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HOUSING & INFRASTRUCTURE SURVEY
1
Step 1
2
Step 2
3
Step 3
Community/Town Name
*
Required: For geographical data collection.
Number of Residents
*
Total number of people currently residing in the dwelling.
Access to Clean Water
*
Always Available
Sometimes Restricted
Frequently Restricted
Rate the reliability of clean water access.
Next: Step 2
Working Facilities (Select all facilities in your dwelling that are currently working)
*
Stove/Oven
Hot Water
Toilet
Cooler/Aircon
None of the above
Overcrowding Issue
*
Yes
No
Do you feel your dwelling is overcrowded for the number of residents?
Required Repairs
(Optional)
Optional: Detail urgent infrastructure issues.
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Next: Step 3
Desire for Training
*
Yes
No
Would you be interested in housing maintenance training?
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