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Follow Up Survey
Questionnaire
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* Indicates required question
Email
*
Your email
First and Last Name
*
Your answer
On a scale of 1-10 (10 most satisfied) how satisfied were you with the woodstove change out program overall?
1
2
3
4
5
6
7
8
9
10
Clear selection
How did you hear about the program?
Portola Reporter insert or ad
NSAQMD website
Participating woodstove retailer
Flyer
Radio/Social Media
Word of mouth
Door hanger
How was your experience with the application process?
Your answer
On a scale of 1-10 how satisfied were you with the participating retailer/contractor
Dissatisfied
1
2
3
4
5
6
7
8
9
10
Satisfied
Clear selection
What is your new heating device?
Woodstove
Pellet Stove
Propane Stove
Kerosene Monitor
Heat Pump
Clear selection
How/Where do you receive your source of fuel?
Your answer
On a scale of 1-10 (10 being most satisfied) how satisfied are you with your new heating device?
1
2
3
4
5
6
7
8
9
10
Clear selection
Do you notice a difference in the amount of fuel used in your new device compared to the old device?
Using more fuel
Using less fuel
Fuel amounts unchanged
How many cords of wood did you burn this past winter if using wood as fuel?
Your answer
Do you notice a difference in heat output efficiency in your home?
More heat output
Less heat output
Same heat output
Do you notice a difference in smoke emissions from your chimney?
Greater smoke emissions
Less smoke emissions
No noticeable difference in smoke emissions
Do you notice a difference in smoke emissions INSIDE of your home?
More smoke inside
Less smoke inside
No noticeable change in smoke inside
What motivated you to participate in this program (check all that apply)?
Improved energy efficiency
Improved outdoor air quality
Less time and energy handling wood
Improved safety
Improved indoor air quality
Low cost participation
Community Outreach Education
Would you be willing to share your experience with this program with others considering a woodstove change-out?
Yes
No
Option 2
Clear selection
Are you aware of the Clear the Air, Check Before You Light program in Portola?
Yes
No
Clear selection
What suggestions would you make to improve the program?
Your answer
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