Name (Optional):

Gender:

Age:
Occupation: Student
Job or University:

Employed

Unemployed

Others pls. specify: ___________

INSTRUCTION
Check the box which applies to your answer
GARBAGE MANAGEMENT.
What day/days is garbage collected in your area?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
What time is it collected?
5-6am 6-7am 7-8am 8-9am 9-10am 10-11am 11am-12pm Others pls. specify: ___________
Are the garbage collectors always on time?
Yes No
Is it mandatory to segregate your garbage?
Yes No
If yes, do you segregate the garbage on your own?
Yes No
If you do not segregate the garbage on your own, who segregates the garbage?
Sanitary Personnel Family/Household Members Others pls. specify: __________
What do you use to dispose your garbage?
Garbage bags Garbage Bins Dumpsters Reused Plastic Bags
Others pls. specify: __________
WATER SUPPLY
What is the source of water in your household/dormitory/boarding house?
Pumps Water Delivery Well Water Line Others pls. specify: __________
Do you have a separate source for drinking water?
Yes No
If yes, what is your source for drinking water?
Drinking water refilling stations Water Delivery Branded Purified Water
Others pls. specify: __________
Have you experienced shortage in water supply this summer?
Yes No

Environmental Concerns
Garbage
Segregation Recycle Disposal Dumping Burning of Garbage
Water
Saving Lack of Water Sanitation Water Price Wasting of Water

Other Concerns
Forest Fire Cutting of Trees Air Pollution Due to Vehicles Passing by
Noise Pollution due to Road Repairs Over Population