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PLANO MUNICIPAL DE SANEAMENTO BÁSICO
ESTÂNCIA - SE
QUESTIONÁRIO
ENTREVISTADO
Local:
Data:
Hora:
Nome:
Sexo:
Atividade / profissão:
Idade:
GERAL
área urbana
Onde você mora?
Centro
Cidade Nova
Porto de Areia
São Jorge
Botequim
Qual o seu bairro?
área rural
litoral
Colônia Rio Fundo 3
Colônia Entre Rios
Colônia Mato Grosso
Colônia São José
Colônia Vertente
Colônia Ranchão do Teté
Colônia Estancinha
Farnaval
Praia de Abaís
Porto do Mato
Outro:
Há iluminação pública?
não
sim, está adequada
sim, mas insuficiente (luz fraca,
poucos postes, falta manutenção)
Assinale quais equipamentos
públicos existem no bairro
( ) escola ( ) posto saúde ( ) creche ( ) outro
você ou alguém da sua família
teve alguma destas doenças
( ) dengue ( ) febre amarela ( ) hepatite A ( ) leptospirose
( ) diarreia frequente ( ) nenhuma ( ) Outro:
O agente de saúde visita sua
família com qual frequência?
( ) uma vez ao ano ( ) uma vez por semestre ( ) uma vez a cada 2 meses
( ) uma vez ao mês ( ) uma vez por semana ( ) nunca visitou
( ) Outro:
Você considera a frequência
suficiente?
( ) sim ( ) não
Já fez alguma atividade de
conscientização sobre
saneamento básico?
Se sim, qual? Quem
realizou a atividade?
(descrever)
( ) sim ( ) não
ABASTECIMENTO DE ÁGUA
Qual a fonte de água que
abastece sua residência?
( ) água da rede ( ) poço raso (cacimba) ( ) poço tubular profundo
( ) rio ou nascente ( ) não sei ( ) Outro:
A água é de boa qualidade?
( ) sim ( ) regular ( ) não ( ) não sei
Há falta d'água?
( ) somente na época de seca ( ) toda semana ( ) todo mês ( ) não falta água nunca
página 1/2
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PMSB Estância - SE_ Plano de Mobilização _ Junho de 2014
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ESGOTAMENTO SANITÁRIO
Sua residência possui banheiro?
( ) vala ou rio ( ) fossa rústica (buraco com tampa)
( ) fossa séptica (fossa+filtro anaeróbio) ( ) Outro:
Se o esgoto não vai para a rede
de coleta, qual o destino?
Há pontos de esgoto a céu
aberto próxima da sua casa?
Se possui banheiro, o
esgoto de sua residência ( ) sim ( ) não ( ) não sei
vai para a rede municipal?
( ) sim ( ) não
( ) sim ( ) não ( ) não sei
Se sim, onde? (descrever)
LIMPEZA URBANA E MANEJO DE RESÍDUOS SÓLIDOS
Há coleta do lixo domiciliar?
Qual a freqûencia?
A frequencia de coleta de lixo é
adequada?
Se o lixo não é coletado, qual o
destino?
Como é o pavimento da sua rua?
( ) não há coleta ( ) 1 vez por semana ( ) 2 a 3 vezes por semana ( ) todos os dias
Há coleta seletiva (material
reciclável)?
( ) sim ( ) não
( ) jogado no córrego / rio / mar ( ) enterrado
(
) asfalto ( ) paralelepípedo (
(
) queimado
) terra ( ) Outro:
Existe sistema de drenagem na
via onde mora?
( ) sim ( ) não
Houve deslizamento de terra nas
redondezas?
( ) sim ( ) não
Quando? Houve vítimas?
Há ocorrência de alagamentos?
( ) sim ( ) não
Onde? Qual a frequência?
Houve vítimas?
( ) bueiros
( ) sim ( ) não
( ) boca de lobo ( ) canaleta ( ) Outro:
CONCLUSÃO
Você já participou de alguma
atividade do Plano de Municipal
de SaneAmento Básico de
Estância?
( ) sim ( ) não
( ) não, mas pretendo participar da próxima atividade
(descrever em ordem de prioridade)
Quais os maiores problemas a
serem solucionado na sua
região?
(coloque sua opinião, críticas e sugestões)
Observações:
página 2/2
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