Western Institute of Technology Western Institute of Technology

College of Engineering College of Engineering

Bachelor of Science in Civil Engineering Bachelor of Science in Civil Engineering
Dicen St., La Paz, Iloilo City Dicen St., La Paz, Iloilo City

Part I: Personal Profile

Name (Optional): _______________________________________Gender: Male Female 6. Generally, does your water smell foul?
Age: __________ ____ Yes
Part II: Residents’ Water Consumption and Level of Satisfaction ____ No
Below are the items that are related to determining your water consumption and level of ____ Do not know
satisfaction with your current water supply. Please assess yourself on the following items below and check 7. Generally, what does your water look like?
the blank that corresponds to your answer. ____ Clear
____ Cloudy
1. How many people usually live in your household? ____ Dirty
____ 1-3 8. Do you ever experience a water shortage?
____ 4-6 ____ Yes
____ 7-9 ____ No
____ 10-12 9. How many times per week do you experience water shortage?
____ 12 or more ____ 1
2. What is the main source of water supply in your household? ____ 2
____ Spring ____ 3
____ Deep well ____ 4
____ Shallow Tubewell (Tasok) ____ 5 or more
____ Communal/ Public faucet 10. Do you have any diseases that you believe were caused by your drinking water??
____ Others (Please specify) ______________________________________________ ____ Yes
3. What water supply fixture is most commonly used in your household? ____ No
____ Flushing toilet ____ Do not know
____ Dishwashing and Laundry 11. How would you rate the quality of your main source of water supply?
____ Shower ____ Very good
____ Others (Please specify) ______________________________________________ ____ Good
4. How many gallons of drinking water does your household use per day? ____ Bad
(1 water container=20 liters=5 gallons) 12. How would you rate the quantity and availability of your main source of water supply?
____ 1-5 ____ Satisfied
____ 6-10 ____ Dissatisfied
____ 11-15 ____ Neutral
____ 16-20 13. Do you ever use the water from the river for cleaning and bathing?
____ 21 or more ____ Yes
5. How many gallons of water does your household use per day in fixture units? ____ No
(1 water container=20 liters=5 gallons) 14. If the river water will be treated, would you consider using it?
____ 1-10 ____ Yes
____ 11-20 ____ No
____ 21-30 ____ Maybe
____ 31-40 15. Do you agree to have a water system in your area using the river as a source?
____ 41 or more ____ Yes
____ No

THANK YOU!