Environmental Health Survey
Español: https://forms.gle/M8NrXa31XNe5PJqi6

English:
Here on St. Paul's West Side, our health is tied to our environment: our homes, the air on our block, our water, our soil. We want to learn what the most pressing health and environmental concerns of our neighbors are, so we can create positive changes. Your answers help us identify risk factors in your home and neighborhood that affect your health.

Not all questions are required, but we ask that you share as much as you are able. All information will remain confidential.

This survey is conducted by the West Side Community Organization in coordination with Minnesota Community Care. Questions? Contact Ellie at elliel@wsco.org.
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Email *
Name (optional)
Address or nearest intersection *
Please describe your race
Please describe your gender identity
What is your approximate household income?
How long have you lived in your current housing?
What kind of housing do you live in?
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Please chose the option that best describes you
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How do you heat your space? (check all that apply)
How do you cool your space? (check all that apply)
Which of the following do you have available to help with airflow in your space? (check all that apply)
What signs of moisture have you noticed in your space? (check all that apply)
Which of the following do you have in your space? (check all that apply)
Do you know of exposure to any of the following in your space? (check all that apply)
Do you have problems with any pests in your space? (check all that apply)
Have you consistently experienced any of the following symptoms inside of your space? (check all that apply)
Do your symptoms improve after leaving the property?
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Has anyone in your space been diagnosed with any of the following? (check all that apply)
Are you located near any environmental hazards that you know of? (check all that apply)
In your opinion, what are the biggest environmental hazards on the West Side? *
Have you notified your landlord about an issue? If yes, which issue (i.e. mold, pests) and how did they respond?
Is there anything else you wish this survey had asked that you would like to share?  Is there a story about one of the issues on here (such as asthma getting worse, cloudy drinking water, etc.) that you would like to share with us?  
Are you interested in volunteering with neighbors to improve health and environmental issues on the West Side? *
Contact info (optional): Please share your phone or email if you'd like to connect with the West Side Community Organization!
How did you hear about this survey?
Thank you for participating!

We will use these responses to better understand what environmental hazards affect our neighbors and use this information to advocate for you!

To learn more about WSCO or to get involved, please visit our website: https://www.wsco.org/

To access a free home radon test kit follow this link: https://www.co.dakota.mn.us/HealthFamily/HealthyLiving/Environment/Pages/test-your-home-for-radon.aspx

To access a free home lead test kit follow this link: https://www.stpaul.gov/departments/saint-paul-regional-water-services/about-your-water/lead#free-lead-testing


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