1. Do you live in:
one-level, free-standing home
multi-level, free standing home
an apartment/condominium community

2. Do you have an infant in your home (0-12 months)?
Yes
No

3. Do children ages 1-6 years old:
live in your home with you or frequently visit your home?
rarely/never visit your home?

4. Do you have older adults living at home (over the age of 65)?
Yes
No

5. Does your home have an attached garage?
Yes
No

6. Do you have any fuel-burning appliances, such as a furnace, wood stove, space heater or fireplace?
Yes
No

7. Does your home or apartment have a pool or do you have an outside sauna, whirlpool or jacuzzi?
Yes
No