WASH Kit Evaluation EnglWASH Kit Evaluation EnglHas the permission slip been filled out?YesDate and TimeGPS CoordinatesPlease note accuracyName of SurveyorJoanaIsimeliNickyIsoaWaqaLuisaIfereimiProvinceNadrogaBaDistrictNawakaMalomaloSabetoRukurukuNavatusilaMagodroRaviraviCommunity NameYavuna VillageMulomulo VillageSolovi SettlementMeigunyah SettlementNamoli SettlementNasau SettlementMulomulo SettlementKajiqari SettlementTovatova SettlementMeigunyah Indian SettlementMomi VillageNabila VillageMalamala VillageNagaga SettlementNabila SettlementNagado VillageKorobebe VillageNavilawa VillageNalesutale VillageNagado SettlementVunamoli villageUto VillageNawaqadamu VillageVagadra VillageRadar SettlementTunalia SettlementNamarasa SettlementLoqi SettlementBukuya VillageTabalei VillageNavaga VillageNatabaquto VillageBila SettlementNanoka SettlementNubutautau VillageNasauvakarua VillageMare SettlementTokoni VillageNabuabua SettlementNatoka SettlementTuvavatu SettlementTodrokadroka SettlementDelainavaga VillageNamulomulo Muslim (EC)Namarasa-NaweicobaAumgali-MomiNabila Settlement-MomiTabalei VillageTabuquto VillageSariyawa-MomiNagaga-MomiType of CommunityVillageSettlementSquatter SettlementName of Head of HouseholdNumber of people in HouseholdPlease select a digit123456789101112131415more than 15Person 1 - GenderFemaleMalePerson 1 - AgePlease enter the age of the personPerson 2 - GenderFemaleMalePerson 2 - AgePerson 3 - GenderFemaleMalePerson 3 - AgePerson 4 - GenderFemaleMalePerson 4 - AgePerson 5 - GenderFemaleMalePerson 5 - AgePerson 6 - GenderFemaleMalePerson 6 - AgePerson 7 - GenderFemaleMalePerson 7 - AgePerson 8 - GenderFemaleMalePerson 8 - AgePerson 9 - GenderFemaleMalePerson 9 - AgePerson 10 - GenderFemaleMalePerson 10 - AgePerson 11 - GenderFemaleMalePerson 11 - AgePerson 12 - GenderFemaleMalePerson 12 - AgePerson 13 - GenderFemaleMalePerson 13 - AgePerson 14 - GenderFemaleMalePerson 14 - AgePerson 15 - GenderFemaleMalePerson 15 - Age1) Did you and your family receive kits during or after TC Evan in 2012?If the answer is "no", please select "no" and submit the survey.YesNo2) How many kits did you receive?12345more than 5Do not know3a) Were the kits distributed in a timely manner?This question refers to the time between the cyclone and the distribution time.YesNoDo not know3b) How long after the cyclone were the kits distributed?1 - 2 days3 - 4 days5 - 7 days2 weeks3 weeks4 weeksMore than one monthDo not know4) From which organization did you receive the kits ?Check all that applyRed CrossMinistry of HealthCommissioners OfficeUNICEFDo not know5a) Do you know the reason behind the distribution of WASH Kits?Yes (Prevention of WASH related diseases in emergencies)Yes (Help in emergencies)Yes (other)No5b) What is their understanding of the reason behind the distribution?6a) Can you name some of the contents of the kits?Please tick all that apply.Water ContainersSoap (powder)Soap (bars)Water Purification TabletsIEC MaterialsCooking PotsCondomsBathing TowelBaby BlanketTarpaulinToothbrushToothpastePantiesCandlesMatchesMosquito CoilOthersDo not know7a) If you needed more items, which ones would that have been?Please check all that apply.Water ContainersSoap (bars)Water Purification TabletsIEC MaterialsDo not know7b1) How many more pieces of soap would you have needed?Please enter a number.7b2) How many more boxes of Water Purification Tablets would you have