Household Chemical Roundup Comment and Survey Form (2009)

Comment Form and Survey Instructions:

Answer the questions on each page, then click the " Next >> " button at the bottom of the page to go to continue. All questions (except the first) are optional. You may go back at any time by clicking on the " << Prev " ("previous") button.

On the last page, click the "Done >>" button to submit the your information and return to the Tri-County Health Department Household Chemical Roundup website. You may quit the survey at any time by closing your web browser window.

Question Title

* 1. Which Roundup did you attend?

June 5 - Parker / Joint Service Facility

May 2 - Water World / Federal Heights

August 8 - Highlands Ranch / Shea Stadium

September 19 - Thornton IMC Facility / Thornton

September 12 - Castle Rock / Utiliites Department

None / Other

Question Title

* 2. Let us know about your experience at the Household Chemical Roudup by telling us whether you agree or disagree with the following statements. Please answer using the 9-point rating scale where 9 means "completely agree" and 1 means "completely disagree."

	agree completely	disagree completely		disagree somewhat		neither agree nor disagree		agree somewhat		N/A
The Roundup was in a convenient location.	The Roundup was in a convenient location. agree completely	The Roundup was in a convenient location. disagree completely	The Roundup was in a convenient location.	The Roundup was in a convenient location. disagree somewhat	The Roundup was in a convenient location.	The Roundup was in a convenient location. neither agree nor disagree	The Roundup was in a convenient location.	The Roundup was in a convenient location. agree somewhat	The Roundup was in a convenient location.	The Roundup was in a convenient location. N/A
The event staff were friendly and helpful.	The event staff were friendly and helpful. agree completely	The event staff were friendly and helpful. disagree completely	The event staff were friendly and helpful.	The event staff were friendly and helpful. disagree somewhat	The event staff were friendly and helpful.	The event staff were friendly and helpful. neither agree nor disagree	The event staff were friendly and helpful.	The event staff were friendly and helpful. agree somewhat	The event staff were friendly and helpful.	The event staff were friendly and helpful. N/A
I was, overall, satisfied with the service I received.	I was, overall, satisfied with the service I received. agree completely	I was, overall, satisfied with the service I received. disagree completely	I was, overall, satisfied with the service I received.	I was, overall, satisfied with the service I received. disagree somewhat	I was, overall, satisfied with the service I received.	I was, overall, satisfied with the service I received. neither agree nor disagree	I was, overall, satisfied with the service I received.	I was, overall, satisfied with the service I received. agree somewhat	I was, overall, satisfied with the service I received.	I was, overall, satisfied with the service I received. N/A
I was able to dispose of all of my household hazardous waste.	I was able to dispose of all of my household hazardous waste. agree completely	I was able to dispose of all of my household hazardous waste. disagree completely	I was able to dispose of all of my household hazardous waste.	I was able to dispose of all of my household hazardous waste. disagree somewhat	I was able to dispose of all of my household hazardous waste.	I was able to dispose of all of my household hazardous waste. neither agree nor disagree	I was able to dispose of all of my household hazardous waste.	I was able to dispose of all of my household hazardous waste. agree somewhat	I was able to dispose of all of my household hazardous waste.	I was able to dispose of all of my household hazardous waste. N/A
The event was well organized.	The event was well organized. agree completely	The event was well organized. disagree completely	The event was well organized.	The event was well organized. disagree somewhat	The event was well organized.	The event was well organized. neither agree nor disagree	The event was well organized.	The event was well organized. agree somewhat	The event was well organized.	The event was well organized. N/A

Question Title

* 3. How did you hear about this Household Chemical Roundup? Please check all that apply.

Flyers/Poster in in public building

I called my local government

City/Town newsletter

Advertisements in local newspapers

Website other than www.tchd.org

My waste hauling company

Utility bill

Tri-County Health Department Website (www.tchd.org)

Email alerts

Flyers/Poster in a retail store

Radio Public Service Announcements

Someone I know

HOA newsletter

TV News Broadcasts

Other (please specify)

Question Title

* 4. Why did you use the service? Please check all that apply.

Routine cleaning

I'm moving and need to clean my house and/or get rid of items my moving company won't take.

Safety (i.e., remove flammable, reactive, or toxic materials from my home)

Prevent accidental poisoning of children or pets

Protect the environment

The waste was left in my home by a previous tenant/owner.

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* 5. Is this the first time you've participated in a Household Chemical Roundup?

Yes

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* 1. Which Roundup did you attend?

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* 2. Let us know about your experience at the Household Chemical Roudup by telling us whether you agree or disagree with the following statements. Please answer using the 9-point rating scale where 9 means "completely agree" and 1 means "completely disagree."

Question Title

* 3. How did you hear about this Household Chemical Roundup? Please check all that apply.

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* 4. Why did you use the service? Please check all that apply.

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* 5. Is this the first time you've participated in a Household Chemical Roundup?

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* 6. Other comments about your exerience at the Household Chemical Roundup: