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Swachh Bharat Mission (Gramin) Questionnaire / Schedule for Open Free (ODF) verification in Districts

Ministry of and एक कदम वछता क ओर A. VILLAGE SCHEDULE

Investigator to visit PRIs, places of and in addition at least 5 more public locations in a village at random:

Places to be visited by the S. Investigator Options Skip No.

1. Yes 1 Does every household have a ? 2. No Does anyone go out and defecate in the 1. Yes 2 open in your village? 2. No Are these faeces from the toilet being 3 1. Yes disposed in the river? 2. No Is there any OD spot / excreta in an open 4 1. Yes place? 2. No Are there institutional at schools, 5 1. Yes anganwadis and PHCs? 2. No Is waste from restaurants, public places 6 1. Yes dumped into the river? 2. No 7 Is there a prevalence of tourist OD? 1. Yes 2. No Is there an institutional mechanism to 8 1. Yes check OD by insiders/outsiders? 2. No 9 Are twin-pit toilets common in your village? 1. Yes 2. No Are septic tank toilets (non-porous) 10 1. Yes common in your village? 2. No 11 Is there a P- in all toilet? 1. Yes 2. No 1. 5-10 feet On an average how deep are the pits in 12 2. 10-20 feet your village? 3. more than 20 feet

Page 1 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर

B. HOUSEHOLD SCHEDULE

At least 10 randomly selected households shall be covered from each Village for canvassing the Household Schedule. The main portions of the Household Schedule will comprise:

Household Schedule

S. Question Options Skip No

1. Own toilet If 1 OR 2, go to Access to a functional 2. Shared toilet Q2 toilet (Please take GPS 1. 3. Public/community toilet enabled photograph if 4. No toilet If 3, go to Q5 option 1, 2 or 3) If 4, go to Q8

Is water available in 1. Yes /for the toilet? 2. No

2. (Observe Evidence of water availability in the household)

1. Toilet has functional water-seal Is toilet “fly-proof” – or present 3. Hygienic? 2. Toilet has other fly proof arrangements

3. Eco-san toilets 4. Toilet has no fly-proof arrangement 1. Toilet discharges waste directly into If (d) specify a) Drain, which water body b) Nallahs, c) Open pit; d) Ponds or river or streams or

any water body etc. Where is the human OR waste disposed of from 2. Toilet discharges wastes directly into 4. the toilet? or is connected to a) Closed Septic tank with a Soak Pit b) Enclosed Twin Pit

c) Enclosed Single pit; d) Closed drain which empties into If Answer is (f) Sewer system/nallah/pond/river then specify after treatment e) Biogas System for digestion f) Other safe options

Page 2 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर Household Schedule

S. Question Options Skip No

1. Yes If Yes, the specify whether Did any member of the 2. No household defecate in a. Elders 5. the open in the last b. Adults three months or after gaining access to toilet? c. Teens

d. Children

Do you have any 1. Yes If 1, go to Q7 2. No 6. children of below 3 If 2, go to Q8 years age? directly

How is child faeces 1. Into Toilet 7. disposed of? 2. Buried in the ground 3. Thrown in open area Is there any garbage or 1. Yes litter piled up or 2. No dumped within 10 feet perimeter of the house, 8. outside the premises of the household being canvassed

(Please take photograph)

Whether any member 1. Yes of the household have 9. 2. No heard about ?

Page 3 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर Coverage of non-household units of enquiry in the Village

Investigator shall cover at least one Anganwadi (preferably largest One) and one School (preferably of the highest order; For example if there is a primary school and an Intermediate College in a village then Intermediated College shall be chosen for filling up the Questionnaire) in each villages, if available. In addition, public toilets (the main one or one if more than one) shall be covered as well as separately, public places as guided below.

C. ANGANWADI SCHEDULE

S. Question Options Skip No

Access to a 1. Have a toilet in own premises If 1, go to Q2 functional toilet 2. No toilet 1. If 2 go to next (Please take Section photograph)

Is there provision of 1. Yes 2. water for use in the 2. No toilet?

1. Toilet has functional water-seal present Is toilet “fly-proof” 2. Toilet has other fly proof arrangements 3. – or Hygienic? 3. Eco-san toilets 4. Toilet has no arrangement (Provide answer “Yes” or “No” to the above) 1. Toilet discharges waste directly into If (d) specify which a) Drain, water body b) Nallahs, c) Open pit; d) Ponds or river or streams or any

Where does excreta water body etc. discharge from the OR 4. toilet? 2. Toilet discharges waste directly into or (Please take connected to photograph) a) Closed Septic tank with a Soak Pit b) Enclosed Twin Pit c) Enclosed Single Pit; d) Closed drain which empties into Sewer If Answer is (f) then system/nallah/pond/river after treatment specify e) Biogas System for digestion f) Other Safe options 1. Toilet appears to be well kept, in Functionality/usage 5. regular use with water inside or nearby – of public toilets OR

Page 4 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर S. Question Options Skip No

2. Toilet appears to be poorly maintained with a) Human waste visible in the toilet, inside or nearby, b) No water available; c) Appears to be seldom used; d) Locked, not in use e) No toilet in the premises Who is responsible 1. Cleaners organized by Anganwadi for upkeep, 2. Anganwadi Worker 6. cleaning, 3. No arrangement maintenance, etc.? 4. Others (specify)

How many times 1. 1-4 times 7. the toilets are 2. 5 or more than 5 times cleaned in a week?

