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Wash Survey Form - Enter School Survey Screen: Tagbacan ES (122702) SY 2015

This document summarizes a survey of water, sanitation and hygiene facilities and practices at Tagbacan Elementary School for the 2015 school year. It collects information on water sources, sanitation infrastructure, cleanliness, hygiene education and practices, menstrual hygiene management, resources and maintenance. Key findings based on 30 questions include the school having piped water, functional toilets for both boys and girls, teaching of handwashing and toothbrushing, involvement of students in hygiene promotion, and allocation of funds for repairs in their school improvement plan.

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MYLAH GERENA
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71 views4 pages

Wash Survey Form - Enter School Survey Screen: Tagbacan ES (122702) SY 2015

This document summarizes a survey of water, sanitation and hygiene facilities and practices at Tagbacan Elementary School for the 2015 school year. It collects information on water sources, sanitation infrastructure, cleanliness, hygiene education and practices, menstrual hygiene management, resources and maintenance. Key findings based on 30 questions include the school having piped water, functional toilets for both boys and girls, teaching of handwashing and toothbrushing, involvement of students in hygiene promotion, and allocation of funds for repairs in their school improvement plan.

Uploaded by

MYLAH GERENA
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
 Don't know where to access/buy chlorination /solution
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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