Rural Water Baseline Data Collection
Please complete and submit this form for each project under your LGA.
Your reports are crucial for performance management and decision making.
Thank you for your time.
Sign in to Google to save your progress. Learn more
Fiscal Year *
From                                                                                    
MM
/
DD
/
YYYY
Name of region *
Name of LGA *
List of LGA is in alphabetical order
Name of District Water Engineer *
Project Data
Name of Project *
Any Updates? *
Select 'No' if there are no updates for this week.
Technology *
Power Drive *
Initiative *
Category *
Source of funds *
Please state source for 'Other funding'
Operational Status *
Implementation Status *
Name of Village(s) *
Present Population *
Design Population *
Design Engineering Estimate in Tshs. *
Per Capita Cost in Tshs. *
Contract Cost *
Planned Starting Date *
MM
/
DD
/
YYYY
Actual Starting Date *
MM
/
DD
/
YYYY
Planned Date of Completion *
From
MM
/
DD
/
YYYY
Actual Date of Completion *
From
MM
/
DD
/
YYYY
Commission Date *
From
MM
/
DD
/
YYYY
Expiry date of Design Period *
MM
/
DD
/
YYYY
Design Production Capacity (cubic meter per hour) *
Operating Production Capacity (cubic meter per hour) *
 Distribution Design Capacity (cubic meter per hour) *
Operating Distribution Capacity (cubic meter per hour) *
Number of Water Points Constructed *
Please enter ' 0 ' (zero) if not applicable
Number of Water points rehabilitated *
Please enter ' 0 ' (zero) if not applicable
Number of Water points extended *
Please enter ' 0 ' (zero) if not applicable
Number water points repaired *
Please enter ' 0 ' (zero) if not applicable
Total Number of Water Points *
Number of Functional Public Water Points *
Number of Functional Private Water Points *
Total Number of Non Functional Water Points *
Action required for Non Functional Water Points
Please recommend actions that can be taken to fix the non functional water points, if any.
Total Number of Population *
Current total population in the area covered by this project
Number of Population Served *
Actual population currently served through this project
Name and Type of COWSO
Status of COWSO
O & M  Funds Balance in Tshs.
O & M  Collection in Tshs.
O & M Expenditure in Tshs.
Project Implementation Remarks
Please fill in this section if there are any additional information on the project
Asante sana!
Thank you for your update.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms