Attachment_6d_Water Protocol_2024JULY16

Attachment 6d

Water Collection Protocol

Attachment 6d: Water Collection Protocol 

Form Approved

OMB No. 0920-0950

Exp. Date XX/XX/20XX

Notice – CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS H21-8, Atlanta, GA 30333; ATTN: PRA (0920-0950).

Assurance of Confidentiality – We take your privacy very seriously.  All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.  NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act or CIPSEA (44 U.S.C. 3561-3583).  In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151 note) which protects Federal information systems from cybersecurity risks by screening their networks.

 

 

Preloads Needed 

 

ADDRESS

{STREET ADDRESS, CITY, STATE, ZIP CODE}

HHROSTER:  

HOUSEHOLD ROSTER MEMBERS WHO ARE 18 YEARS OR OLDER (ALL HOUSEHOLD
MEMBERS DETERMINED TO BE 18+ IN THE SCREENER THROUGH SCQAGE, SCQAGEEST,
AND SCQAGEREF)

INTERPRETERS:

INTERPRETER NAMES FROM SCREENER

WCQSLCTR
ASK	ALL RESPONDENTS
SELECT RESPONDENT FOR THE WATER COLLECTION FOR <TEXT FILL 1>.
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS	TEXT FILL 1: FILL {STREET ADDRESS, CITY, STATE, ZIP CODE}.
NOTES	DISPLAY HOUSEHOLD ROSTER MEMBERS WHO ARE 18 YEARS OR OLDER, AND ‘SOMEONE NOT LIVING IN HH’ AS OPTION.IF THE NAMES WERE UPDATED SINCE THE SCREENER USE THE UPDATED NAMES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.006
NEXT	WCQRDON/WCQPER

WCQRDON/WCQRPER
ASK	ALL RESPONDENTS
IS THIS RESPONDENT THE SAME RESPONDENT WHO COMPLETED ANOTHER INTERVIEW TODAY SUCH AS AN SP INTERVIEW OR A HOUSEHOLD INTERVIEW? YES NO HAS THIS RESPONDENT CONSENTED TO BEING RECORDED IN EITHER OF THOSE INTERVIEWS CONDUCTED TODAY? YES NO
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES	DISPLAY WCQRDON. IF WCQRDON = 1, DISPLAY WCQRPER.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	New
NEXT	IF WCQSLCTR: ‘SOMEONE OUTSIDE HOUSEHOLD’ SELECTED AS RESPONDENT’: WCQROHH ELSE: WCQINT.

WCQROHH/ WCQROHHO
ASK	IF WCQSLCTR in {SOMEONE OUTSIDE HOUSEHOLD’}
COLLECTION SHOULD BE CONDUCTED WITH HOUSEHOLD MEMBER 18 YEARS OR OLDER WHO KNOWS ABOUT HOUSEHOLD MATTERS. WHY IS THE COLLECTION BEING CONDUCTED WITH SOMEONE OUTSIDE THE HOUSEHOLD? 1. ONLY HOUSEHOLD MEMBER HAS COGNITIVE PROBLEMS 2. ‘SOMEONE OUTSIDE THE HOUSEHOLD’ SELECTED IN ERROR 3. OTHER (SPECIFY)
SPANISH	N/A
QUESTION TYPE	WCQROHH: Radio button WCQROHHO: Text box (“Other specify”)
FILLS
NOTES	IF WCQROHH IS 3, DISPLAY ON SCREEN WCQROHHO: WHY IS THE COLLECTION BEING CONDUCTED WITH SOMEONE OUTSIDE THE HOUSEHOLD? CHARACTER LIMIT FOR OTHER SPECIFY: 500.
HELP SCREEN
HARD CHECK	IF 'SOMEONE OUTSIDE THE HOUSEHOLD' SELECTED IN ERROR (CODE 2), DISPLAY THE FOLLOWING MESSAGE: "INCORRECT RESPONDENT SELECTED. BACK UP AND PICK THE CORRECT RESPONDENT." ALLOW RETURN TO WCQROHH.
SOFT CHECK
VERSION NOTES	RIQ.041
NEXT	WCQSUPERM

