This template is a structured Environmental Health (EH) assessment questionnaire developed by the International Rescue Committee to support rapid field assessments at household and community level. It starts with basic visit/location metadata (date, compiler, organization, location type, district, and GIS coordinates) and interviewer/interviewee details, then collects key household characteristics (household size and whether members include IDPs/refugees/affected people).
The core of the tool focuses on WASH and environmental health risks: it assesses water supply (sources, distance/time to collect, queuing, share of needs, delivery/tankering, barriers, storage containers, and treatment practices), sanitation (access and use of latrines, type and distance, open defecation areas, and an observation checklist on latrine condition), plus solid waste disposal and hygiene behaviors (handwashing times, soap access, animal presence in shelters). It also includes an “Additional Topics for EH Specialists” section for broader community/camp-level questions—such as population size, other agencies’ services, water source reliability/safety, groundwater contamination risks, drainage/flooding patterns, and vector-borne disease risks—to inform program priorities and response planning.

Table of contents
1. Cover information and location profile (date, compiler, organization, location type, district, GIS)
2. Questionnaire administration details (interviewer, interviewee, role in community)
3. Household profile (household size, who stays overnight, IDPs/refugees/affected)
4. Water Supply (quantity collected, sources, access/time, delivery, uses, obstacles, storage, payment, treatment)
5. Sanitation (latrine access/use/type/distance; open defecation fields; latrine condition observation checklist)
6. Solid waste / household garbage disposal (methods and distance of disposal site)

7. Hygiene (handwashing times; soap access; animals entering/sleeping in shelter; other observations)
8. Additional topics for EH specialists (camp/community-level WASH risks, groundwater, drainage/flooding, vectors, hygiene issues)