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28th District O'Hare Air Traffic Complaint Form
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First Name
*
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zipcode
*
Your answer
Home Phone (including area code)
Your answer
Cell/Alternate Phone (including area code)
Your answer
E-mail address
*
Your answer
Whom do you believe to be responsible for the problem?
Your answer
NATURE OF COMPLAINT
Noise Pollution
For the purposes of this section, noise pollution and noise interference relate to situations where normal conversations are impossible or impedes activities such as sleep.
Has the added air traffic increased the noise around your residence?
No
Yes
Clear selection
How often do you experience noise interference at your residence? (times per day)
Your answer
How long does the noise interference occur? (minutes)
Your answer
Please provide airplane ID numbers for the disturbances, if possible.
Airplane ID numbers can be found on the bottom or side of a plane and are generally visible from ground while planes are ascending or descending in flight.
Your answer
Environmental Pollution
What environmental problems are you experiencing as a result of the increased air traffic in your community?
Please check all that apply.
Dust/particulates
Emissions
Oily residue
Odor
Open dumping
Other:
At what frequency do you notice the environmental contaminants that are affecting your community?
Daily
Weekly
Less frequently than weekly
Other:
Has the environmental pollution damaged your property?
No
Yes
Clear selection
If you answered yes to the previous question, please explain how your property has been damaged in the comment field below.
Your answer
Public Health
Has the problem affected your health?
No
Yes
Don't Know
Clear selection
If you answered yes to the previous question, please explain how your health has been affected in the comment field below.
Your answer
Have you consulted a doctor?
No
Yes
Clear selection
Has your health been negatively affected by increased air traffic in any of the following ways?
Lack of sleep
Increased frequency of upper respiratory issues
Increased allergies
Chronic cough
Other:
Do you believe that the increased air traffic is affecting your overall quality of life?
No
Yes
Clear selection
If you answered yes to the previous question, please check the areas of your life affected below.
Personal
Work
Family
Other:
Additional Information
Have you used any other avenues to file complaints regarding this issue (Department of Public Health, Environmental Protection Agency, FAA, O'Hare Noise Compatibility Commission)
No
Yes
Clear selection
If you answered yes to the previous question, please describe the outcome of your previous complaint in the comment field below.
Your answer
Would you like to testify under oath at an upcoming enforcement hearing?
If you answer yes to this question, please ensure that you have provided both telephone and e-mail contact information in the first section of your complaint form.
No
Yes
Clear selection
Do you have any additional information or experiences relating to the increased air traffic that you would like to share?
Your answer
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