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Household Environment Survey: Data Entry Form

To add your school's results to those of other schools, type the total number of responses for each answer category in the space provided and press the Verify button. A program will perform simple edit checks:

comparing the sum of all responses to certain questions to the number of households surveyed, and
ensuring that "skip patterns" in the questionnaire were followed.

For example, the sum of yes, no and don't know responses to question 10 should equal the number of households surveyed. Or, the sum of yes, no and don't know to question 26 should equal the number of no responses to question 25.

How many households did you survey?

[You must enter the total number of households surveyed.]

Access to recycling programs

Does this household have access to curbside recycling or recycling depots for:	No	Don't know	Yes
10. Paper?
12. Metal cans?
14. Glass bottles?
16. Plastics?
18. Special disposal programmes for hazardous products (paints,chemicals, batteries, etc.)?


Use of recycling programs	Yes	No
11. Paper
13. Metal cans
15. Glass bottles
17. Plastics
19. Special disposal programmes for hazardous products (paints, chemicals,batteries, etc.)


Use of disposable diapers
20. Are there any children under the age of two years living in this dwelling?	Yes	No

21. Are disposable diapers used for the child(ren)...	All of the time?
	Most of the time?
	Sometimes?
	Never?
	Child(ren) not in diapers


Other enviromental practices
	Yes	No	Don't know	Not Applicable
22. Does anyone in this household regularly purchase paper towels or toilet paper made from recycled paper?
23. Does anyone in this household regularly take their own shopping bag when shopping?
24. Is there a thermostat in this dwelling to control the temperature?
25. Is it a programmable thermostat? (i.e., the thermostat can be programmed to automatically raise or lower the temperature)

26. In the winter, does someone regularly lower the thermostat temperature setting at night or when leaving the home?

27. Does this dwelling have any screw-in energy efficient compact fluorescent light bulbs?
28. In this dwelling, is there a water saving, low flow or modified shower head?
29. In this dwelling, is there a water saving, low volume toilet or modified toilet tank? (Include brick, bottle, etc.)
30. Does this dwelling have a purifier or filter for drinking water? (Attached to a tap or as a stand alone container)
31. In the last four weeks, has anyone in this household purchase bottled water for drinking at home?
32. Does this dwelling have a yard, lawn or garden?

In the last twelve months, did anyone, including commercial operators, apply the following chemicals to the yard, lawn or garden:
33. Pesticides?
34. Fertilizers?

35. Does this household use a compost heap, compost container or composting service?

Principal method of travel to work
36. Last week, did any household members travel to work outside the home? (Include part-time work.)	Yes	No
How many of these people used the following as their principal method of travel to work last week:
37. Public transit?
38. Motor vehicle as driver?
39. Motor vehicle as passenger?
40. Bicycle?
41. Walk only?
42. Other? (Include motorcycles)