Name(Optional)Address__________________________________________________Source of water Baguio Water District (BWD)Own private well Others:_________________For those whose source of water is the BWD proceed to following questions:Number of people living in your household: _____________

ACTIVITYTIMES PER DAY

SUNMONTUEWEDTHUFRISAT

TOILET FLUSHING

TEETH BRUSHING

WASHING DISHES WITH RUNNING WATER

WASHING DISHES BY FILLING A BASIN

SHORT SHOWER 5-10 MINUTES

LONG SHOWER More than 10 minutes

Washing Clothes by hand

Washing clothes by machine

Others using water:________________

Do you have any problems regarding the water supplied to you by the Baguio Water District?_________________________________________________________________________________________________________________________________________________________________________