.1 On average, how long does it take to boil 1 litre of water for drinking using your main boiling stove/device? (tick one) *

Less than 5 minutes 5–10 minutes More than 10 minutes Not applicable Don’t know / Not sure

8.2 How often do you boil drinking water in a day? (tick one) *

Never Once 2–3 times More than 3 times Don’t know / Not sure

8.3 Do you mix methods to boil water (use multiple stove types)? (tick one) *

Yes No Not applicable Don’t know / Not sure

8.4 If cost were not a concern, would you use more fuel for boiling drinking water? (tick one) *

Yes No Not applicable Don’t know / Not sure

8.5 If yes, estimate how much more (optional)

Section 9: Service feedback and satisfaction

9.1 Are you satisfied with the quality of your current main drinking water source? (tick one) *

Yes No Sometimes Don’t know / Not sure

9.2 What improvements would you recommend for local drinking water services? (tick all that apply) *

Better water quality Easier access Reduced waiting times More water points in the area No recommendations Other (specify)

9.3 Do you prefer your main source over other sources? (tick one) *

Yes No Don’t know / Not sure

9.4 Would the availability of alternative water solutions reduce your dependence on forest resources? (tick one) *

Yes No Don’t know / Not sure Not applicable

Section 10: SDG impact support (Health, sanitation, hygiene education)

10.1 In the past month, has any household member experienced waterborne illness? (tick all that apply) [SDG 3 support] *

No Yes, diarrhoea Yes, cholera Yes, other (specify) Prefer not to say Don’t know / Not sure

10.2 Has anyone in your household experienced respiratory conditions linked to smoke from cooking or boiling water? (tick one) [SDG 3 support] *

No Yes, mild Yes, severe Prefer not to say Don’t know / Not sure

10.3 Have there been burns/accidents related to water heating or cooking in the past year? (tick one) [SDG 3 support] *

No Yes, minor burns Yes, major burns Prefer not to say Don’t know / Not sure

10.4 Toilet facility type used (tick one) [SDG 6 support] *

Flush/pour flush to sewer Flush/pour flush to septic tank Pit latrine with slab Pit latrine without slab No facility (bush/field) Don’t know / Not sure

10.5 Do you share this toilet facility with other households? (tick one) *

No Yes, with 1–2 other households Yes, with more than 2 households Don’t know / Not sure Not applicable

10.6 Where is this toilet facility located? (tick one) *

In own dwelling In own yard/plot Elsewhere Don’t know / Not sure Not applicable

10.7 Where do members of the household most often wash hands? (tick one) [SDG 6 support] *

Fixed facility (sink/tap) Mobile object (bucket/jug) No handwashing facility Don’t know / Not sure

10.8 Is water available at the handwashing place? (tick one) *

Yes No No handwashing facility Don’t know / Not sure

10.9 Is soap available at the handwashing place? (tick one) *

Yes No Don’t know / Not sure

10.10 In the last 6 months, have you received any hygiene or safe water education or messaging? (tick one) [SDWS 20] *

Yes No Don’t know / Not sure

10.11 If yes, how did you receive it? (tick all that apply) *

Community meeting / training session Household visit School session Poster / leaflet Radio / public announcement SMS / phone message Other (specify) Don’t know / Not sure

10.12 If yes, what topics were covered? (tick all that apply) *

Handwashing with soap Safe water storage Treating drinking water Keeping the water point clean Latrine use Other (specify) Don’t know / Not sure

Section 11: Sign-off

11.1 Respondent Signature *

Sign above using touch or mouse

11.2 Enumerator signature *

Sign above using touch or mouse

survey Baseline

Section 1: Photos and consent

Section 2: Survey identification and location

Section 3: Respondent and household/premises profile

Section 4: Drinking water sources and access (baseline)

Section 5: Water collection time and main collector (SDG 5 baseline)

Section 6: Drinking water quantity for drinking (SDWS 24)

Section 7: Treatment and boiling behaviour (baseline)

Section 7a: Stove/device and fuel used for boiling drinking water (SDWS 6, 8, 11)

Section 7b: Water boiling practice and efficiency (cross-checks)

Section 9: Service feedback and satisfaction

Section 10: SDG impact support (Health, sanitation, hygiene education)

Section 11: Sign-off

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