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Sustainability in your household!
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* Indicates required question
Would you be okay if we used your responses anonymously in a blog post?
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Yes
No
I need more information
What is your name
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Your answer
Your contact information (this will not be shared publicly)
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Your answer
Would you be okay being contacted for follow up information if needed?
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Yes
No
Maybe
Do you own your home?
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Yes
No
Other:
Where is your house located?
Your answer
Do you live in a building that shares a roof with other households (apartment, shared living space, etc)
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Yes
No
Other:
What practices do you implement to make your home more sustainable? (regarding energy, waste, water, etc.)
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Your answer
Check all the apply to your home/household
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Solar/renewable energy on your property
Clean energy coming from an outside source (ex. MCE deep/light green)
Recycling
Compost
Drive an electric vehicle
Energy efficient light bulbs (LED's)
Double pane windows
Carpooling
Other:
Required
What is your main source of transportation?
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Car
Bike
Carpool
Public transit
Other:
Are you currently working on anything now to become more environmentally friendly?
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Your answer
What is keeping you from becoming making your household more sustainable? (money, time, space, etc.)
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Your answer
What sustainable aspect is the biggest challenge in your household?
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Reduction of waste (recycling, composting, reduction of plastics & non renewables)
Reduction of energy (solar panels, more windows, proactively turning off the lights, unplugging devices)
Reduction of water (low flow sinks/toilets/showers, generally conserving water)
Do you know what passive design is?
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Yes
No
Maybe
If yes, what kind of passive design strategies are implemented in your home?
Your answer
Would you be interested in learning more about passive design?
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Yes
No
Maybe
Have you checked your water quality recently? (within the last year)
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Yes
No
Is your home in close proximity to a highway / powerplant / factory?
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Yes
No
Other:
Do you have access to clean drinking water?
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Yes
No
Has your household had any type of lead exposure (a toxic pollutant found in tap water / paint)?
Yes
No
Clear selection
Is it hard to breathe / live in your house because of an abundance of air borne pollutants and greenhouse gases?
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Yes
No
I am unaware if there are any air borne pollutants in my house
Could you describe any unhealthy living conditions (such as lead poisoning, asthma, etc)due to the sustainability of your house? (if none write NA)
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Your answer
Is your house LEED certified?
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Yes
No
I don't know what that is
Is there anything else you want to tell us about your home?
Your answer
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