Request edit access
Green Lents Air Quality Survey
The intent of this survey is to gauge respondents' exposure to and knowledge of air toxics in their neighborhood.

Your e-mail address will not be shared or used in any way without your consent.
Email address *
How would you rate the air quality in your neighborhood?
Please elaborate on your previous response.
Your answer
How would you say your air quality compares to other parts of the city?
Are you aware of any of the following facilities located in your neighborhood?
How long have you and/or your family lived in this area?
Do you believe air pollution has negatively affected the health or well-being of you or your family? If so, how?
Your answer
What are your primary modes of transportation? Select all that apply.
On average, how much time do you spend outdoors in your neighborhood?
Do you engage in any of the following activities in your neighborhood?
Please indicate if you would like free respirator masks, air filters or to borrow a home air quality monitor.
Would you like to receive updates from Green Lents about ways to get involved in air quality advocacy?
Next
Never submit passwords through Google Forms.
This form was created inside of Green Lents. Report Abuse