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Wash Survey Form - Enter School Survey Screen

This document is a survey form for Tagbacan Elementary School for the 2015 school year regarding water access, sanitation, cleanliness, hygiene practices, and resources for wash programs. It contains 31 questions that gather information on water sources, number of toilets, cleanliness, handwashing and oral hygiene education, availability of hygiene supplies, menstrual hygiene management, staff training, information materials, and operations/maintenance of wash facilities. The survey aims to assess the school's wash conditions and needs.

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shermaine geniston
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200 views

Wash Survey Form - Enter School Survey Screen

This document is a survey form for Tagbacan Elementary School for the 2015 school year regarding water access, sanitation, cleanliness, hygiene practices, and resources for wash programs. It contains 31 questions that gather information on water sources, number of toilets, cleanliness, handwashing and oral hygiene education, availability of hygiene supplies, menstrual hygiene management, staff training, information materials, and operations/maintenance of wash facilities. The survey aims to assess the school's wash conditions and needs.

Uploaded by

shermaine geniston
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Wash Survey Form - Enter School Survey Screen

Tagbacan ES (122702)
SY 2015

School Profile

Survey Date April

School Head
Contact No.

Water Access for Handwashing and Cleaning

1. Does the school have access to water in the school ground?


2. What is the type of water source available in day care after Yolanda?

Piped-water from Water District Open well


Hand pump well/dugwell Water Tanker /Bottled
Water
Rain collector
Surface water (river, lake)
3. Is the water source functional and can be used now?
3a. If Yes, how many hours is the water available?
3b. If No, why is water source not functional?

Lack / missing parts Schedule is not regular


Water system beyond repair Typhoon damaged
No funds for repair Others:
4. If school has no water access, is there a functional water source
available outside the school premises?

Water Access for Drinking

5. Do children bring water tumblers/water containers to school


everyday?
6. Are drinking water points/areas available in the school
premises?
7. Do you treat water for drinking?
7a. If 'Yes', in what ways do you treat water for drinking?

Boiling Chlorination (hyposol, aquatabs)


Use of ceramic/cartridge/sand filter Use cloth to filter
Let is stand and settle down Others:
7b. If 'No', What is/are the reason/s for not treating water?

Water quality is okay No knowledge on how to treat water


No storage capacity for drinking water No money to buy chlorine tablets
/solution
Don't know where to access/buy chlorination
tablets/solution Don't like the taste of chlorine
Others:

Sanitation

8. Total Number of children


Male Female
Kinder to Grade 3
Grade 4 to 6
9. Total Functional toilets (Permanent/Temporary)
Male Female Shared
Kinder to Grade 3
Grade 4 to 6
Detached toilets
10. Is there a toilet in the school accessible for children with disabilities?

Cleanliness of Surroundings

11. Is the school ground free from trash?


12. Are there trash bins present in the school grounds?
13. Is the school practicing waste segregation?

Hygiene

14. Are handwashing and toothbrushing taught in school? (part of the curriculum)
14a. If yes, by whom?

Teachers Parents
Health workers Pupils
15. Do all the children have hygiene kits (specifically soap, toothpaste and toothbrush)
in the school?

Soap Toothpaste
Toothbrush Others:
16. Is there a handwashing facility near the toilet?
17. Is soap and water available in the handwashing facility?
18. Is there a group handwashing facility in the school that can accommodate at least
ten (10) pupils?
19. Is there a proper toothbrush holder in the classrooms?
20. Is the group handwashing / toothbrushing activities included in the daily class
program?
21. Are children (wash clubs) involved in the daily wash activities and hygiene
promotion activities?

Menstrual Hygiene Management

22. Is Menstrual Hygiene Management taught in schools? In what grade


level/s?

Grade 4 Grade 6
Grade 5
23. Are there sanitary pads available for use in the classroom/school?
24. Is there a garbage bin with cover inside the toilets?
25. Is there soap and water inside the toilets?

Human Resource

26. Has the school head received orientation about Deped SBM WASH in schools?
27. Are the GPTAs oriented on DepEd SBM WASH in Schools?

IEC Materials

28. What WASH in Schools (WinS) IEC materials are utilized and visible in the
school?

Manuals Videos
Stickers Mural
Posters Others:
29. Are IEC materials present in the classrooms?

Operation and Maintenance

30. Are there parent volunteers/ staff/children assigned to clean toilets for detached toilet
facilities?
31. Is there allocation for repairs and maintenance intended for WASH facilities in the
MOOE?
32. Is WASH included in the School Improvement Plan (SIP)?

Surveyor Data

Name of Surveyor
Organization
Designation
Contact Number

Submit Cancel

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