LOM& LINDA UNIVERSITY MARSHALL TSLAND
EIVOACNMENTAL SEALTH SURVEY
ATOLL NAME
Island Name
Surveyor'’s Name
Aid's Name
Source of Information
Population No.
{ ] Census (date
)
{ ] Other, specifiy
No. of dwelling units
No. of people/unit
BOUS ING
Main wall construction.
[ ] cemene (block)
{[ ] wood
{ ] mat
( ] other, specify
Main floor construction. { ] tile
{ ] stone
( ] earth
Main rocf construction.
[ ] wood
[ ] cement
[ ] mat
{ ] other, specify
[{ ] metal
General state of repair. [ ] good
[ ] ehatch
[ ] other, specify
( ] fair
{ ] poor
Comments
TOILET FACILITIES
Type
{ ] pit privies ( [ ] with water-seal
{ ] without wacer-seal)
( J] inside flush toilee
{ ] other, specify
Condition
[ ] adequate
[ ] oder
[ ] fltes
( ] surafce contamination
Comments
No. of persons using each unit
Sewer System [{ ] no
Other disposal system(s)
f ] yes, if yes, type of trearmenc