School-Based Management

Name

School & School Address

Occupation

Does the school provide drinking water? Check only one.

• All the time
• Yes, but the supply is not regular
• No

Is the drinking water provided by the school for free?

• Yes
• No

Does the school coordinate with the LGU or water district to test the quality of water?

• Yes
• No

What other mechanism are used to ensure that drinking water in school is safe?

• Teachers ask the learners to bring their own drinking water to school.
• If drinking water is from a refilling station, the school requires a water quality certificate.
• Water from an accessible water source is boiled.
• Water from an accessible water source is filtered.

Are all functional toilets secure, private, and have a door with lock?

• Yes
• No

Do all functional toilets have lighting (includes natural light and alternative sources)

• Yes
• No

Do all functional toilets have adequate ventilation?

• Yes
• No