WCQSUPERM
ASK	IF WCQROHH in (1) OR (3)
DO YOU HAVE SUPERVISOR PERMISSION TO CONDUCT THE COLLECTION WITH SOMEONE OUTSIDE THE HOUSEHOLD? 1. YES 2. NO
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES	IF 'NO' (CODE 2), DISPLAY THE FOLLOWING MESSAGE: "SUPERVISOR PERMISSION IS REQUIRED TO USE A PROXY FOR THIS COLLECTION." PRESS EXIT TO BREAK OFF INTERVIEW TO GET SUPERVISOR PERMISSION.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.042
NEXT	IF WCQSUPERM in {1}: WCQRNAME IF WCQSUPERM in {2}: TOUCHING ‘EXIT’ BREAKS OFF INSTRUMENT AT THIS MODULE. ALLOW RETURN TO WCQSUPERM AFTER SUPERVISOR PERMISSION IS OBTAINED..

WCQRFNAME / WCQRLNAME
ASK	IF WCQSUPERM in (1)
ENTER RESPONDENT NAME. FIRST NAME [WCQRFNAME] LAST NAME [WCQRLNAME]
SPANISH	N/A
QUESTION TYPE	Textboxes
FILLS
NOTES	WCQRFNAME : ALLOW 50 CHARACTERS WCQRLNAME : ALLOW 50 CHARACTERS
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.045a/b
NEXT	WCQRPHONE

WCQRPHONE
ASK	IF WCQSUPERM in (1)
ENTER RESPONDENT'S PHONE NUMBER. ENTER '000' IN AREA CODE IF NO PHONE. |___|___|___| |___|___|___| - |___|___|___|___| AREA CODE ENTER PHONE NUMBER 999 DON’T KNOW 777 REFUSED
SPANISH	N/A
QUESTION TYPE	Numeric
FILLS
NOTES
HELP SCREEN
HARD CHECK	ONLY ALLOW "000" OR 10-DIGIT PHONE NUMBER.” DISPLAY HARD RANGE CHECK MESSAGE IF NOT "000" OR 10 DIGITS THAT ARE NOT ALL THE SAME (I.E., 1111111111): ‘PLEASE ENTER A VALID PHONE NUMBER’.
SOFT CHECK
VERSION NOTES	RIQ.047
NEXT	WCQRRELAHH

WCQRRELAHH
ASK	IF WCQSUPERM in (1)
DESCRIBE RESPONDENT'S RELATIONSHIP TO HOUSEHOLD. 99 DON’T KNOW 77 REFUSED
SPANISH	N/A
QUESTION TYPE	Textbox
FILLS
NOTES	ALLOW 100 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.049
NEXT	WCQINT

WCQINT
ASK	ALL RESPONDENTS
IS AN INTERPRETER BEING USED FOR THE COLLECTION? 1. YES 2. NO
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.001
NEXT	IF WCQINT in (1): WCQINTL IF WCQINT in (2): IF WCQRPER in (1): WCQRECREM ELSE WCQRECORD:

WCQINTL
ASK	IF WCQINT in (1)
LANGUAGE USED FOR THE COLLECTION 1. AMERICAN SIGN LANGUAGE 2. CHINESE (CANTONESE) 3. CHINESE (MANDARIN) 4. FRENCH 5. GERMAN 6. ITALIAN 7. JAPANESE 8. KOREAN 9. RUSSIAN 10. SPANISH (READER) 11. VIETNAMESE 90. OTHER SPECIFY
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.003
NEXT	IF WCQINTL in (90): WCQINTLO ELSE: WCQINTOI

WCQINTLO
ASK	IF WCQINTL in (90)
ENTER LANGUAGE USED FOR THE COLLECTION.
SPANISH	N/A
QUESTION TYPE	Textbox
FILLS
NOTES	ALLOW 50 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.004
NEXT	WCQINTOI

