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Borehole Inspection Form

This document contains information from a water sampling and borehole inspection. It provides details such as the location, date of sampling, and results of tests for fecal coliform, residual chlorine, pH, and turbidity. The second section examines potential risks to water quality from factors within 10 meters of the hand pump, such as latrines, animal waste, stagnant water, or inadequate fencing. It provides a risk score based on these factors and recommendations for treatment or discontinuing use based on the score.

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Sibanda Mqondisi
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0% found this document useful (0 votes)
401 views2 pages

Borehole Inspection Form

This document contains information from a water sampling and borehole inspection. It provides details such as the location, date of sampling, and results of tests for fecal coliform, residual chlorine, pH, and turbidity. The second section examines potential risks to water quality from factors within 10 meters of the hand pump, such as latrines, animal waste, stagnant water, or inadequate fencing. It provides a risk score based on these factors and recommendations for treatment or discontinuing use based on the score.

Uploaded by

Sibanda Mqondisi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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GENERAL INFORMATION

Name of responsible authority …………………………………………

Province …………………………………….

District …………………………………………

Town/Village/Resettlement ……………………………….

Locality ………………………………..

Geographical coordinates
Latitude……………………………………………..

Longitute……………………………………………

Water Sampling
Form of source…………………………

Season………………………………..

Date of sampling……………………………… Time………………………….

Date sent…………………………….. Time

ANALYSIS OF RESULTS

Feacal coaliforms ………………………CFU/100ml

Residual Chlorine…………………………..mg/litre

Ph………………………………….

Turbidity………………………

Name of EHT….........................................................
BOREHOLE INSPECTION FORM
Water Point Name: .........................................
GPS Coordinates: .........................................
Date: .........................................
WPC Member present: ...........................................

RISK If answer is
SPECIFIC DIAGNOSTIC INFORMATION FOR ASSESSMENT YES,
YES NO Add points

1 Is there a latrine within 10m of the hand-pump?

2 Is the latrine on higher ground than the hand-pump?

3 Is there any source of pollution within 10m of the hand-pump [e.g.


rubbish, animal excreta, and surface water]?
4 Is the drainage poor, causing stagnant water within 2m of the hand-
pump?
5 Is the hand-pump drainage channel faulty? [is it broken, permitting
ponding]
6 Is the fencing around the hand-pump inadequate, allowing animals
in?
7 Is the concrete floor less than 1m wide all around the hand-pump?

8 Is there any ponding on the concrete floor around the hand-pump?

9 Are there cracks in the concrete floor around the hand pump-which
would permit water to enter the well?
10 Is the hand-pump loose at the point of attachment to the base so that
water could enter the casing?
TOTAL SCORE

KEY TO RISK SCORE:


9TO20 Very high-condemn and discontinue use
6to8 High-treat
3to5 Medium-may be subjected to treatment
0to2 Very low-can be used

Recommendations
...............................................................................................................
...............................................................
Name of Inspector ......................................................…Designation EHT

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