Questionnaire for Water Sanitation and Hygiene
KAP (Knowledge Attitude Practices) Survey

Name of Site: ______________________ Number of Tents: ____________________Contact number: ____________________ | Date:__________________Age: __________________ Male Female Children | 1. Where do you get your main source of safe drinking water? | ACF water built facility (Bladder tank) Public tap/standpipe ( COWD) Bottled water Tanker-truck (from different agency)________ | 2. Which is your main source of water for domestic purposes (cooking, bathing, and washing)? | ACF water built facility (Bladder tank) Public tap/standpipe ( COWD) Tanker-truck (from different agency) | 3. Do you treat your water in any way to make it safer to drink? | Yes No Don’t Know | 4. What do you usually do to the water to make it safe to drink? | Cover the water container Boil Always keep the water storage clean Add bleach/chlorine Filter with clothes Use water filter (sand, ceramic, composite) | 5. How do you keep the surroundings of water source clean? | Clean the surroundings of water source regularly Avoid throwing of garbage near the water source Avoid stagnation of water near the water source Avoid presence of animal ditch near the water source Do nothing Don’t know |

6. What kind of latrine do members of your family usually use? | Latrine built by ACF for designated family Pit latrine with slab Bush or open field Elsewhere | 7. What do you usually do to keep the latrine and shower clean? | Clean and wash with water only every after use Clean and wash with soap and disinfectant Everyday Do nothing Don’t Know | 8. Who cleans and maintains the cleanliness of the latrine and shower? | User (Clean every after use) Assigned families of the day Caretaker Appointed Leader WASH committee | 9. What is the arrangement in using the latrines? | Open to all/communal (no designated cubicle for men and women) With key and padlock for every family/latrine Separate cubicle for men and women | 10. What is the arrangement in using the available shower? | Open to all/communal (common for both men and women) With key and padlock for every family Spare the available shower only for women Men also take shower in latrine area | 11. Are the sanitation facilities comfortable to use? | Yes No | 12. How do you dispose baby’s faeces? | Child used toilet/latrine Put/rinsed faeces into the toilet or latrine Buried the faeces on the ground Put/rinsed faeces into drain or ditch Faeces thrown into the garbage Faeces left on the ground Don’t Know |

13. Do you know the proper hand washing? | Yes No | 14. How long should you wash your hands? | 5-10 second 10-15 seconds 15-20 seconds Others_____ | 15. When and how often do you wash your hands? | Before preparing foods Before and after eating After defecation or latrine use After handling child stool After handling rubbish After feeding animals( h ) Only if with visible dirt Others: specify:____________ | 16. How do you clean your hand before and after eating? | Wash with water only Wash with water and soap Alcohol/ Hand sanitizer | 17. How do you clean your hand after defecation? | Wash with water only Wash with water and soap Alcohol/ Hand sanitizer | 18. Which is the single most important way to prevent the spread of illness, including colds and flu or other diseases? | Covering your mouth when you cough Sneezing into a tissue. Washing your hands regularly | 19. Do you cover the leftover food? | Yes No | 20. What do you use to cover the food? | Cloth Plastic Cover Lid Plate Cellophane None | 21. How do you keep your food safe? | Washing the fruits and vegetables before cooking Washing hands before preparing food Others:________________ | 22. How do you manage your solid waste materials? | Burned Buried (composting) Throw away anywhere Throw in a garbage bags/bins Collect by garbage truck | 23. What do you do to keep the surroundings clean? | Sweeping the surrounding everyday Grass cutting Throw the waste in the garbage bin Throw anywhere Do nothing |