WCQINTOI
ASK	IF WCQINT in (1)
INTERPRETERS USED IN SCREENER: <TEXT FILL 1> SELECT SOURCE 1. SAME INTERPRETER USED IN SCREENER 2. NEW INTERPRETER
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS	TEXT FILL 1: DISPLAY INTERPRETER NAMES FROM SCREENER
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.013
NEXT	IF WCQINTOI in (1): WCQINTNUM IF WCQINTOI in (2): WCQINTOB

WCQINTOB
ASK	IF WCQINTOI in (2)
HOW WAS INTERPRETER OBTAINED? 1. ARRANGED BY THE OFFICE 2. RECRUITED DURING VISIT OR APPOINTMENT
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.005
NEXT	IF WCQINTOB in (1): WCQINTNOFC IF WCQINTOB in (2): WCQINTOBS

WCQINTNOFC
ASK	IF WCQINTOB in (1)
ENTER FIRST AND LAST NAME OF INTERPRETER HERE
SPANISH	N/A
QUESTION TYPE	Text Box
FILLS
NOTES	ALLOW 150 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.006
NEXT	WCQINTNUM

WCQINTOBS
ASK	IF WCQINTOB in (2)
SELECT INTERPRETER SOURCE 1. RELATIVE LIVING IN HOUSEHOLD 2. NON-RELATIVE LIVING IN HOUSEHOLD 3. NEIGHBOR, RELATIVE OR FRIEND – NOT IN HOUSEHOLD
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.007
NEXT	IF WCQINTOBS in (3): WCQINTOBSN ELSE WCQINTOBSHHR

WCQINTOBSHHR
ASK	IF WCQINTOBS in (1) OR (2)
SELECT NAME OF INTERPRETER FROM HOUSEHOLD ROSTER. <TEXT FILL 1>
SPANISH	N/A
QUESTION TYPE	Dropdown
FILLS	TEXT FILL 1: {DISPLAY LIST OF ADULTS 18+ FROM HH ROSTER}
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.008
NEXT	WCQINTNUM

WCQINTOBSN
ASK	IF WCQINTOBS in (3)
ENTER FIRST AND LAST NAME OF INTERPRETER.
SPANISH	N/A
QUESTION TYPE	Textbox
FILLS
NOTES	ALLOW 150 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	INT.009
NEXT	WCQINTNUM

WCQINTNUM
ASK	IF WCQINT in {1}
ENTER PHONE # OF INTERPRETER. ENTER '000' IN AREA CODE IF NO PHONE. |___|___|___| |___|___|___| - |___|___|___|___| AREA CODE ENTER PHONE NUMBER 999 DON’T KNOW 777 REFUSED
SPANISH	Spanish translation goes here
QUESTION TYPE	Numeric
FILLS
NOTES
HELP SCREEN
HARD CHECK	ONLY ALLOW "000" or 10 DIGIT PHONE NUMBER.” DISPLAY HARD RANGE CHECK MESSAGE IF NOT "000" or 10 DIGITS THAT ARE NOT ALL THE SAME (I.E., 1111111111): ‘PLEASE ENTER A VALID PHONE NUMBER’.
SOFT CHECK
VERSION NOTES	INT.010
NEXT	IF WCQRPER in (1) WCQRECREM ELSE WCQRECORD:

WCQRECORD
ASK	IF (WCQRDON = 1 AND WCQRPER) in {2} OR WCQRDON = 2
We would like to record this collection for training and data quality. The computer is now recording our conversation. Do I have your permission to continue recording? 1. YES 2. NO
SPANISH	Nos gustaría grabar la conversación sobre esta obtención de muestra de agua para fines de capacitación y la calidad de los datos. La computadora está grabando nuestra conversación ahora. ¿Tengo su permiso para seguir grabando? 1. YES 2. NO
QUESTION TYPE	Radio button
FILLS
NOTES (ENG)	IF WCQRECORD in (2) ‘NO’, STOP RECORDING AND DISPLAY A MESSAGE: INTERVIEWER INSTRUCTION: INFORM THE RESPONDENT: “I will turn off the recording now.”
NOTES (SPA)	IF WCQRECORD in (2) ‘NO’, STOP RECORDING AND DISPLAY A MESSAGE: INTERVIEWER INSTRUCTION: INFORM THE RESPONDENT: “Apagaré la grabación ahora.”
HELP SCREEN (ENG)	How long will the recording be kept? The audio recording will be deleted after three years. You can call our toll free number 800-344-1386 at any time to have your audio recording deleted prior to that time." Who will have access to my recordings? Recordings are only used by persons authorized to work on NHANES for reviewing the quality of my work and tools and questionnaires used in the survey.
HELP SCREEN (SPA)	¿Cuánto tiempo se conservará la grabación? La grabación de audio se borrará después de tres años. Puede llamar a nuestra línea gratuita al 800-344-1386 en cualquier momento si quiere que la borremos antes." ¿Quién tendrá acceso a mis grabaciones? Las grabaciones solo son usadas por las personas autorizadas a trabajar en la Encuesta Nacional de Examen de la Salud y Nutrición (NHANES), para revisar la calidad de mi trabajo y las herramientas y cuestionarios que se usan en la encuesta.
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.211
NEXT	WCQWCC

