Survey Monitoring

Monitoring Project Borehole

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

1.3 Respondent photo (if consented, otherwise skip) *

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

1.5 Project borehole/pump photo (if possible) *

1.6 GPS coordinates of premises captured by enumerator *

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 Project borehole number *

2.8 Premises proximity to project borehole. *

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 (optional)

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 in your household usually drink water from the project borehole? (number) [supports SDG 6 Py and SDWS 26] *

Section 4: Project borehole use and access (monitoring)

4.1 Do you use the project borehole as a source of drinking water? (tick one) *

Yes, as main source Yes, sometimes No Don’t know / Not sure

4.2 In the last 7 days, on how many days did you collect drinking water from the project borehole? (tick one) [supports Up,y] *

0 1–2 3–4 5–6 7 Don’t know / Not sure

4.3 Do you use the project borehole all year round? (tick one) *

Yes No Only rainy season Only dry season Don’t know / Not sure Not applicable (do not use)

4.4 Do you experience shortages from the project borehole? (tick one) *

Yes No Don’t know / Not sure Not applicable (do not use)

4.5 Main challenges when using the project borehole (tick all that apply) *

Long waiting times Water quality concerns Frequent breakdowns Distance too far High cost No challenges Other (specify) Not applicable (do not use)

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

Yes No Don’t know / Not sure Not applicable (do not use)

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

5.1 Who mainly collects drinking water for this premises now? (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 now, how much total time does your household spend collecting drinking water (walking, waiting, filling, returning) from all sources? (tick one) [SDG5 Tp,y] *

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

5.3 Before the project, how much total time did your household spend collecting drinking water per day? (tick one) [baseline Tb,y recall for change narrative] *

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 now, how much drinking water does each person drink? Only count water people drink (not cooking, washing, animals). (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 continued boiling in year y (monitoring)

7.1 Do you treat drinking water from the project borehole before drinking it? (tick one) *

No, never Yes, sometimes Yes, always Not applicable (do not use) Don’t know / Not sure

7.2 Do you boil drinking water that comes from the project borehole? (tick one) [SDWS 22 Xcleanboil,y] *

Never Rarely Sometimes Often Always Not applicable (do not use) Don’t know / Not sure

7.3 Before the project borehole was installed/rehabilitated, how often did you boil drinking water for safety? (tick one) *

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

7.4 If you still boil project borehole water, why? (tick all that apply) *

Habit Concern about safety Taste preference For children/elderly Advice from others Other (specify) Not applicable

Section 7a: Stove/device and fuel used for boiling drinking water (monitoring)

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

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

7a.2 If you boil drinking water now, which stove/device do you mainly use? (tick one) *

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.3 If you boil drinking water now, which fuel do you mainly use? (tick one) *

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

7a.4_firewood 7a.4 (Optional cross-check) Firewood used per week for boiling drinking water (kg):

7a.4_charcoal Charcoal used per week for boiling drinking water (kg): *

7a.4_lpg LPG used per week for boiling drinking water (litres): *

7a.4_electricity Electricity used per week for boiling drinking water (kWh): *

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

7b.1 On average, how long does it take to boil 1 litre of water 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

7b.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

7b.3 Do you mix methods to boil water (use multiple stove types)? (tick one) *

Yes No Not applicable Don’t know / Not sure

7b.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

Section 8: Service feedback and satisfaction

8.1 Are you satisfied with the water quality from the project borehole? (tick one) *

Yes No Sometimes Not applicable (do not use) Don’t know / Not sure

8.2 In the last 30 days, was the project borehole ever not working when you needed it? (tick one) *

No Yes Don’t know / Not sure Not applicable (do not use)

8.3 What improvements would you recommend for this borehole? (tick all that apply) *

Faster repairs Better water quality Reduced waiting times More boreholes/water points in the area No recommendations Other (specify)

8.4 Do you prefer using this borehole over other water sources? (tick one) *

Yes No Not applicable (do not use) Don’t know / Not sure

Section 9: SDG impact support (Health, sanitation, hygiene education)

9.1 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

9.2 Has anyone in your household experienced respiratory conditions linked to smoke from cooking or boiling water? (tick one) *

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

9.3 Have there been burns/accidents related to water heating or cooking in the past year? (tick one) *

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

9.4 Toilet facility type used (tick one) *

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

9.5 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

9.6 Where do members of your household most often wash hands? (tick one) *

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

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

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

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

Yes No Don’t know / Not sure

9.9 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

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

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

9.11 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 10: Sign-off

10.1 Respondent Signature *

Sign above using touch or mouse

10.2 Enumerator signature *