522 – Post-Assessment Report
Community:
Country:
Chapter:
Project ID(s):
Submittal Date:
Dates Traveled:
Authors:
Acknowledgements
The Project Leads and Mentor Team acknowledge that:
(Please initial each line item to acknowledge that each line item has been completed.)
The chapter reviewed the accompanying 522 – Post-Assessment Report Instructions
for accurate completion of this report
This was the first assessment trip for the program, the 901 – Program Plan and
Baseline Study was completed by the PMEL lead and is submitted as a separate
document with this report.
or
This was not the first assessment trip for the project, the 901B – Program Impact and
Monitoring Report was completed by the PMEL lead and it is submitted as a separate
document with this report.
The PMEL lead completed the 905 – Program Logic Framework and included it as an
appendix to the 901 or 901B report.
The team has included the signed 902 – Project Partnership Agreement as an
appendix to this report.
The most current contact information is updated in this report and all other reports
included with this submittal.
If there were any health and safety incidents during the trip, a completed 612 - Incident
Report document is included as a separate document with this report.
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 1 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
Revised 11/2015
We, the project team leadership confirm that the above information and tasks have been
completed and that this report accurately reflects our chapter’s collected data and other
activities during the assessment trip.
_________________________________________________________________________________________________________________________________________
Project Lead Printed Name
Project Lead Signature
Date
_____________________________________________________________________________________________________________________________ ____________
Mentor Printed Name
Mentor Signature
Date
Or
_________________________________________________________________________________________________________________________________________
Faculty Advisor Printed Name
Faculty Advisor Signature
Date
It is the responsibility of the Responsible Engineer In Charge (REIC) to ensure that the team’s
Post-Assessment report meets reasonable standard of care for a project of this type. I have
reviewed the subject document. I am qualified by education and experience to perform the
assessment and design for this type of project. In my best engineering judgement,
___ The data collected on this assessment trip will allow the chapter to develop a complete and
comprehensive design which will meet a reasonable standard of care for a facility of this type,
Or (please delete the statement that does not apply)
____Additional data will be collected during a follow-up assessment trip because the data
collected are too preliminary for a final design.
_________________________________________________________________________________________________________________________________________
REIC Printed Name
REIC Signature
© 2015 Engineers Without Borders USA. All Rights Reserved
Date
Page 2 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
Revised 11/2015
Table of Contents
Part I –Administrative Information .............................................................................................. 4
1.0
Contact Information...................................................................................................... 4
2.0
Budget ......................................................................................................................... 5
2.1
Project Budget .......................................................................................................... 5
2.2
Professional Mentor Team Hours ............................................................................. 5
3.0
Project Discipline(s) ..................................................................................................... 6
Part II – Pre-Assessment Report – Technical Information .......................................................... 7
1.0
Executive Summary ..................................................................................................... 7
2.0
Project Description ....................................................................................................... 7
3.0
Trip Description............................................................................................................ 7
4.0
Data Collection And Analysis ....................................................................................... 7
4.1
Site Mapping ............................................................................................................ 7
4.2
Technical Data Collection ......................................................................................... 7
4.3
Monitoring and Evaluation Data................................. Error! Bookmark not defined.
5.0
Photo Documentation .................................................................................................. 8
6.0
Lessons Learned ......................................................................................................... 9
7.0
Project Phase .............................................................................................................. 9
8.0
EWB-USA Project Monitoring ...................................................................................... 9
8.1
EWB-USA Project Status Table ................................................................................ 9
8.3
Periodic Maintenance Indicators..............................................................................10
8.5
Additional Monitoring Information ............................................................................10
Appendices ...............................................................................................................................11
Appendix A – Signed 902 – Project Partnership Agreement ..................................................11
Appendix B – 612 – Incident Report ......................................................................................11
Appendix C – List of Locally Available Material Costs............................................................11
Appendix D – Additional Information Collected ......................................................................11
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 3 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
Revised 11/2015
Part I –Administrative Information
1.0
Contact Information
Correspondence regarding report reviews will be sent to the emails listed below.