WCQRECREM
ASK	IF (WCQRDON = 1 AND WCQRPER in {1})
A reminder that the computer is now recording our conversation. Do I have your permission to continue recording? 1. YES 2. NO
SPANISH	Le recuerdo que la computadora está grabando nuestra conversación ahora. ¿Tengo su permiso para seguir grabando? 1. YES 2. NO
QUESTION TYPE	Radio button
FILLS
NOTES	IF WCQRECREM in (2) ‘NO’, STOP RECORDING AND DISPLAY A MESSAGE: INTERVIEWER INSTRUCTION: INFORM THE RESPONDENT: “I will turn off the recording now.”
HELP SCREEN (ENG)	How long will the recording be kept? The audio recording will be deleted after three years. You can call our toll free number 800-344-1386 at any time to have your audio recording deleted prior to that time." Who will have access to my recordings? Recordings are only used by persons authorized to work on NHANES for reviewing the quality of my work and tools and questionnaires used in the survey.
HELP SCREEN (SPA)	¿Cuánto tiempo se conservará la grabación? La grabación de audio se borrará después de tres años. Puede llamar a nuestra línea gratuita al 800-344-1386 en cualquier momento si quiere que la borremos antes." ¿Quién tendrá acceso a mis grabaciones? Las grabaciones solo son usadas por las personas autorizadas a trabajar en la Encuesta Nacional de Examen de la Salud y Nutrición (NHANES), para revisar la calidad de mi trabajo y las herramientas y cuestionarios que se usan en la encuesta.
HARD CHECK
SOFT CHECK
VERSION NOTES	RIQ.200
NEXT	WCQWCC

WCQWCC
ASK	ALL RESPONDENTS
NHANES is studying the water used in people’s homes for fluoride. I would like to collect about an ounce of tap water for our study. May I please collect a water sample from the water source you use for drinking and cooking? 1. YES 2. NO
SPANISH	NHANES estudia el agua que se usa en los hogares para detectar la presencia de fluoruro. Quisiera recolectar aproximadamente una onza de agua de la llave para nuestro estudio. ¿Podría recolectar una muestra de agua de donde obtiene agua para beber y cocinar? 1. YES 2. NO
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN (ENG)	NHANES collects water to test for fluoride levels. The proper amount of fluoride helps prevent and control tooth decay in children and adults.    Potential sources of fluoride exposure include:  Toothpaste,   Drinking water in fluorinated communities,   Beverages and food processed with fluorinated water,   Dietary prescription supplements that include fluoride (e.g., tablets or drops), and   Other professional dental products such as mouth rinses, gels, and foams.     In the U.S., water can provide approximately 75% of a person’s fluoride intake. The purpose of the NHANES fluoride study is to determine the fluoride concentration in households’ primary water consumption source.
HELP SCREEN (SPA)	NHANES recolecta agua para revisar los niveles de fluoruro. La cantidad adecuada de fluoruro ayuda a prevenir y controlar las caries dentales en niños y adultos.    Fuentes posibles donde las personas se exponen al fluoruro incluyen:  pasta dental;   agua potable en comunidades con agua fluorada;   bebidas y comidas procesadas con agua fluorada;   suplementos alimenticios de venta con receta que incluyen fluoruro (por ejemplo, comprimidos o gotas); y   otros productos dentales profesionales como enjuagues bucales, geles y espumas.     En Estados Unidos, el agua puede proporcionar alrededor del 75 % de la cantidad de fluoruro que una persona toma. El objetivo del estudio sobre el fluoruro de NHANES es determinar la concentración de fluoruro en la principal fuente de consumo de agua de los hogares.
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.010
NEXT	WCQADDR

