Swachh Bharat Mission (Gramin) Survey

एक कदम व छता क ओर
A. VILLAGE SCHEDULE

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

Places to be visited by our

S. team Options Skip
No.

1 Does every household have a toilet? Yes

Does anyone go out and defecate in the

2 Yes
open in your village?
Are these faeces from the toilet being
3
disposed in the river? Yes
Is there any OD spot / excreta in an open
4
place? Yes
Are there institutional toilets at schools,
5
anganwadis and PHCs? Yes
Is waste from restaurants, public places
6
dumped into the river? No

7 Is there a prevalence of tourist OD?

Yes
Is there an institutional mechanism to
8
check OD by insiders/outsiders? No

9 Are septic tank toilets (non-porous) No

common in your village?
10 On an average how deep are the pits in
5-10 feet
village?

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एक कदम व छता क ओर

B. HOUSEHOLD SCHEDULE

At least 5 randomly selected households shall be covered from Village for canvassing the Household
Schedule. The main portions of the Household Schedule will comprise:

Household Schedule

S. Question Options Skip

No

If 1 OR 2, go to
Access to a functional Q2
toilet Own toilet
1.
If 3, go to Q5

If 4, go to Q8

Is water available in
/for the toilet? Yes
2.

1. Toilet has functional water-seal

Is toilet “fly-proof” – or present
3. Hygienic? 2. Toilet has other fly proof

Where is the human

waste disposed of from Toilet discharges wastes directly into
4. the toilet? or is connected to
Closed Septic tank with a
Soak
Pit

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एक कदम व छता क ओर
Household Schedule

S. Question Options Skip

No

If Yes, the specify

whether
Did any member of the 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

Where the people If 1, go to Q7

Into Toilet
6. disposed the faeces of
below 3years old child? If 2, go to Q8
directly

7.

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 Yes, most of the people heard about

of the household have Swachh Bharat Mission
9.
heard about Swachh
Bharat Mission?

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एक कदम व छता क ओर
Coverage of non-household units of enquiry in the Village

Our team shall cover at least one Anganwadi (preferably largest One) and one School (preferably of
the highest order of children).

C. ANGANWADI SCHEDULE

S. Question Options Skip

No

Access to a They have a toilet in own If 1, go to Q2

functional toilet premises
1. If 2 go to next
Section

Is there provision of
2. water for use in the Yes
toilet?

1. Toilet has functional water-seal presented

Is toilet “fly-proof” 2. Toilet has other fly proof arrangements
3. 3. Eco-san toilets are present.
– or Hygienic?

If (d) specify which

water body

Where does excreta .

discharge from the
4. toilet?
Toilet discharges waste directly into
Closed Septic tank with a Soak Pit.

If Answer is (f) then

specify

Functionality/usage Toilet appears to be well kept, in regular use

5.
of public toilets with water inside or nearby is present.

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 Ministry of Drinking Water and Sanitation
एक कदम व छता क ओर
S. Question Options Skip
No

Who is responsible
for upkeep, Cleaners organized by Anganwadi
6.
cleaning,
maintenance, etc.?

How many times The toilets are

the toilets are regulaely cleaned.
cleaned in a week?

7.

Whether parents
heard about Yes
8. launching of
Swachh Bharat
Mission?

What is the
perception of Very Good
9. parents about
cleanliness of the
toilets?

What is the
perception of Very Good
parents about
10.
cleanliness of the
compound of the
Anganwadi?

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एक कदम व छता क ओर
D. SCHOOL SCHEDULE

S. Question Options Skip

No

1. Type of school Co-educational

If 1 go to Q3
Access to a Yes
2. If 2 go to next
functional toilet
section

Separate toilet for

3. Yes
boys and girls

How many users Boys: 10-20

4. are there per toilet
seat? Girls: 5-15

Is water available
for use in toilets? Yes
5.

If (d) specify which

water body

Where does Toilet discharges waste directly into

6. excreta discharge closed Septic tank with a Soak Pit
from the toilet?

If Answer is (f) then

specify

Toilet appears to be well kept,

Functionality/usage in regular use with water inside or
7.
of public toilets nearby always present.

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 Ministry of Drinking Water and Sanitation
एक कदम व छता क ओर
S. Question Options Skip
No

Who is responsible Cleaners organized by school.

for upkeep,
cleaning,
8 maintenance, etc.?

9. How many times 5 or more than 5 times

the toilets are
cleaned in a week?

Whether students
heard about Yes
10. launching of
Swachh Bharat
Mission?

What is the
perception of Very Good
11. students about
cleanliness of the
toilets?

What is the
perception of Very Good
students about
12.
cleanliness of the
compound of the
school?

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एक कदम व छता क ओर
E. PUBLIC TOILET SCHEDULE

Our team 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

If (1) give numbers

Is there a Public and reference
1. Toilet in the Yes, but they are very less
village? in number If (2) Note it and skip
to next section

Are there separate

2. sections for Men Yes
and Women

Toilet appears to be well kept, in regular

use with water inside or nearby always
Functionality/usage
3. present.
of public toilets

If (d) specify which

water body

Where does
4. excreta discharge Toilet discharges waste directly
from the toilet? into or connected to closed Septic tank
with a Soak Pit

If Answer is (c) or (e)

then specify

Page 8 of 10
एक कदम व छता क ओर
S. Question Options Skip
No

Who is responsible
for upkeep, Cleaners organized by Gram
5.
cleaning, Panchayat.
maintenance, etc.?

How many times

6. the toilets are
cleaned in a week? 1-4 times

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एक कदम व छता क ओर
F. PUBLIC SPACES SANITATION SCHEDULE

Our team 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
No
Defecation in the past
Is there garbage/litter strewn on If answer is 1 then,
Other Important Public
ground? specify locations
2. Places or Locations
Take photographs
(Specify) No

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