needed?Please enter a number.7b3) How many more Water Containers would you have needed?Please enter a number:8a) On a scale from 0 (not at all) to 10 (very much) how useful were the WASH Kits to you and your family?0123456789108b) Can you name the items most useful?undefinedWater ContainersSoap (bars)Water Purification TabletsIEC MaterialsDo not know9a) Were the IEC materials clear and concise? YesNoDo not know9b) What did you learn from the IEC Materials?Please check all that apply.Keep your food safeBreastfeeding is BestBoil Drinking Water – Even from TapsRemove Rubbish SafelyWash your hands with soap & waterCheck where family members are, check if they need help and keep them close and safe at all timesChildren under the age of 5 should be immunised against measles and rubella.Excreta should be disposed safelyIf anyone gets diarrhoea, give them oral re-hydration salt solutionCover foodDispose dead animals safelyLet children playTalk with children about what has happenedTry to keep a daily routineNothingOther10a) Do you have any suggestions on other items should also be included in the kits?First just ask question, if they cannot think of anything, please suggest the below.NappiesMenstrual Hygiene ItemsHand SanitizerFace towelsToothbrushToothpasteToilet paperCondomsORS (Oral re-hydration salt)Other10c1) How many nappies?10c2) How many menstrual hygiene items?10c3) How many face towels?10c4) How many toothbrushes?10c5) How many rolls of toilet paper?10c6) How many condoms?10c7) How many packages of ORS?10b) If other, please indicate:11a) Was there enough clarification given by the person that distributed the items on how the items were to be used?YesNoDo not know11b) Do you think advice should be given?YesNoDo not know11c) On which item would you have liked to have more advice?Water ContainersSoap (bars)Water Purification TabletsIEC MaterialsDo not know12a) If there are elderly people in the household, did they need special help during the emergency?YesNo, no help.No elderly people in household12b) If so, what kind of help was needed?13a) If there are disabled people in the household, did they need special help during the emergency?YesNo, no help.No disabled people in household13b) If so, what kind of help was needed?14a) If there are babies in your household, did they need special help during the emergency?YesNo, no help.No babies in household.14b) If so, what kind of help was needed?15) Do you have any recommendations about the WASH kits in general?YesJIsmNIsoWLIfNadrBa1MaloSabRukuNavaMagRaviYavunaVMulomuloVSoloviSMeigunyahSNamoliSNasauSMulomuloSKajiqariSTovatovaSMeigunyahISMomiVNabilaVMalamalaVNagagaSNabilaSNagadoVKorobebeVNavilawaVNalesutaleVNagadoSVunamoliV2UtoVNawaqadamuVVagadraVRadarSTunaliaSNamarasaSLoqiSBukuyaVTabVNavagaVNatabaqutoVBilaSNanokaSNubutautauVNasauvakaruaVMareSTokoniVNabuabuaSNatokaSTuvavatuSTodrokadrokaSDelainavagaVNamuluECNamarasaNAumgaliMNabilaSMTabVTabuqutoVSariyawaMNagagaMvillsettsquatsett12345678910111213141516p1Fp1Mp2Fp2Mp3Fp3Mp4Fp4Mp5Fp5Mp6Fp6Mp7Fp7Mp8Fp8Mp9Fp9Mp10Fp10Mp11Fp11Mp12Fp12Mp13Fp13Mp14Fp14Mp15FP15Mq1Yesq1Noq2_1q2_2q2_3q2_4q2_5q2_more5q2_dnkq3aYesq3aNoq3aDNK1to2dq3b_3to4dq3b_5to7dq3b_2wq3b_3wq3b_4wq3b_over1mq3b_DNKq5a_YesPrevq5a_YesHelpq5a_YesOthq5a_Noq8a_0q8a_1q8a_2q8a_3q8a_4q8a_5q8a_6q8a_7q8a_8q8a_9q8a_10q9Yesq9Noq9DNKq11aYesq11aNoq11aDNKq11bYesq11bNoq11bDNKq12aYq12aNq12aNNq13aYq13aNq13aNNq14aYq14aNq14aNN