WCQADDR
ASK	ALL RESPONDENTS
<TEXT FILL 1> <TEXT FILL 2> INTERVIEWER: IS THIS THE CORRECT ADDRESS? YES NO
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS (ENG)	TEXT FILL 1: IF WCQWCC in {1}:Before I collect the water, I want to make sure I have your correct address – what is your full address? IF WCQWCC in {2}: Even though we won’t collect water from your household, I want to make sure I have your correct address – what is your full address? TEXT FILL 2: FILL {STREET ADDRESS, CITY, STATE, ZIP CODE}.
FILLS (SPA)	TEXT FILL 1: IF WCQWCC in {1}:Antes de recolectar el agua, quiero asegurarme de tener su dirección correcta: ¿cuál es su dirección completa? IF WCQWCC in {2}: Aunque no vamos a recolectar agua de su hogar, quiero asegurarme de tener su dirección correcta: ¿cuál es su dirección completa? TEXT FILL 2: FILL {STREET ADDRESS, CITY, STATE, ZIP CODE}.
NOTES
HELP SCREEN
HARD CHECK	IF WCQADDR in {2}, DISPLAY: CLICK EXIT TO BREAK OFF THE INTERVIEW
SOFT CHECK
VERSION NOTES	New
NEXT	IF WCQADDR in (2}: EXIT OUT OF THE PROGRAM AND CODE AS WRONG ADDRESS IF WCQADDR in {1} AND WCQWCC in {2}: WCQWNC IF WCQWCC in (1) AND WCQADDR in {1}: WCQWCINS

WCQWCINS
ASK	IF WCQWCC in (1) AND WCQADDR in {1}
Water Collection Instructions Interviewer: Must collect the water sample yourself: Ask respondent to identify the faucet or tap water dispenser used most for drinking and cooking. If the household uses one tap source for drinking and a different tap source for cooking, choose the drinking source for collection. If only bottled water is used for cooking and drinking, still take a tap water sample from a faucet in the home. Do not take a water sample from bottled water. All samples must be tap water. Turn on the water. Let the water run for 10-15 seconds. (The first water out of the faucet or tap dispenser may have higher amounts of fluoride due to evaporation). Use the 32-ounce water container as needed to avoid spillage from the refrigerator. Remove the tube from the plastic bag and take the cap off the tube. Carefully fill the tube to the 25 mL line with water. Turn the water off. Screw the cap tightly on the tube. Turn the tube upside down to make sure it does not leak. If the tube does leak, then remove the cap and try tightening the cap again. Be sure the tube is filled to the 25 mL line with water. PRESS NEXT TO CONTINUE.
SPANISH	Instrucciones para la recolección de agua Interviewer:I Must collect the water sample yourself: Pida al/a la participante que identifique la llave o el dispensador de agua que más usa para beber y cocinar. Si en el hogar se usa una llave para beber y otra llave diferente para cocinar, elija el dispositivo de agua que se usa para beber en el momento de obtener la muestra. Si solo se usa agua embotellada para cocinar y beber, tome igualmente una muestra de agua de una llave del hogar. No tome una muestra de agua embotellada. Todas las muestras deben ser de agua de la llave. Abra la llave. Deje correr el agua durante 10 a 15 segundos (el primer chorro de agua que sale de la llave o del dispensador podría tener mayores cantidades de fluoruro debido a la evaporación). Use el recipiente de agua de 32 onzas de ser necesario para evitar derrames del refrigerador. Saque el tubo de la bolsa de plástico y quítele la tapa. Llene con cuidado el tubo con agua hasta la marca de 25 ml. Cierre la llave del agua. Cierre bien la tapa del tubo. Dé vuelta el tubo para asegurarse de que no gotee. Si el tubo gotea, retire la tapa y vuelva a intentar cerrarla bien. Asegúrese de que el tubo se haya llenado hasta la marca de 25 ml. PRESS NEXT TO CONTINUE.
QUESTION TYPE	Text Instructions with Images
FILLS
NOTES	PLEASE FIT AS MUCH OF THESE INSTRUCTIONS ON ONE PAGE. IF BREAKS ARE NEEDED, PLEASE DO NOT SPLIT A NUMBERED INSTRUCTION ACROSS TWO PAGES. INCLUDE THE INSTRUCTION TO PRESS ENTER TO CONTINUE.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	Hand Card – no previous variable.
NEXT	WCQWCCONF

