CWIS Household Sanitation Survey

ID

Survey Identification

City / Municipality *

Select the city or municipality where your household is located.

Barangay *

Respondent Name *

Enter the full name of the person answering this survey.

Contact Number *

Enter your 10-digit mobile number (e.g. 9171234567).

+63

B

Flood Risk

B1. Has flood water ever entered your containment system or toilet? *

Think about whether flood water has ever reached or entered your toilet, septic tank, or pit during heavy rains or typhoons.

B2. Up to what level does water generally reach? *

Estimate how high the flood water rises around your toilet or tank area.

B3. How frequently does this flooding happen? *

How often does flood water reach your toilet or tank — every year, occasionally, or just once?

D

Household Information

D1. How many family members live in this household? *

Count everyone who regularly lives and sleeps in this house, including children.

D2. Type of dwelling *

What material is your house mainly built with? Concrete = Permanent, mixed materials = Semi-permanent, light materials (wood/nipa) = Temporary.

E

Containment System / Septic Tank

E1. What type of onsite sanitation system do you have? *

This is the underground tank or pit where your toilet waste goes. A septic tank is usually a concrete box; a pit is a hole in the ground (lined or unlined).

E1a. Please specify other sanitation type

E2. WALL construction: Sealed or Porous? *

Sealed = concrete/masonry with plaster; Porous = brick without plaster, stone

E3. BOTTOM construction: Sealed or Not sealed? *

Sealed = concrete slab at bottom; Not sealed = open to soil

E4. Does the tank have internal partition wall(s)? *

A partition is a wall inside the tank that divides it into 2 or more chambers. Select "Don't Know" if you're unsure.

E5. How many partition walls inside the tank? *

A partition divides the tank into separate chambers.

E6. Is there any OUTLET from the tank? *

An outlet is a pipe coming out of the tank that lets liquid flow out. Check if there is any pipe leading away from your tank.

E7. Where does the outlet discharge to? *

Where does the liquid from the outlet pipe go? A soak pit absorbs it into the ground; an open drain is a visible channel.

E8. How old is this tank/pit? *

Approximate age of your septic tank or pit.

E9. Approximate size of the tank *

Do you know the approximate dimensions of your tank/pit?

Enter the dimensions

Enter the length, width and depth of the tank/pit.

Meters Feet

Length

Width

Depth

Unit: Meters

F

Greywater Management

F1. Does kitchen wastewater go into the SAME tank as toilet wastewater? *

Check if the water from your kitchen sink drains into the same septic tank/pit as your toilet.

F2. Does bathroom / washing water go into the SAME tank? *

Check if the water from bathing, handwashing, or laundry goes into the same tank as your toilet.

F3. Where does the greywater discharge? *

Greywater is the used water from your kitchen, bathroom, or laundry (not toilet). Where does it go?

G

Desludging History

G1. Has your septic tank ever been desludged (emptied)? *

Desludging means pumping out the solid waste from your septic tank, usually done by a vacuum truck or manually.

G2. When was the LAST desludging done? *

How long ago was your septic tank last emptied?

G3. How was the desludging done? *

Was a vacuum truck (tanker) used, or was it emptied manually by workers using buckets/tools?

G4. How many trips did the truck take? *

How many times did the vacuum truck come to empty your tank?

G5. How much were you charged? (PHP) *

Approximate cost you paid for desludging service.

G6. Why has the tank never been emptied? *

Select all that apply

G6a. Please specify

H

Water Supply Sources

H1. Source of water supply *

Select all the sources your household uses for water. You can choose more than one.

H1a. Please specify other water source

I

Toilet & Sanitation Issues

I1. Any past issues with your toilet functioning? *

For example: clogging, bad smell, overflowing, slow flushing, or water backing up.

I2. Please describe the issue(s) *

J

Documentation & Closure

J1. Address *

Enter your complete house/lot address including street name, purok/sitio if applicable.

J2. Nearby Landmark *

Mention a well-known place or structure near your house (e.g., church, school, store, barangay hall).

J3. Any suggestions to improve sanitation in your area?

Share any sanitation problems you face or ideas to improve sanitation services in your community.

J4. Respondent consent for data use confirmed? *

By selecting "Yes", you agree that your responses can be used for the CWIS sanitation planning project.

CWIS Household Sanitation Survey

CWIS Household Sanitation Survey

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Before You Begin