Repair and Maintenance Setting
Repair Date
| ASSOCIATION NAME | |||||||||||
| DATE REGISTERED | |||||||||||
| LAST ASSEMBLY | |||||||||||
| CHAIRPERSON | |||||||||||
|
|
|||||||||||
| CONTACT # | |||||||||||
| VICE-CHAIRPERSON | |||||||||||
|
|
|||||||||||
| CONTACT # | |||||||||||
| SECRETARY | |||||||||||
|
|
|||||||||||
| CONTACT # | |||||||||||
| TREASURER | |||||||||||
|
|
|||||||||||
| CONTACT # | |||||||||||
| AUDITOR | |||||||||||
|
|
|||||||||||
| CONTACT # | |||||||||||
|
|||||||||||
| TOTAL MEMBERS | |||||||||||
| ACTIVE MEMBERS | |||||||||||
| INACTIVE MEMBERS | |||||||||||
| MEMBERSHIP FEE | |||||||||||
| CONTACT PERSON/S | |||||||||||
| OFFICIAL CONTACT NUMBER/S | |||||||||||
| HECTARES IRRIGATED | |||||||||||
| HOUSEHOLDS SERVED | |||||||||||
| PEOPLE SERVED | |||||||||||
| MALE | |||||||||||
| FEMALE | |||||||||||
| CHILDREN (0-12) | |||||||||||
| COST OF WATER OR WATER FETCHING | |
| TIME SPENT FOR WATER FETCHING | |
| LITERS OF WATER FETCHED | |
| WATER USED FOR DRINKING | |
| WATER USED FOR HOUSEHOLD | |
| WATER USED FOR IRRIGATION | |
| TOTAL WATER USED | |
| DISTANCE OF WATER SOURCE | |
| PEOPLE FETCHING WATER | |
| SENIOR CITIZEN (M) | |
| SENIOR CITIZEN (F) | |
| PWD (M) | |
| PWD (F) | |
| MALE (0-12) | |
| FEMALE (0-12) | |
| MALE (13-19) | |
| FEMALE (13-19) | |
| MALE (20-UP) | |
| FEMALE (20-UP) |
| COST OF WATER OR WATER FETCHING | |
| TIME SPENT FOR WATER FETCHING | |
| LITERS OF WATER FETCHED | |
| WATER USED FOR DRINKING | |
| WATER USED FOR HOUSEHOLD | |
| WATER USED FOR IRRIGATION | |
| TOTAL WATER USED | |
| DISTANCE OF WATER SOURCE | |
| PEOPLE FETCHING WATER | |
| SENIOR CITIZEN (M) | |
| SENIOR CITIZEN (F) | |
| PWD (M) | |
| PWD (F) | |
| MALE (0-12) | |
| FEMALE (0-12) | |
| MALE (13-19) | |
| FEMALE (13-19) | |
| MALE (20-UP) | |
| FEMALE (20-UP) |
| HANDWASHING FACILITY | |
| SANITATION FACILITY | |
| TREATING WATER | |
| BOILING | |
| FILTER | |
| WATER-RELATED ILLNESSES | |
| CHOLERA | |
| DIARRHEA | |
| TYPHOID | |
| AMOEBIASIS | |
| SKIN DISEASES | |
| DEHYDRATION | |
| DIED FROM WATER-RELATED ILLNESSES |