Project Title
T Name
r
a
v
e
l
Email
Phone
Chapter Name
or Organization
Name
Project Lead
Additional
Project Lead (if
applicable)
President
Responsible
Engineer in
Charge
Traveling
Mentor
Faculty Advisor
(if applicable)
Planning,
Monitoring,
Evaluation and
Learning (PMEL)
Lead
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 4 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
2.0
Revised 11/2015
Budget
Insert the 508 - EWB-USA Trip Budget Worksheet into this section of the report only including
financials pertaining to this trip. Please provide explanation if required below. If it is desired to
include further budget details for this trip please include in an appendix to this report.
2.1
Project Budget
2.2
Professional Mentor Team Hours
This information helps EWB-USA report its annual value.
Name(s) of Professional Mentor(s) Pre-trip
hours
1.
2.
3.
During trip
hours
© 2015 Engineers Without Borders USA. All Rights Reserved
Post-trip
hours
Total
Hours
Page 5 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
3.0
Revised 11/2015
Project Discipline(s)
Check the specific project discipline(s) addressed in this report. Check all that apply.
Water Supply (Project Type)
____ Source Development (Project Discipline)
____ Water Storage
____ Water Distribution
____ Water Treatment
____ Water Pump
Sanitation
____ Latrine
____ Gray Water System
____ Black Water System
____ Solid Waste Management
Structures
____ Bridge
____ Building
____ Retaining Wall
Civil Works
____ Roads
____ Drainage
____ Dams
Energy
____ Fuel
____ Electricity
Agriculture
____ Irrigation Pump
____ Irrigation Line
____ Water Storage
____ Soil Improvement
____ Fish Farm
____ Crop Processing Equipment
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 6 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
Revised 11/2015
Part II – Pre-Assessment Report – Technical Information
(Please provide pertinent figures, tables, and photographs with figure numbers, table numbers
and photograph numbers in the section where discussed. Full drawing sets, complete lab
reports, and any information larger than 2 pages should be included at the end of the report as
an appendix.)
1.0
Executive Summary
2.0
Project Description
3.0
Trip Description
4.0
Data Collection And Analysis
4.1
Site Mapping
(Highly Recommended)
4.2
Technical Data Collection
(Highly Recommended)
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 7 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
5.0
Revised 11/2015
Photo Documentation
Label each photo with a photo number and give a full description.
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 8 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
6.0
Lessons Learned
7.0
Project Phase
Assessment Continues
8.0
Revised 11/2015
Design
Cancelled
EWB-USA Project Monitoring
8.1
EWB-USA Project Status Table
List all completed and current projects within program, for incomplete projects leave last four
columns blank.
Project Project
ID
Type
Project
Date of
Functionality
Periodic
Discipline(s) Completion (check one range Maintenance
(list all in one (mm/dd/yy) per project)
(yes or no)
05176cell)
50%
75%
Demonstration
of Community
Capacity
(yes or no)
100%
8.2
EWB-USA Project Functionality Indicators
Include 3 indicators per project type. Include monitoring results or explain the condition before
any EWB-USA implementation.
Project ID Project
Type
Project Functionality Indicator
(select from document 906)
Monitoring Result (include baseline
data where applicable)
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 9 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
Revised 11/2015
8.3
Periodic Maintenance Indicators
Include 3 indicators per project type. Include a monitoring result or explain the condition before
any EWB-USA implementation.
Project ID Project
Type
Periodic Maintenance Indicator
(select from document 906)
Monitoring Result (include baseline
data where applicable)
8.4
Periodic Maintenance Indicators
Include 3 indicators per project type. Include a monitoring result or explain the condition before
any EWB-USA implementation.
Project ID Project
Type
8.5
Community Capacity Indicator
(select from document 906)
Monitoring Result (include baseline
data where applicable)
Additional Monitoring Information
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 10 of 11
522 – Post-Assessment Report
Name of Chapter
Country, Community, Project Id(s)
Revised 11/2015
Appendices
Appendix A – Signed 902 – Project Partnership Agreement
(Required)
Appendix B – 612 – Incident Report
(If Applicable)
Appendix C – List of Locally Available Material Costs
(Highly Recommended)
Appendix D – Additional Information Collected
(Suggested)
© 2015 Engineers Without Borders USA. All Rights Reserved
Page 11 of 11