WCQWCCONF
ASK	IF WCQWCC in (1)
HAS WATER BEEN COLLECTED FROM THE HOUSEHOLD? 1. YES 2. NO
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.020
NEXT	IF WCQWCCONF in (2): WCQWNC IF WCQWCCONF in (1): WCQLABEL1

WCQLABEL1
ASK	IF WCQWCCONF in (1)
ENTER 8-DIGIT BARCODE NUMBER. |___|___|___|___|___|___|___|___| WATER SAMPLE LABEL NUMBER
SPANISH	N/A
QUESTION TYPE	Numeric entry
FILLS
NOTES
HELP SCREEN
HARD CHECK	HARD EDIT: ENTRY MUST BEGIN WITH 2 AND MUST HAVE 8 DIGITS. DISPLAY THE FOLLOWING ERROR MESSAGE, “THE WATER SAMPLE ID MUST BEGIN WITH 2 AND MUST CONTAIN 8 DIGITS. PLEASE RE-ENTER ALL NUMBERS.” HARD EDIT: THE 8-DIGIT BARCODE MUST BE DIFFERENT FROM THE WATER SAMPLE BARCODE ENTERED FOR ANY OTHER CASE ON THE TABLET. DISPLAY THE FOLLOWING ERROR MESSAGE: “WATER SAMPLE ID IS ALREADY IN USE. PLEASE RE-ENTER ALL NUMBERS.”
SOFT CHECK
VERSION NOTES	WCQ.030
NEXT	WCQLABEL2

WCQLABEL2
ASK	IF WCQWCCONF in (1)
RE-ENTER 8-DIGIT BARCODE NUMBER. |___|___|___|___|___|___|___|___| WATER SAMPLE LABEL NUMBER
SPANISH	N/A
QUESTION TYPE	Numeric entry
FILLS
NOTES
HELP SCREEN
HARD CHECK	HARD EDIT: ENTRY MUST BEGIN WITH 2 AND MUST HAVE 8 DIGITS. DISPLAY THE FOLLOWING ERROR MESSAGE, “THE WATER SAMPLE ID MUST BEGIN WITH 2 AND MUST CONTAIN 8 DIGITS. PLEASE RE-ENTER ALL NUMBERS.” HARD EDIT: IF THE ENTRY DOES NOT MATCH THE ENTRY IN WCQLABEL1, DISPLAY THE FOLLOWING ERROR MESSAGE: “THE TWO ENTRIES DO NOT MATCH. PLEASE RE-ENTER THE 8-DIGIT BARCODE NUMBERS.” HARD EDIT: THE 8-DIGIT BARCODE MUST BE DIFFERENT FROM THE WATER SAMPLE BARCODE ENTERED FOR ANY OTHER CASE ON THE TABLET. DISPLAY THE FOLLOWING ERROR MESSAGE: “WATER SAMPLE ID IS ALREADY IN USE. PLEASE RE-ENTER ALL NUMBERS.”
SOFT CHECK
VERSION NOTES	WCQ.030
NEXT	WCQDT

