Domains:

A. Excreta disposal
1. Your type of toilet at home is:
2. How many times a week do you clean your toilet?
a.0-1
b.
2-4
c.5-7
3. Do you wash your hands after you use your toilet?
a.Always
b.
Often
c.Sometimes
d.
Seldom
e.Never
4. You disinfect your hands using:
a.Soap
b.
Alcohol
c.Liquid hand wash
d.
Just water
5.

B. Water
1.
2.
3.
4.
5.

From where do you get your drinking water?

How do you fetch water?
How do you store your water?
You use our water for:
I drink water with:

C. Personal
1. Do you use footwear in/out your house?
2. How often do you bathe in a day:
a. Once
b.
Twice
c. Thrice
d.
More than three (3) times?
3. How often do you wash your hands in a day?
a.Once
b.
Twice
c. Thrice
d.
More than three (3) times?

4. How often do you clean your nails in a week?

a.Once
b.
Twice
c. Thrice
d.
More than three (3) times?
5. How often do you brush your teeth in a day?
a.Once
b.
Twice
c. Thrice
d.
More than three (3) times?

D. Food
1.
2.
3.
4.
5.
6.

Do you select properly and appropriately your raw fruits and vegetables?
How often do you wash your foods before preparation?
How often do you wash your hands before food preparation?
Do you store your food properly?
How often do you use utensils when eating?
How often do you use your hands when eating?

E. Environmental
1. Do you obtain your water for cleaning from a reliable source?
2. Do you store your water for cleaning in a safe container?
3. Do you dispose properly your pets stool?
4. How often do you bathe your pets?
5. How often do you control pests at home?
6. Do you dispose garbage properly at home?
7. How often do you clean your house?