APPS WISE PROJECTS DATA PROVIDED BY MUNICIP

District: M1
Municipality:

Name of Reporting Agency/Person:

SN Ward Inventory Sustainability Household(HH) Questionnaire Community Sanitati

No

Total Completed Total Completed

Total
Water Supply Water Supply 10% HH sample
Total HH Completed
Project in the Project in the Nos
CS Project
Municipality Municipality

1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13

Note: 1. This data should provided by Municipality, so that we can Verify the Numbers of data Collection by Enumerator
2. This list should be provided before data collection
ROVIDED BY MUNICIPALITY

Community Sanitation(CS) Unserved Population Health Care School Piblic toilet

Facility(HCF) Questionnaire

Total Nos.
of
Total Ongoing Total New Total Ongoing Total New Total Nos. of Total Nos. of
Existing
project project planed project project planed HCF School
Public
toilet

llection by Enumerator
Piblic toilet Remarks

Total Nos.
of Public
toilet
new
planned
District:
Municipality:

Name of Reporting Agency/Person:

Ward
SN Inventory Sustainability
No

Total Completed Total Completed Data

Data collected
Water Supply Water Supply collected till Remain
till reporting Remaining
Project in the Project in the reporting ing
data
Municipality Municipality data

1 1 २४ २४ ० २४ २४
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13

Note: 1. This format can be used for running bill payment

2. The Yellow color column should fillup by Municipality, so that we can Verify with Enumerator data collection Com
 APPS WISE PROGRESS REPORTING OF DATA COLLECTION
M2

Household(HH) Questionnaire Community Sanit

Total
Total Ongoing
Total HH HH sample Nos Data collected Remaining Completed
project
CS Project

60 6 5 1 ३

Enumerator data collection Completeness

TION

Community Sanitation(CS) Unserved Population

Total New Total Data Total Ongoing Total New Total Data
Remaining
project planed collected project project planed collected
 Health Care Facility(HCF)
lation School Questionnaire Piblic toilet

Total Nos. Total Nos.

of of Public
Total Nos. data Remainin Total Nos. data Remainin
Remaining Existing toilet
of HCF collected g of School collected g
Public new
toilet planned
 M1

Piblic toilet Remarks

data
Remaining
collected
 DATA VERIFICATION REPORTING FORM
District: M3
Municipality:
Estimated total number of schemes:
Name of Reporting Agency:

Data collected The person to contact for verification

Ward
SN Name of the Scheme Scheme code no no using NWASH Inventery using NWASH Name Contact no.
apps Project
Sustainability
apps

1
2
3
4
5
6
7
8
9
10
11
12
M

ontact for verification

Verified by
using
Date of verify verification Issues/Remarks
sheet
 DATA VERIFICATION FORM for Inventory and Sustainability Apps
Name of the Scheme:
Code Number:
Name of the Municipality:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the project area) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Project Name Type
1.1 Name Khahare Khola Gravity
2 Source
2.1 Khahare Khola Stream
Name and type of the Source
2.2 (Include all sources)
2.3

Conditions (Good,
3 structures Number Minor repair, major
repair, reconstruction)

3.1 Intake 2 Good, Minor Repair

3.2 CC 1 Good
3.3 IC
3.4 AV
3.5 WO
3.6 RVT (number and capacity) 1(20) Good
3.7 BPT
3.8 VC
3.9 Tap (Institution)
4 Tap (Public)
4.1 Tap (Yard)
4.2 Pipe Crossing
4.3 RF
4.4 Package Plant
4.5 SSF
4.6 RSF
4.7 PS
4 Service area:
4.1 a. Benefited HH
4.2 b. Benefited Population
5 Management
5.1 WSUC formed (Y/N)
5.2 Total number of members
5.3 Total number of female members
 5.4 At least one female member in
executive post(Y/N)
5.5 WSUC Registered (Y/N)
5.6 Number of meetings in a year
5.7 Yearly AGM held (Y/N)
5.8 Yearly Auditing (Y/N)
5.9 Nos of VMWs
5.10 Tariff rate (monthly)
5.11 Total Expenditure for O&M works
(Including salary)

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Yes", o
type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell which conta
collected data has different value and required Editing.

Verification by:
Date:
nventory and Sustainability Apps

WASH Unit Engineer Observation Remarks

Name Type
Kali Khola yes

Kali khola yes

Conditions (Good,
Minor repair, major
Number
repair,
reconstruction)
1 yes

yes yes
ame then write on Verification cell "Yes", otherwise write observed value. If you
r, So after verification the cell which contain Yellow color indicate that the
 DATA VERIFICATION FORM for HH Survey
Name of the Municipality:
Ward Number:
Name of the HH Owner's:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Male population 2
2 Female Population 1

3
Is any member in household no
differently abled?
4 Toilet type Pour flush
5 Is toilet Private ? yes
6 Fecal management option Pit connected with pipe sewerage

7 Presence of handwashing facility yes

8
Presence of Soap near to yes
handwashing facility
9 is toilet disable friendly? no
10 Presence of water in toilet yes

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
you type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell whi
the collected data has different value and required Editing.

Verification by:
Date:
ON FORM for HH Survey

WASH Unit Engineer Observation Remarks

the same then write on Verification cell "Yes", otherwise write observed value. If
e diappear, So after verification the cell which contain Yellow color indicate that
 DATA VERIFICATION FORM for Existing Community Sanitation Surv
Name of the Municipality:
Ward Number:
Name of the Sanitation Project:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Scheme type
2 Ward No
3 Community Name
4 Household
5 Population
6 Completed year
Asset value of conveyance at
7 completed year (As per Detailed
estimate)
8 Repair condition of conveyance
9 Is treatment plant available
Asset value of treatment unit if
10
available at completed year

11 Repair condition of treatment plant

12 Repair condition of treatment plant

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
you type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell whi
the collected data has different value and required Editing.

Verification by:
Date:
Existing Community Sanitation Survey

WASH Unit Engineer Observation Remarks

the same then write on Verification cell "Yes", otherwise write observed value. If
e diappear, So after verification the cell which contain Yellow color indicate that
 DATA VERIFICATION FORM for Ongoing Community Sanitation Sur
Name of the Municipality:
Ward Number:
Name of the Sanitation Project:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Scheme type
2 Ward No
3 Community Name
4 Household
5 Population
6 Total Estimate as per DPR
7 Construction Start year

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
you type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell whi
the collected data has different value and required Editing.

Verification by:
Date:
Ongoing Community Sanitation Survey

WASH Unit Engineer Observation Remarks

yes

the same then write on Verification cell "Yes", otherwise write observed value. If
e diappear, So after verification the cell which contain Yellow color indicate that
 DATA VERIFICATION FORM for New Community Sanitation Surve
Name of the Municipality:
Ward Number:
Name of the Sanitation Project:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Scheme type FSM

2 Ward No 4,5
3 Community Name
4 Household 125
5 Population 530
6 Total Estimate as per DPR No DPR

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
you type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell whi
the collected data has different value and required Editing.

Verification by:
Date:
r New Community Sanitation Survey

WASH Unit Engineer Observation Remarks

the same then write on Verification cell "Yes", otherwise write observed value. If
e diappear, So after verification the cell which contain Yellow color indicate that
 DATA VERIFICATION FORM for New Unserved Community Surve
Name of the Municipality:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Name of Scheme

2 Scheme type
3 Community Name
4 Ward No
5 Household
6 Population
7 DPR/Feasibility report prepared
8 Cost from DPR/Feasibility

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
you type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell whi
the collected data has different value and required Editing.

Verification by:
Date:
r New Unserved Community Survey

WASH Unit Engineer Observation Remarks

the same then write on Verification cell "Yes", otherwise write observed value. If
e diappear, So after verification the cell which contain Yellow color indicate that
 DATA VERIFICATION FORM for Ongoing Unserved Community Surv
Name of the Municipality:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Name of Scheme

2 Scheme type
3 Community Name
4 Ward No
5 Household
6 Population
7 Is DPR available?
8 Project cost as per DPR
Population that will be benefited by
9
private Tap connection

Treatment plants availability in the

10
Ongoing project
Is Projects expenditure till 2020
11
Known ?
12 Project expenditure till 2020
13 Project start year

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
you type Yes on your observation cell then the yellow color of the cell will be diappear, So after verification the cell whi
the collected data has different value and required Editing.

Verification by:
Date:
Ongoing Unserved Community Survey

WASH Unit Engineer Observation Remarks

the same then write on Verification cell "Yes", otherwise write observed value. If
e diappear, So after verification the cell which contain Yellow color indicate that
 DATA VERIFICATION FORM for Tubewell
Name of the Municipality:
Name of the Person contacted for verification:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters

1 Tubewell Owner's/ Representive name

2 Community Name
3 Ward No
4 Total household
5 Sampling size
6 Tubewell number in sampling size

7 Is tubewell under New project+ ongoing project area of piped system?

Private
8 Tubewell connection Type
Public

Private
9 Population Served
Public
10 Treatment Units availability
12 Fecal contamination
13 Priority chemical contamination
14 Completed year
15 Schemes original cost
16 Repair cost

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
then the yellow color of the cell will be diappear, So after verification the cell which contain Yellow color indicate that t

Verification by:
Date:
A VERIFICATION FORM for Tubewell Survey

Data Extracted from NWASH MIS WASH Unit Engineer Observation

re the same then write on Verification cell "Yes", otherwise write observed value. If you type Yes on your observation cell
cell which contain Yellow color indicate that the collected data has different value and required Editing.
 Remarks

e. If you type Yes on your observation cell

ue and required Editing.
 DATA VERIFICATION FORM for School Surv
Name of the Municipality:
Ward No:
Name of the Person contacted for verification:
Designation:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters

1 School Name

2 School category
Boys
3 Students
Girls
Male
4 Staffs
Female
Existing Water Supply
5
Details Water supply ownership of main
5.1
drinking water source
5.2 Water Supply system
5.3 Adequate Water availability
5.4 Fetching time
5.5 water tank
5.6 Capacity of water tank
5.7 Treatment unit available
5.8 condition of treatment unit
6 Taps (in number)
Physically intact (excluding disable
6.1
friendly taps)
Number of physically intact disable
6.2
friendly taps
6.3 Minor repair
6.4 Major repair
6.5 Reconstruction
7 Existing Sanitation and hygiene Details
7.1 Fecal contamination
7.2 Priority chemical contamination
7.3 Number of usable toilet for boys
7.4 Total number of toilets for girls
Number of usable toilet for girls with
7.5 MHM facility
Number of usable toilet for girls without
7.6 MHM facility
7.7 Number of usable common toilet

7.8 Number of usable disable friendly toilet

Number of toilets with minor repair

7.9
required
 Number of toilets with major repair
7.10
required
Number of toilets with reconstruction
7.11
required
Number of usable handwashing facilities
7.12
for boys
Number of usable handwashing facilities
7.13
for girls
Number of usable common
7.14
handwashing facilities
Number of usable disable friendly
7.15
handwashing facilities

7.16 Soap present in Handwashing facility

7.17 MHM products provided

7.18 MHM education given
Number of handwashing facilitiess with
7.19
minor repair required
Number of handwashing facilitiess with
7.20 major repair required
Number of handwashing facilitiess with
7.21
reconstruction required
7.22 incinerator for MHM available
7.23 condition of incinerator

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
observation cell then the yellow color of the cell will be diappear, So after verification the cell which contain Yellow colo
Editing.

Verification by:
Date:
DATA VERIFICATION FORM for School Survey

Data Extracted from NWASH MIS WASH Unit Engineer Observation

40 yes
32 35
tion are the same then write on Verification cell "Yes", otherwise write observed value. If you type Yes on your
o after verification the cell which contain Yellow color indicate that the collected data has different value and required
Remarks
d value. If you type Yes on your
data has different value and required
 DATA VERIFICATION FORM for HCF Surve
Name of the Municipality:
Ward No:
Name of the Person contacted for verification:
Designation:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters

1 Health care facility Name

2 Type of HCF
Male
3 Population Female
Staffs
Existing Water Supply
4
Details Water supply ownership of main
4.1
drinking water source
4.2 Water Supply system
4.3 Adequate Water availability
4.4 Fetching time
4.5 water tank
4.6 Capacity of water tank
4.7 Treatment unit available
4.8 condition of treatment unit
5 Taps (in number)
Physically intact (excluding disable
5.1
friendly taps)

5.2 Number of physically intact disable

friendly taps
5.3 Minor repair
5.4 Major repair
5.5 Reconstruction
6 Water quality
6.1 Fecal contamination
6.2 Priority chemical contamination
7 Existing Sanitation details
7.1 Number of usable toilet for male
7.2 Total number of toilets for female
Number of usable toilet for female with
7.3 MHM facility
7.4 Number of usable toilet for staff

7.5 Number of usable disable friendly toilet

Number of toilets with minor repair

7.6
required
Number of toilets with major repair
7.7
required
 Number of toilets with reconstruction
7.8
required
8 Existing Handwashing details

8.1 Soap present in Handwashing facility

8.2 Alchol based rub present in point of care

Number of usable handwashing facilities

8.3
present at point of care
Number of handwashing facilities with
8.4
minor repair
Number of handwashing facilities with
8.5
major repair
Number of handwashing facilitiess with
8.6 reconstruction required
Existing Solid waste,
9 hospital waste and
9.1 placenta management Number of bins
Sharp and infectious waste seperated
9.2
and disposed
9.3 incinerator for MHM available
9.4 condition of incinerator for MHM

9.5 incinerator for Hazardous waste

available
Condition of incinerator for Hazardous
9.6
waste
9.7 Placenta pit available
9.8 condition of placenta pit
10 Environment cleaning
10.1 Protocal for environmental cleaning
10.2 Staff for environmental cleaning

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
observation cell then the yellow color of the cell will be diappear, So after verification the cell which contain Yellow colo
Editing.

Verification by:
Date:
DATA VERIFICATION FORM for HCF Survey

Data Extracted from NWASH MIS WASH Unit Engineer Observation

56 yes
tion are the same then write on Verification cell "Yes", otherwise write observed value. If you type Yes on your
o after verification the cell which contain Yellow color indicate that the collected data has different value and required
Remarks
d value. If you type Yes on your
data has different value and required
 DATA VERIFICATION FORM for Public Place Survey
Name of the Municipality:
Ward No:
Name of the Person contacted for verification:
Designation:
Phone Number of the Person:
Verify with the person (Is the survey team were visited the HH) ? (Y/N):

S.N. Parameters Data Extracted from NWASH MIS

1 Recommended public places name

Status of Toilet construction in public

2
place
Number of male toilet in recommended
3
public
Number place
of female toilet in
4
recommended place
Has at least one toilet the provision for
5
people with limited mobility
Has at least one toilet the provision for
6
Children
Number of block with handwashing
7
facilities

8 Number of block without handwashing

facilities
9 Handwashings accessibility
is soap available in all handwashing
10
facilities
Adequate water available in all
11
handwashing facilities and toilets
12 water tank availability
is water tank big enough to reserve
13
sufficient water for one day
14 Overall physical condition

Note: If the data extracted from NWASH and data from field verification are the same then write on Verification cell "Ye
on your observation cell then the yellow color of the cell will be diappear, So after verification the cell which contain Ye
different value and required Editing.

Verification by:
Date:
RM for Public Place Survey

WASH Unit Engineer Observation Remarks

e same then write on Verification cell "Yes", otherwise write observed value. If you type Yes
fter verification the cell which contain Yellow color indicate that the collected data has