WCQDT
ASK	IF WCQWCCONF in (1)
USING AN INK PEN, WRITE THE FOLLOWING ON THE GREEN LABEL:    HH ID: {HOUSEHOLD ID}  DATE: {YYYY-MM-DD}  TIME: {HH:MM}    PLACE THE WATER TUBE INTO THE SMALL PLASTIC BAG AND SEAL THE BAG.
SPANISH	N/A
QUESTION TYPE	Instructions
FILLS
NOTES	SYSTEM POPULATES THE HOUSEHOLD ID, AND THE DATE (YYYY-MM-DD) AND TIME (HH:MM, IN 24-HOUR FORMAT) AS THE SAMPLE LABEL IS SCANNED.      STORE THE DATE AND TIME IN WCQDT IN THE DATA BASE.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.040
NEXT	WCQWFIL

WCQWFIL
ASK	IF WCQWCCONF in (1)
Is there a whole house filtration system or a filter attached to the faucet or dispenser where the tap water was drawn? INTERVIEWER INSTRUCTION: VERIFY IF MENTIONED PREVIOUSLY. 1. YES 2. NO 9 DON’T KNOW 7 REFUSED
SPANISH	¿Hay un sistema de filtración para todo el hogar o un filtro integrado a la llave o al dispensador de donde se obtuvo el agua de la llave? INTERVIEWER INSTRUCTION: VERIFY IF MENTIONED PREVIOUSLY. 1. YES 2. NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN (ENG)	Water Filtration Devices: Any device intended to improve the safety and quality of water in the home.  There are seven main types of treatments: carbon filters, fiber filters, reverse osmosis units, neutralizers, chemical feed pumps, disinfection, and softeners.
HELP SCREEN (SPA)	Dispositivos de filtración de agua: Se refiere a cualquier dispositivo destinado a mejorar la seguridad y la calidad del agua en el hogar. Hay siete tipos principales de tratamientos: filtros de carbón, filtros de fibra, unidades de ósmosis inversa, neutralizadores, bombas de alimentación química, desinfección y ablandadores.
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.050
NEXT	WCQWTAP

WCQWTAP
ASK	IF WCQWCCONF in (1)
Is this home tap water used as a primary water source for drinking or cooking? INTERVIEWER INSTRUCTION: VERIFY IF MENTIONED PREVIOUSLY. 1. YES, BOTH DRINKING AND COOKING 2. YES, DRINKING ONLY 3. YES, COOKING ONLY 4. NO 9 DON’T KNOW 7 REFUSED
SPANISH	¿Se usa esta agua de la llave del hogar como fuente primaria de agua para beber o cocinar? INTERVIEWER INSTRUCTION: VERIFY IF MENTIONED PREVIOUSLY. 1. SÍ, TANTO PARA BEBER COMO COCINAR 2. SÍ, SOLO PARA BEBER 3. SÍ, SOLO PARA COCINAR 4. NO 9 DON’T KNOW 7 REFUSED
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.060
NEXT	WCQEND

WCQWNC
ASK	IF WCQWCCONF in (1)
ENTER THE REASON WATER WAS NOT COLLECTED. 1. SP REFUSED 2. SAMPLE LOST 3. INTERVIEW NOT CONDUCTED IN HOME 4. OTHER
SPANISH	N/A
QUESTION TYPE	Radio button
FILLS
NOTES
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.070
NEXT	IF WCQWNC in (4): WCQWNCO ELSE: WCQEND

WCQWNCO
ASK	IF WCQWNC in (4)
SPECIFY WHY THE WATER WAS NOT COLLECTED.
SPANISH	N/A
QUESTION TYPE	Textbox
FILLS
NOTES	ALLOW 100 CHARACTERS.
HELP SCREEN
HARD CHECK
SOFT CHECK
VERSION NOTES	WCQ.080
NEXT	WCQEND

WCQWNC

ASK

ALL RESPONDENTS WHO DO NOT EXIT OUT OF INTERVIEW

INTERVIEWER: YOU HAVE REACHED THE END OF THE INTERVIEW. TOUCH THE SUBMIT BUTTON BELOW TO FINALIZE CASE AND RETURN TO THE CASE MANAGEMENT SYSTEM.

SPANISH

N/A

QUESTION TYPE

Instructions

FILLS

NOTES

HELP SCREEN

HARD CHECK

SOFT CHECK

VERSION NOTES

WCQ.070

NEXT

END OF INTERVIEW

6d-14