Follow-Up Worksheet
1. Date: _______/_______/________ Time at start of interview: ______________
2. Household number (if available):_______________ Zip Tie Number:___________
3. Name of interviewer: __________________________________________________
4. Name of the person interviewed: _______________________________________
Nickname: __________________________________________________________
5. Please note the age and sex of people who live in the household:
Sex:
>=5 years old
<5 years old
Total
Male
Female
6. Were you present the day the filter was installed?
Yes
No
7. Were you the person who received training on how to use the filter?
Yes, I am
No, I am not
8. Have you received a follow-up visit from your community facilitator who helped
install the filter?
Yes _____________ #of visits
No, I have not
9. Are you still using the filter?
Yes, I am
No, I am not
If not, why? (Don’t read the options, circle all that they say)
a) The filter broke and was unable to be fixed
b) Did not like using it
c) Felt it was not necessary
d) Felt it was not improving the quality of your water
e) Found it to be too time consuming
f) It is no longer here in this household
g) Found a better or more trusted source of water
If the BSF is no longer in this household, please describe where it went or is?
If not using the BSF, what is your main source of drinking water?
Note: For households not using the BSF, this concludes the survey.
For households using the BSF, continue with question #10 until the end
of the survey.
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Содержание BioSand
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