1-HWS-06-005 Structured Observation Form:

Date:
	Start time:	Household ID:	
Observer name:
	Finish time:	Initials of consenting household member:	
Signature:
	Timepoint: 
	
 Time	Event	Person	Hands Washed	Soap Use	Notes	
	Before eating or handling  food /drink…1 
After defecation ……………………..…2
After cleaning child’s bottom …..……..3
After other contact with stools…...…….4
 	Woman….……...1
Man…….……….2
Schoolboy……....3
Schoolgirl……....4
Pre-school child...5	No............….1
One hand..…2
Both hands...3
Body wash...4
Don’t know...99
	Water only......0
Soap ...............1
Ash ...…..........2
Mud……....…3
Stone ……….4
Other ……….5
Don’t know….99		
	Before eating or handling  food /drink…1 
After defecation ……………………..…2
After cleaning child’s bottom …..……..3
After other contact with stools…...…….4
 	Woman….……...1
Man…….……….2
Schoolboy……....3
Schoolgirl……....4
Pre-school child...5	No............….1
One hand..…2
Both hands...3
Body wash...4
Don’t know...99
	Water only......0
Soap ...............1
Ash ...…..........2
Mud……....…3
Stone ……….4
Other ……….5
Don’t know….99		
	Before eating or handling  food /drink…1 
After defecation ……………………..…2
After cleaning child’s bottom …..……..3
After other contact with stools…...…….4
 	Woman….……...1
Man…….……….2
Schoolboy……....3
Schoolgirl……....4
Pre-school child...5	No............….1
One hand..…2
Both hands...3
Body wash...4
Don’t know...99
	Water only......0
Soap ...............1
Ash ...…..........2
Mud……....…3
Stone ……….4
Other ……….5
Don’t know….99		
	Before eating or handling  food /drink…1 
After defecation ……………………..…2
After cleaning child’s bottom …..……..3
After other contact with stools…...…….4
 	Woman….……...1
Man…….……….2
Schoolboy……....3
Schoolgirl……....4
Pre-school child...5	No............….1
One hand..…2
Both hands...3
Body wash...4
Don’t know...99
	Water only......0
Soap ...............1
Ash ...…..........2
Mud……....…3
Stone ……….4
Other ……….5
Don’t know….99