Master Well Owner Evaluation

1. Introduction

Sometime in the past six months you interacted with a Master Well Owner volunteer. This volunteer may have talked with you individually or as part of a group presentation. We would like to find out what you thought of your interaction with the volunteer and what actions you may have taken to better manage your water supply. Please take a few minutes to answer the eight questions in this survey to help us measure and improve our performance. Thank you for your help!

1. In what county of Pennsylvania is your private well, spring or cistern located?

In what county of Pennsylvania is your private well, spring or cistern located?

2. How did you interact with the Master Well Owner Volunteer (check all that apply)?

How did you interact with the Master Well Owner Volunteer (check all that apply)? Personal conversation

Attended a program where they spoke

Talked to them at a display at a fair, exhibit, etc.

Read something that they wrote or handed out

Other (please specify)

3. How helpful did you find your interaction with the Master Well Owner to be (check one)?

How helpful did you find your interaction with the Master Well Owner to be (check one)? Very helpful

Somewhat helpful

Not helpful

4. What kind of water supply do you use?

What kind of water supply do you use? Drilled well

Hand-dug well

Spring

Cistern

Other water supply (please specify)

5. To your knowledge, has your water supply ever been tested for any pollutants?

To your knowledge, has your water supply ever been tested for any pollutants? Yes

6. How much did you learn about proper management of your water supply from your interaction with the Master Well Owner volunteer?

How much did you learn about proper management of your water supply from your interaction with the Master Well Owner volunteer? Learned many new ideas

Learned a few new ideas

Learned one new idea

Learned nothing new

7. After interacting with the volunteer, you may have taken some action on your water supply or plan to take action in the near future. For the list of actions below, indicate if you have taken the action, plan to take the action based on your interaction with the volunteer or do not plan to take the action.

	I took this action	I'm planning on doing this	Not planning on taking this action
Developed a new source of water (i.e. drilled new well)	After interacting with the volunteer, you may have taken some action on your water supply or plan to take action in the near future. For the list of actions below, indicate if you have taken the action, plan to take the action based on your interaction with the volunteer or do not plan to take the action. Developed a new source of water (i.e. drilled new well) I took this action	I'm planning on doing this	Not planning on taking this action
Had my water tested	Had my water tested I took this action	I'm planning on doing this	Not planning on taking this action
Inspected my water supply	Inspected my water supply I took this action	I'm planning on doing this	Not planning on taking this action
Installed a sanitary well cap	Installed a sanitary well cap I took this action	I'm planning on doing this	Not planning on taking this action
Sloped the ground away from my well or spring	Sloped the ground away from my well or spring I took this action	I'm planning on doing this	Not planning on taking this action
Sealed my spring box	Sealed my spring box I took this action	I'm planning on doing this	Not planning on taking this action
Shock chlorinated my well or spring	Shock chlorinated my well or spring I took this action	I'm planning on doing this	Not planning on taking this action
Reduced or stopped applying fertilizer or herbicides near my water supply	Reduced or stopped applying fertilizer or herbicides near my water supply I took this action	I'm planning on doing this	Not planning on taking this action
Identified potential sources of pollution around my water supply	Identified potential sources of pollution around my water supply I took this action	I'm planning on doing this	Not planning on taking this action
Sought additional information about water testing or treatment	Sought additional information about water testing or treatment I took this action	I'm planning on doing this	Not planning on taking this action
Organized my water supply information in one place	Organized my water supply information in one place I took this action	I'm planning on doing this	Not planning on taking this action
Installed water treatment equipment	Installed water treatment equipment I took this action	I'm planning on doing this	Not planning on taking this action
Started conserving water at home	Started conserving water at home I took this action	I'm planning on doing this	Not planning on taking this action
Other action(s) not listed above	Other action(s) not listed above I took this action	I'm planning on doing this	Not planning on taking this action

8. Please use this space to make general comments about your interaction with the Master Well Owner volunteer.

Please use this space to make general comments about your interaction with the Master Well Owner volunteer.

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