SURVEY OF REALITY CHECK ON OPEN DEFECTION
Social science project of students of Damodar Academy in collaboration with Peace Development Research Center.
Name of Respondent
*
First Name
Last Name
Ward no
*
1
2
3
4
5
6
Type of house
*
Thatched
Tin/ asbestos
Concrete
Do you have toilet in your home ( if No move to the next section)
*
YES
No
Under construction
How many toilets do you have in home?
Do you have toilet card
Yes
No
I don't know what is a toilet card
Have you built a septic tank
Yes
No
Under construction
Who all use the toilet in your home
Only females
Only males
Both
Do you still go outside near pond and river for defection (toilet)
Yes
No
What type of toilet?
Indian
Western
Open pit
Others
Do you have water supply in your toilet?
Yes
No
Did you receive any support( money, equipments) to build the toilet from government or NGO
Yes
No
If Yes, then what or how much did you receive for construction of toilet?
How often do you clean your toilet?
Everyday
Once in 2 days
Twice a week
Weekly
Are you aware that your palika is Open defection free?
Yes
No
Did you hear about any program about open defection held in your ward or palika?
Yes
No
How many school going girls are there in your house?
Do your girl child avoid going to school due to non availability of toilet in school?
Yes
No
Back
Next
If they don't have toilet then fill the form below
Do you plan to construct toilet in near future?
Yes
No
Maybe
If yes then by when ( in months )
What is the reason for not having a toilet
Do you have toilet card
Yes
No
Did you have to pay some money to get the toilet card
Yes
No
Did government people or NGO approach you for construction of toilet?
Yes
No
Did you face problem due to non availability of toilet ( explain )
Yes
No
What type of challenges
Could not apply for government identity card ( nagarkita, zanmdartha, others)
Did not receive relief materials
Was neglected in the society
Submit
Should be Empty: