QUESTIONS -English | QUESTIONS -Bahasa Indonesia | PROMPT / OPTIONS -English | PROMPT / OPTIONS -Bahasa Indonesia | NOTES | |
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## | WATER ACCESS AND QUALITY | ||||
59 | What is your household’s main source of drinking water? | Sumber air bersih | |||
* | main | utama | PDAM | PDAM | |
* | additional | tambahan | purchased bottled water/ purified/ distilled water | beli di toko atau pedagang air keliling | |
* | purchased tanker truck/peddler | ||||
* | relative importance | piped water system -individual household access | |||
* | piped water system -access via other households (HHS) | ||||
* | piped water system -access via single village / community sourcepoint | ||||
* | dug/ shallow well - personal use / individual household access | ||||
* | dug/ shallow well - shared access with other households (HHS) | ||||
dug/ shallow well -access via single village / community sourcepoint | |||||
* | artesian shallow well - personal use / individual household access | ||||
* | artesian shallow well - shared access with other households (HHS) | ||||
* | artesian shallow well -access via single village / community sourcepoint | ||||
* | artesian deep well - personal use / individual household access | ||||
* | artesian deep well - shared access with other households (HHS) | sumur umum | |||
* | artesian deep well -access via single village / community sourcepoint | ||||
* | spring water, specify | mata air, tentukan | |||
* | river, stream, lake, spring and/or other natural water sources | sungai | |||
* | rainwater | air hujan | |||
* | other (specify) | lainnya (sebutkan) | |||
60 | How far is it to this source? | ||||
* | under 100m | ||||
* | 100m to 1 km | ||||
* | over 1 km | ||||
61 | How long does it take for each return trip to gather water from this source? | (minutes/hours) | |||
62 | How do you get there, on average? | Bagaimana Anda sampai di sana, rata-rata? | |||
* | on foot | berjalan kaki | |||
* | on foot, with hand trolley | berjalan kaki, dengan tangan troli | |||
* | bicycle, self-owned | sepeda, milik sendiri | |||
* | bicycle, borrowed | sepeda, dipinjam | |||
* | bicycle, rented / hired | sepeda, menyewa | |||
* | motorbike, self-owned | sepeda motor, milik sendiri | |||
* | motorbike, borrowed | sepeda motor, dipinjam | |||
* | motorbike taxi | ojek | |||
* | car, self-owned | mobil, milik sendiri | |||
* | car, rented / hired | mobil, menyewa | |||
* | van, self-owned | van, milik sendiri | |||
* | van, rented / hired | van, disewa | |||
* | bus, hired | bus, disewa | |||
* | non-motor boats: catamaran | perahu tanpa motor: jukung | |||
* | non-motor boats: small | perahu tanpa motor: kecil | |||
* | non-motor boats: medium | perahu tanpa motor: sedang | |||
* | non-motor boats: large | perahu tanpa motor: besar | |||
* | outboard motor boat | perahu motor tempel | |||
* | onboard motor boat | kapal motor | |||
* | public transportation | transportasi umum | |||
* | others (specify) | lainnya (sebutkan) | |||
63 | How much does it cost to get there, if any? | ||||
* | no cost | ||||
* | (rupiah) | ||||
64 | What is your daily consumption of water for drinking? | Apa konsumsi sehari-hari Anda air untuk minum / mandi? | (liters/pails/gallons/tanks) | ||
65 | How plentiful (quantity) is the availability of your water sources? | ||||
* | abundant | ||||
* | adequate | ||||
* | scarce | ||||
* | unknown / uncertain | ||||
66 | How is the quality of your water sources? | ||||
* | good | ||||
* | bad | ||||
* | unknown / uncertain | ||||
67 | color | ||||
* | opaque | ||||
* | colored / tinted | ||||
* | clear | ||||
68 | taste | ||||
* | has good taste | memiliki selera yang baik | |||
* | has bad taste | memiliki rasa yang buruk | |||
* | tasteless | hambar | |||
69 | odor | ||||
* | has odour | memiliki bau | |||
* | odourless | tanpa bau | |||
70 | Has the water been tested for chemicals/microbiological contents? | ||||
* | yes (results) | ya (hasil) | |||
* | no (note reason, if given) | tidak ada (catatan alasan, jika diberikan) | |||
* | unknown / uncertain | tidak diketahui / tidak pasti | |||
71 | Are you aware if your water is treated with any purification process before consuming it? | ||||
* | no purification, drink directly | tidak ada pemurnian, minum langsung | |||
* | sedimentation | pengendapan | |||
* | filtration | penyaringan | |||
* | distillation | distilasi | |||
* | flocculation | flokulasi | |||
* | chlorination | klorinasi | |||
* | UV lights/ozon | lampu UV / ozon | |||
* | others (specify) | lainnya (sebutkan) | |||
72 | Do you sterilize / disinfect your water before consuming it? | ||||
* | no desinfection, drink directly | ||||
* | boiled | ||||
* | others (specify) | ||||
73 | What is your primary clean water source for bathing? | Apa sumber air utama Anda bersih untuk minum / mandi? | |||
* | main | utama | PDAM | PDAM | (if multiple answers given, record order of priority) |
* | additional | tambahan | purchased tanker truck/peddler | ||
* | relative importance? | piped water system -individual household access | |||
* | piped water system -access via other households (HHS) | ||||
* | piped water system -access via single village / community sourcepoint | ||||
* | dug/ shallow well - personal use / individual household access | pribadi sumur gali | |||
* | dug/ shallow well - shared access with other households (HHS) | tetangga 'sumur gali | |||
* | dug/ shallow well -access via single village / community sourcepoint | tetangga 'sumur gali | |||
* | artesian shallow well - personal use / individual household access | sumur bor | |||
* | artesian shallow well - shared access with other households (HHS) | sumur bor | |||
* | artesian shallow well -access via single village / community sourcepoint | sumur bor | |||
* | artesian deep well - personal use / individual household access | sumur umum | |||
* | artesian deep well - shared access with other households (HHS) | sumur umum | |||
* | artesian deep well -access via single village / community sourcepoint | sumur umum | |||
* | spring water, specify | mata air, tentukan | |||
* | river, stream, lake, spring and/or other natural water sources | sungai, tentukan | |||
* | rainwater | air hujan | |||
* | other (specify) | lainnya (sebutkan) | |||
74 | How long does it take to get to your primary water source? | Berapa lama waktu yang diperlukan untuk sampai ke sumber air utama Anda? | |||
* | (meters/kilometers) | ||||
* | (minutes / hours) | ||||
75 | How do you get there, on average? | Bagaimana Anda sampai di sana, rata-rata? | |||
* | on foot | berjalan kaki | |||
* | on foot, with hand trolley | berjalan kaki, dengan tangan troli | |||
* | bicycle, self-owned | sepeda, milik sendiri | |||
* | bicycle, borrowed | sepeda, dipinjam | |||
* | bicycle, rented / hired | sepeda, menyewa | |||
* | motorbike, self-owned | sepeda motor, milik sendiri | |||
* | motorbike, borrowed | sepeda motor, dipinjam | |||
* | motorbike taxi | ojek | |||
* | car, self-owned | mobil, milik sendiri | |||
* | car, rented / hired | mobil, menyewa | |||
* | van, self-owned | van, milik sendiri | |||
* | van, rented / hired | van, disewa | |||
* | bus, hired | bus, disewa | |||
* | non-motor boats: catamaran | perahu tanpa motor: jukung | |||
* | non-motor boats: small | perahu tanpa motor: kecil | |||
* | non-motor boats: medium | perahu tanpa motor: sedang | |||
* | non-motor boats: large | perahu tanpa motor: besar | |||
* | outboard motor boat | perahu motor tempel | |||
* | onboard motor boat | kapal motor | |||
* | public transportation | transportasi umum | |||
* | others (specify) | lainnya (sebutkan) | |||
76 | How much does it cost to get there, if any? | ||||
* | no cost | ||||
* | (rupiah) | ||||
77 | For what other purposes do you use water? | ||||
* | irrigation for agriculture | ||||
* | irrigation for plantations | ||||
* | water for livestock | ||||
78 | How much water would you estimate that you consume on average each day? | (liters/pails/gallons/tanks) | |||
79 | Have your ever experienced any water shortage? | ||||
* | yes (duration in month/season) | ya (durasi bulan / musim) | |||
* | yes (duration in days/weeks/months) | ya (durasi dalam beberapa hari / minggu / bulan) | |||
* | no / have not experienced | tidak / belum mengalami | |||
* | cannot recall | tidak ingat | |||
80 | How do you find an alternate for water resources? | ||||
* | never have needed alternative source | pernah diperlukan sumber alternatif | |||
* | look for other water resources (distance / km) | mencari sumber air lainnya (jarak / km) | |||
* | purchase water (cost /liter/pail/gallon/tank etc.) | air pembelian (biaya / liter / pail / galon / tangki dll) | |||
* | use rainwater | menggunakan air hujan | |||
* | others (specify) | lainnya (sebutkan) | |||
## | RESIDENCE / DWELLING LIVING CONDITIONS | ||||
81 | What is the main source of fuel for household cooking? | ||||
* | wood fuel | kayu | |||
* | charcoal | arang | |||
* | coal | batubara | |||
* | kerosene | gas (minyak tanah / kompor minyak tanah) | |||
* | LPG (or bottled gas) -non-subsidy | LPG (atau gas botol) -Non-subsidi | |||
* | LPG (or bottled gas) -subsidized green gas tank | LPG (atau gas botol) -subsidized tangki bensin hijau | |||
* | LPG (or bottled gas) -subsidized blue gas tank | LPG (atau gas botol) -subsidized tangki bensin biru | |||
* | electricity | listrik | |||
* | other (specify) | lainnya (sebutkan) | |||
82 | Are cooking activities conducted indoor? | ||||
* | yes | ya | |||
* | no | tidak | |||
83 | condition of air circulation | (filled in based on observation) | |||
* | bad | buruk | |||
* | moderate | moderat | |||
* | good | baik | |||
84 | Does the residence / structure / house have adequate ventilation? | Apakah rumah bapak/ibu memiliki ventilasi udara yang cukup memadai? | |||
* | yes | ya | |||
* | no | tidak | |||
* | do not know | tidak tahu | |||
85 | Type of existing ventilation? | Jika ya, bagaimana kondisi ventilasi rumah yang bapak/ibu tempatin sekarang? | (filled in based on observation) | ||
* | window | jendela | |||
* | the open roof | atap terbuka | |||
* | spaces between plaited bamboo/rattan wall | celah-celah dinding kayu (bambu atau rotan) | |||
* | other (specify) | lainnya (sebutkan): ......... | |||
86 | Condition of lighting/illumination? | “pencahayaan rumah” | (filled in based on observation) | ||
* | dark | gelap | |||
* | moderate | moderat | |||
* | bright | cerah | |||
* | |||||
87 | Does adequate sunlight get into the house? | Apakah rumah bapak/ibu mendapatkan sinar matahari yang cukup? | |||
* | yes | ya | |||
* | no | tidak | |||
* | do not know | tidak tahu | |||
88 | What kind of lighting is used? (may give more than one answer) | Jenis penerangan apa yang digunakan? | (may give more than one answer) | ||
* | electricity | listrik | |||
* | oil/petromax | ||||
* | oil/kerosene/petromax light | lampu petromax | to combine with secondary data or socio-economic survey | ||
* | lampu minyak tanah | ||||
* | solar cell lamps | ||||
* | candle / paraffin | lilin / parafin | |||
* | others (specify) | lainnya (sebutkan) | |||
89 | Is there any difficulty in getting the energy source? | Apakah ada kesulitan dalam mendapatkan sumber energi tersebut? | (if not, go to qX) | (jika tidak, lanjutkan ke pertanyaan X) | |
* | yes | ya | |||
* | do not | tidak | |||
* | do not know | tidak tahu | |||
90 | If yes, type of difficulties faced in what form? | Jika ya, jenis kesulitan yang dihadapi dalam bentuk apa? | |||
91 | How the father / mother face difficulties? | Bagaimana bapak/ibu menghadapi kesulitan tersebut? | |||
92 | Is there electricity in the house/ building? | ||||
* | if yes, proceed to qX, | ||||
* | if not proceed to qY | ||||
94 | What is the main source of electricity to the dwelling? | sumber energi | |||
* | main | utama | electric company (name?) | ||
* | additional | tambahan | government electricity (PLN) -direct connection | listrik pemerintah (PLN) | |
* | government electricity (PLN) -connected from neighbours | listrik pemerintah (PLN), yang dihubungkan dari tetangga | |||
* | personal generator | generator pribadi | |||
* | generator, connected from neighbours | ||||
* | gas generator | gas generator | |||
* | kerosene generator | minyak tanah | |||
* | solar | Tenaga Surya | |||
* | battery | ||||
* | obor | ||||
* | lampu minyak tanah | ||||
* | others (specify) | lainnya (sebutkan) | |||
## | RESIDENCE / DWELLING STRUCTURAL CONDITIONS | ||||
95 | Does your household own the dwelling in which you are currently living? | Status kepemilikan tempat tinggal / struktur / rumah yang sekarang ditempati? | |||
* | yes -personally owned | dimiliki secara pribadi | |||
* | no -rented/contracted | menyewa / kontrak | |||
* | no -boarding with others | asrama dengan orang lain | |||
* | no -living in others’ yard | tinggal di halaman orang lain | |||
96 | Permanency of the residence/ structure/ house currently occupied? | Pekerjaan tetap tempat tinggal / struktur / rumah yang sekarang ditempati? // Bagaimana kondisi rumah bapak/ibu? | |||
* | permanent | permanen | |||
* | semi permanent | semi permanen | |||
* | shack/temporary shelter | sementara | |||
97 | What is the size of the house? | (area in m2) | |||
98 | How many rooms does the house have? | ||||
99 | From what materials was the residence / household / structure built? | Dari bahan apa yang kediaman / rumah tangga / struktur dibangun? | |||
* | Apa kondisi fisik dari rumah bapak/ibu? | wooden simple house | |||
* | wooden stilt house | (rumah panggung) | |||
* | brick | ||||
* | concrete | ||||
* | other (specify) | lainnya (sebutkan) | |||
100 | What is the wall material for your house? | ||||
101 | Roof typed of occupied house? | Bagaimana kondisi atap rumah bapak/ibu? | (filled in based on observation) | ||
* | thatched roof | atap rumbia/alang-alang | |||
* | shingle roof | atap sirap - ulin | |||
* | tile | genteng | |||
* | pottery | tembikar | |||
* | zinc | seng | |||
* | galvanized corrugated roof | ||||
* | asbestos | asbes | |||
* | asbestos corrugated roof | ||||
* | wood/plywood | kayu/triplek | |||
* | other (specify) | lainnya (sebutkan) | |||
102 | Floor typed of occupied house (filled in based on observation) | Bagaimana kondisi lantai rumah bapak/ibu? | |||
* | hard soil | tanah keras (lantai tanah) | |||
* | plywood | triplek | |||
* | wood | kayu | |||
* | cemented floor | semen | |||
* | tile/ceramic tile (lantai ubin) | ubin/keramik (lantai ubin) | |||
* | others (specify) | lainnya (sebutkan) | |||
103 | What are the characteristics of traditional housing? | ||||
104 | What materials are commonly used in creating shelters? | Bahan apa yang lazim digunakan dalam membangun bivak? | |||
105 | Are any building materials hard to come by? | Apakah ada bahan bangunan yang sulit diperoleh? | |||
106 | What is the average value for different types of houses in this area? | ||||
107 | Do you estimate there is an active market for renting houses in this area? | ||||
108 | Can you please help us try to estimate the rent different house types in this area? | ||||
109 | Can you estimate the rent for a single room? | ||||
## | SANITATION AND PERSONAL HYGENE | ||||
110 | What facilities does your family use for bathing? | ||||
* | season: | bucket, in own home | |||
* | dry | bucket, in neighbour's home | |||
* | rainy | personal bath, indoors | |||
* | personal bath, outdoors | ||||
* | neighbours’ bath, indoors | ||||
* | neighbours’ bath, outdoors | ||||
* | public MCK (bathing, washing & latrine) | ||||
* | river | ||||
* | mangrove | ||||
* | ocean | ||||
* | other (specify) |
| 111 | What kind of toilet facility does the household mainly use? | | | | | | * | season: | | no toilet | | | | * | dry | | bucket, in own home | | | | * | rainy | | bucket, in neighbour's home | | | | * | | | personal water-flush latrine, indoors | | | | * | | | personal water-flush latrine, outdoors | | | | * | | | personal pit latrine, outdoors | | | | * | | | neighbours’ water-flush latrine, indoors | | | | * | | | neighbours’ water-flush latrine, outdoors | | | | * | | | neighbours’ pit latrine, outdoors | | | | * | | | public / community closed pit latrine (shared) | | | | * | | | public / community open pit latrine (shared) | | | | * | | | public / community MCK (bathing, washing & latrine) | | | | * | | | open yard | | | | * | | | in the forest | | | | * | | | in a river | | | | * | | | in a mangrove | | | | * | | | in the ocean | | | | * | | | others (specify) | | |
| 112 | Disposal of bathing/cleaning wastewater | | | | | | * | | | in the forest | | | | * | | | seep on ground | | | | * | | | to gutter near house | | | | * | | | to pond near house | | | | * | | | in the river (specify) | | | | * | | | mangrove | | | | * | | | ocean | | | | * | | | storage cesspool (cubluk) | | | | * | | | septic tank | | | | * | | | other (specify) | | | | 113 | How do you mainly dispose of household solid waste/ garbage (e.g. food/kitchen/domestic waste) | | | | | | * | | | landfill near house, burnt when pile up | | | | * | | | landfill near house, pick up by municipal waste service | | | | * | | | collected by village/ LGU | | | | * | | | compost | | | | * | | | burn | | | | * | | | bury in the ground | | | | * | | | throw in the river | | | | * | | | throw to open yard | | | | * | | | other (specify) | | | | ## | ENVIRONMENTAL HEALTH AND SECURITY | | | | | | 114 | What is your perception of the quality/health of the environment around your house? | | | | | | * | | | good | baik | | | * | | | moderate | moderat | | | * | | | bad / poor | buruk / miskin | | | 115 | How many traffic accidents, spills, releases or injuries have there been in the last 12 months? | | | | | | 116 | What potentially hazardous materials is the community currently exposed to in the area? | | | | |