Whether parents 1. Yes heard about 2. No 8. launching of Swachh Bharat Mission?

What is the 1. Very Good perception of 2. Good 9. parents about 3. Bad cleanliness of the toilets?

What is the 1. Very Good perception of 2. Good parents about 10. 3. Bad cleanliness of the compound of the Anganwadi?

Page 5 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर D. SCHOOL SCHEDULE

S. Question Options Skip No

1. Boys 1. Type of school 2. Girls 3. Co-educational 1. Yes If 1 go to Q3 Access to a 2. 2. No functional toilet If 2 go to next section

Separate toilet for 1. Yes 3. boys and girls 2. No 3. Not applicable How many users Boys: (Number) 4. are there per ? Girls: (Number)

Is water available 1. Yes 5. for use in toilets? 2. No

1. Toilet discharges waste directly If (d) specify which into water body a) Drain, b) Nallahs, c) Open pit;

d) Ponds or river or streams or any water body etc. OR

Where does 2. Toilet discharges waste directly 6. excreta discharge into or connected to from the toilet? a) Closed Septic tank with a Soak Pit b) Enclosed Twin Pit If Answer is (f) then c) Enclosed Single Pit; specify d) Closed drain which empties into Sewer system/nallah/pond/river after treatment e) Biogas System f) Other Safe options

1. Toilet appears to be well kept, Functionality/usage 7. in regular use with water inside or of public toilets nearby –

Page 6 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर S. Question Options Skip No

OR 2. Toilet appears to be poorly maintained with a) Human waste visible in the toilet, inside or nearby, b) No water available; c) Appears to be seldom used; d) Locked, not in use e) No toilet in the premises Who is responsible 1. Cleaners organized by school for upkeep, 2. Informal arrangements 8 cleaning, 3. No arrangement maintenance, etc.? 4. Others (specify)

How many times 1. 1-4 times 9. the toilets are cleaned in a week? 2. 5 or more than 5 times

Whether students 1. Yes heard about 2. No 10. launching of Swachh Bharat Mission?

What is the 1. Very Good perception of 2. Good 11. students about 3. Bad cleanliness of the toilets?

What is the 1. Very Good perception of 2. Good students about 12. 3. Bad cleanliness of the compound of the school?

Page 7 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर E. PUBLIC TOILET SCHEDULE

The Investigator should make note of the number of Public Toilets in use in the village and survey the most used Public Toilet.

S. Question Options Skip No

1. Yes If (1) give numbers Is there a Public 2. No and reference 1. Toilet in the village? If (2) Note it and skip to next section

Are there separate 1. Yes 2. sections for Men 2. No and Women

1. Toilet appears to be well kept, in regular use with water inside or nearby –

OR

2. Toilet appears to be poorly Functionality/usage 3. maintained with of public toilets a) Human waste visible in the toilet, inside or nearby, b) No water available; c) Appears to be seldom used; d) Locked, not in use

e) No toilet in the premises 1. Toilet discharges waste directly If (d) specify which into water body a) Drain, b) Nallahs, c) Open pit;

d) Ponds or river or streams or any water body etc. OR Where does 4. excreta discharge 2. Toilet discharges waste directly from the toilet? into or connected to a) Closed Septic tank with a Soak Pit b) Enclosed Twin Pit c) Enclosed Single Pit;

d) Closed drain which empties into Sewer system/ nallah/pond/river after If Answer is (c) or (e) treatment then specify e) Biogas System for digestion f) Other Safe options

Page 8 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर S. Question Options Skip No

1. Cleaners organized by GP Who is responsible 2. Cleaners organized by Mkt/other for upkeep, 5. Committee cleaning, 3. Informal arrangements maintenance, etc.? 4. Others (Specify) 5. No arrangements How many times 1. 1-4 times 6. the toilets are cleaned in a week? 2. 5 or more than 5 times

Page 9 of 10 Ministry of Drinking Water and Sanitation एक कदम वछता क ओर F. PUBLIC SPACES SANITATION SCHEDULE

Investigator to visit places of earlier open defecation and in addition at least 5 more public locations in a village at random:

Places to be visited S. by the Investigator Options Skip No.

Areas that are / were Whether visible faeces observed? Take photographs 1. used for Open 1. Yes Defecation in the past 2. No Is there garbage/litter strewn on If answer is 1 then, Other Important Public ground? specify locations 2. Places or Locations 1. Yes Take photographs (Specify) 2. No

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