This PEPSA data collection form supports WASH assessments focused on household sanitation and toilet facility conditions. Enumerators can record community details, respondent demographics, water sources and access, defecation practices, and the state of toilet superstructures including ventilation, doors, windows, roofing, and containment. The checklist captures latrine hygiene, slab and manhole presence, waste separation, handwashing stations with water and soap, and identified issues. It also includes photo uploads and GPS location to verify findings. Use this template to standardize sanitation surveys and guide interventions that improve public health outcomes.
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