Template

PEPSA Toilet Facility Data Collection Form

by DYEK MICHAEL, from the Community

This PEPSA data collection form supports community sanitation surveys and toilet facility inspections. It captures enumerator details, location and household information, water source and access, and defecation practices. Inspect toilet structures including superstructure, ventilation, doors, windows, and roof, and record containment, cleanliness, and issues. Document handwashing stations, water and soap availability, and add photos and GPS coordinates. Use this template to standardize WASH assessments and improve sanitation program reporting.

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Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions .

Template
UPDATED PEPSA Data Collection Form
Use this updated PEPSA data collection checklist to assess water, sanitation, and hygiene conditions at household or community level. Record enumerator details, LGA, ward, community, and respondent information. Inspect toilet structures and containment, ventilation, doors, windows, and roof; verify slabs and manholes; check cleanliness and issues. Document handwashing stations, availability of water and soap, and capture photos and GPS coordinates to support accurate reporting.
by DYEK MICHAEL, from the Community
Downloads: 10+
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Template
PEPSA Data Collection Form 2.0
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.
by DYEK MICHAEL, from the Community
Downloads: 40+
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Template
Toilet Checks Checklist
Use this toilet checks template to review restroom standards and cleanliness. Inspect ventilation, floors and tiles, mirrors, sinks and taps, towel dispensers, locks and toilet brushes, toilet pans and seats, and ensure toilet rolls are stocked. Record date and initials to track routine inspections. Ideal for hospitality venues and any facility that needs consistent hygiene and maintenance checks.
by Lachlan Gordon, from the Community
Downloads: 10+
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Template
Pro Poor Household Data Collection
This pro poor household data collection template helps enumerators capture consistent, structured information for social protection and community services programs. Record enumerator details, the name and contacts of the vulnerable household, age and gender, number of children, and occupations. Assess housing conditions including construction materials, roofing, wall plastering, and floor type. Document asset ownership such as smartphone, radio, and TV, and whether the home is connected to electricity. Add GPS coordinates for precise location and attach multiple photos of the home interior and exterior. Ideal for NGOs, local governments, and field teams conducting poverty targeting, baseline surveys, and program monitoring.
by DYEK MICHAEL, from the Community
Downloads: 0
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PEPSA Toilet Facility Data Collection Form

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UPDATED PEPSA Data Collection Form

PEPSA Data Collection Form 2.0

Toilet Checks Checklist

Pro Poor Household Data Collection

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UPDATED PEPSA Data Collection Form

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Pro Poor Household Data Collection