LOMA LINDA UNIVERSITY MARSHALL TSLAND
EXYVIZCNMENTAL HEALTH SURVEY
ATOLL NAME
Island Name
Surveyor's Name
Aid's Name
Source of Informacion
Population No.
{ ] Census (date
}
{ ] Other, specify
No. of dwelling units
No. of people/unit
HOUSING
Main wall construction.
[ ] cement (block)
{ ] wood
{ }] mac
[ ] cement
{ J] mat
( ] other, specify
Main £loor construction. { ] tile
{ ] stone
{ ] earth
Main reof construction.
{ ] wood
{ ] other, specify
[{ ] metal
General state of repair. [ ] good
[ ] thatch
[ ] other, spectty
[ ] fair
[ ] peor
Comments
TOILET FACILITIES
Type
{ ] pic privtes ( [ ] with water-~seal
( ] witheut pacer-seal)
f ] inside flush toilet
{ ] other, specify
Condition
{ ] adequate
[ ] odor
[ ] fltes
{ ] suraice Fontaminacion
Comments
No. of persons using each unit
Sewar System [ ] a0
Other dispesal syscan(s)
{ ] yes, if yes, type of trearmenc