HOUSE HOLD WATER USAGE IN URBAN AREA
SAFE calls for an active participation in the survey:
Your participation will make a difference!
Your Name
Address
Contact no.
Email
Date
Water Source
Select option
Deep Tube well
Well
Municipal Supply
Private Supply
Others
(write your option here if select '
others
')
Water Scarcity
Select option
Very high
High
Moderate
Low
None
Scarcity Factor
Select option
Wastage in misuse
Wastage in leakage
Shortage in supply
Inadequate Source
No source
Water Usage ::
• Lavatory
select one
Very high
High
Moderate
Low
None
• Bathroom
select one
Very high
High
Moderate
Low
None
• Kitchen
select one
Very high
High
Moderate
Low
None
• House
select one
Very high
High
Moderate
Low
None
• Garden
select one
Very high
High
Moderate
Low
None
• Office
select one
Very high
High
Moderate
Low
None
• Garage
select one
Very high
High
Moderate
Low
None
• Others
select one
Very high
High
Moderate
Low
None
Water Tax
select one
Must be imposed
Can be imposed
May be
Not to be imposed
Never be imposed
Water wise-use (savings) ::
• Lavatory
select one
Very high
High
Moderate
Low
None
• Bathroom
select one
Very high
High
Moderate
Low
None
• Kitchen
select one
Very high
High
Moderate
Low
None
• House
select one
Very high
High
Moderate
Low
None
• Garden
select one
Very high
High
Moderate
Low
None
• Office
select one
Very high
High
Moderate
Low
None
• Garage
select one
Very high
High
Moderate
Low
None
• Others
select one
Very high
High
Moderate
Low
None
Rainwater Harvesting
select one
Very Important
Important
Not sure
May be initiated
Not so helpfu