Household Consumption Survey

Household Details

Owner Name Address Education Occupation Household Type Type of House Toilet Arrangement Disabilities

Family Members

Member Age Gender
M1
M2
M3
M4
M5
M6

Water Source

Consumption Items (Repeat for ALL items)

Category Item Weekly Monthly Annually Source Remarks Weight (kg/m) Frequency Type Qty per intake (g) M1 M2 M3 M4 M5 M6