School Water Access Survey Form
Use this form to report school water access conditions, quality observations, infrastructure issues, and follow-up needs.
School and Respondent Details
School Name
*
School Address / Location
*
Respondent Role
*
Please Select
Principal
Teacher
Facilities Staff
Student
Parent/Guardian
Other
Respondent Contact Details (Optional)
Water Access and Availability
Current water access status
*
Always available
Usually available
Sometimes unavailable
Rarely available
Not available
Main water source
*
Please Select
Piped water
Borehole/Well
Rainwater harvesting
Delivered by tanker
Nearby community source
Other
Water access consistency over the past term
*
Very inconsistent
1
2
3
4
5
6
7
8
9
Very consistent
10
1 is Very inconsistent, 10 is Very consistent
Water Quality and Usability Survey
Water clarity
*
Very poor
1
2
3
4
5
6
7
8
9
Very clear
10
1 is Very poor, 10 is Very clear
Water smell
*
Very unpleasant
1
2
3
4
5
6
7
8
9
No noticeable smell
10
1 is Very unpleasant, 10 is No noticeable smell
Water taste
*
Very unpleasant
1
2
3
4
5
6
7
8
9
Very good
10
1 is Very unpleasant, 10 is Very good
Overall water usability
*
Not usable
1
2
3
4
5
6
7
8
9
Highly usable
10
1 is Not usable, 10 is Highly usable
Can students and staff safely drink this water?
*
Yes
No
Unsure
Notable issues observed
Facilities, Maintenance, and Follow-up
Condition of key water facilities
*
Rows
Good
Needs repair
Out of service
Taps
1
2
3
Tanks
4
5
6
Pipes
7
8
9
Handwashing stations
10
11
12
Storage containers
13
14
15
Main maintenance issue
Urgency level
*
Low
Medium
High
Critical
Additional comments or recommendations
Submit
Should be Empty: