How OLD is your house?
built before 1970
built after 1970
Is there chipping or peeling PAINT in your house?
yes
no
Do the WINDOW WELLS have solid material?
yes
no
Is the PLUMBING more than 40 years old?
yes
no
Is the plumbing less than five years old?
yes
no
Do you have LEAD PIPES?
yes
no
Has your water been tested for lead?
yes
no
Do you have a BASEMENT?
yes
no
Are the basement PIPES insulated?
yes
no
Are any CEILINGS covered with sprayed-on or troweled-on material?
yes
no
Are there SLEEPING or PLAYING areas in the basement?
yes
no
Are there CRACKS in the basement floor or walls or GAPS between the basement ceilings and walls?
yes
no
Do you have one or more working FIREPLACES? Does SMOKE enter the room when you use the fireplace?
yes
no
If you have a WOOD-BURNING STOVE in your home, is it properly vented?
yes
no
Do you have STORM WINDOWS?
yes
no
Do you have a GAS STOVE?
yes
no
Does your gas stove have a PILOT LIGHT?
yes
no
Do you use your gas stove for HEAT?
yes
no
Do you use KEROSENE space heaters?
yes
no
Do you use a gas CLOTHES DRYER?
yes
no
Do you have forced HOT-AIR heat?
yes
no
Do you have an electronic AIR CLEANER?
yes
no
Do you have a furnace HUMIDFIER?
yes
no
Is your home INSULATED?
yes
no
Has your house ever been treated for TERMITES?
yes
no
Do you know what PESTICIDE was used during the termite treatment?
yes
no
Do you use PESTICIDES on your lawn or garden?
yes
no
Do you use a commercial LAWN SERVICE?
yes
no
Do you STORE pesticides in the house?
yes
no
Do you DISPOSE of unused or leftover pesticides at a hazardous waste facility?
yes
no
Do you keep old PRESCRIPTION DRUGS in the medicine cabinet?
yes
no
Do you keep MOTOR OIL or GASOLINE in the house or garage?
yes
no
Do you keep SOLVENTS such as alcohol, toluene, dry-cleaning fluids, or degreasing solvents in the house?
yes
no
Does anyone in your house SMOKE?
yes
no
Does anyone in your house MAKE stained glass, pottery, jewelry, or fishing weights?
yes
no
Does anyone REFINISH furniture at your home?
yes
no
Do you use any of the following PRODUCTS: toilet-bowl cleaners, room deodorizers, polishes, varnishes, or paint thinners?
yes
no