1. Peridomestic: | a) Cement tank | b) Broken glass | |
c) Tires | d) Other | ||
2. Domestic: | a) Tanks | b) Earthen and plastic drum | |
c) Plastic bucket | d) Metallic container | e) Other | |
3. External: | a) Tanks | b) Tree hole | |
c) Coconut shell | d) Others | ||
4. Larva containing sample No.: | |||
5. Larva sample volume: | |||
6. Sample examination report: | |||
a) Larva | b) Pupa |