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g)  Frequency of garbage disposal in the village  :

                                Dispose daily


                                Every other day


                                Weekly



                   h)  Presence of domestic animals  :

                                Yes                       Specify:…………………………………


                                No



                   i)  Presence of Insects , rodents  :

                                Yes                       Specify::…………………………………


                                No


                     Problems Identified:


                       ………………………………………………………………………………

                       …………………………………………………………………………….


               Section 2: Population Assessment

                   A. Vital and demographic statistics

                        a) Population density:…………………………………………………………………..


                   b)  Population characteristics:


                       o Major occupations in the village:.............................................................


                       o Education level of most of population: ..................................................


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