Questionnaire Sanitation Engineering

Margonda Residence-1 Apartment

Respondents Name: ______________________________________________

Note:
*Score Scaling:

1 = Good (76% - 100%)

2 = Fair (51% - 75%)
3 = Moderate (26% - 50%)
4 = Bad (< 26 %)

Clean Water
1.

Have you ever experienced any problems regarding to the clean water supply at Margonda
Residence-1 apartment (e.g.: low flow rate, turbidity, unavailability)?
_____ Yes
_____ No
If Yes, please state the problem:

________________________________________________________________________
__________________________________________________________________
2.

Please evaluate the clean water quality (score 1-4)*

: ______________________

3.

Please evaluate the clean water quantity (score 1-4)*

: ______________________

4.

Please evaluate the clean water continuity (score 1-4)*

: ______________________

5.

Outside of basic usual needs (showering, toilet, cleaning dishes, etc.) what other purposes do
you use the clean water for?
______ Cleaning clothes
______ Drinking
______ Consumption (for cooking)
______ Other (please state!)

________________________________________________________________________
__________________________________________________________________
6.

How much is your monthly water bill?

_____ < Rp. 50,000,-

_____ Rp. 50,000-Rp. 100,000

_____ Rp. 100,000-Rp. 150,000

_____ Rp. 150,000-Rp. 200,000

Other billing range: ____________________________________________________________

 Solid and Hazardous Waste

1.

How much domestic waste (expressed in x bin/day) do you produce from your room?
_________________________ bin/day

2.

What type of waste do you throw away each day?

______ Food and beverage packaging
______ Stationary (pen, pencil, eraser, paper, etc.)
______ Toiletries packaging (shampoo, soap, toothpaste, etc.)
______ Bathroom cleaning agent or detergent
______ Bulbs
______ Organic waste (vegetable, egg, etc.)
______ Dirt and debris
______ Batteries
______ Other (please state the type of waste)
_______________________________________________________________________________
____________________________________________________________________________

3.

Are you aware of what hazardous waste is?

4.

______ Yes
______ No
Are you aware to treat hazardous waste differently than the other waste?
______ Yes
______ No
If Yes, please state how you treat the hazardous waste!
_______________________________________________________________________________
____________________________________________________________________________

Drainage System
1.

Have you experienced any puddles at the drainage system surrounding the Margonda Residence1 apartment (e.g.: parking lot, lobby, basement)?
______ Yes
______ No
If Yes, please evaluate the puddles (score 1-4)*: _______________
Where?
_______________________________________________________________________________
____________________________________________________________________________

2.

Have you experienced any flooding at the drainage system surrounding the Margonda
Residence-1 apartment (e.g.: parking lot, lobby, basement)?
______ Yes
______ No
If Yes, please evaluate the flooding (score 1-4)*: _______________
Where?
_______________________________________________________________________________
____________________________________________________________________________

Noise Pollution
1.

2.

Have you experienced any noise disturbance during your stay at Margonda Residence-1
Apartment?
______ Yes
______ No
If Yes, where does it take place*?
______ Bedroom

______ Parking Lot

______ Kitchen

______ Canteen

______ Bathroom

______ Lobby

______ Corridor
Other:
_______________________________________________________________________________
____________________________________________________________________________
*you can choose > 1 option
3.

What is the source of the noise disturbance? Please evaluate the level of noise disturbance (score
1-4)*!
______ Construction noises

______

______ Chattering noises

______

______ Transportation noises

______

______ Electrical noises (e.g.: AC

______

Other:
_________________________________

______

_________________________________

______

Indoor Air Quality

1.

Do you smoke at your room?

______ Yes

______ No

2.

Have you experienced any Air Conditioner leaking at your room (e.g.: discoloration on the wall
near your AC or water comes out of your AC)?
______ Yes

3.

If Yes, please evaluate the AC leaking (score 1-4)*: _______________

What kind of stove do you use at your kitchen?
_____ Gas stove

4.

______ No

______ Electric stove

Do you use air sanitizer, freshener, pest spray or any other similar stuffs in your room?
_____ Yes

______ No

Plumbing System
1.

2.

Have you experienced any plumbing problems during your stay at Margonda Residence-1
Apartment?
______ Yes
______ No
If Yes, what kind of problems? Please evaluate the level of problems (score 1-4)!
______ Leaking faucet

______

______ Clogged toilet

______

______ Toilet cannot flush at all or does not fully flush

______

______ Slow draining

______

______ Leaking pipes

______

Other:
_________________________________________

______

_________________________________________

______

-Thank You for Your ParticipationSan. Eng. Intl-Group: AF-DBP