Report Water Quality Test Results Now Survey

1. What is your first and last name? [IMPORTANT: we will only indicate first name and last initial when we show your datapoint on the WaterGoodness.org website]

What is your first and last name? [IMPORTANT: we will only indicate first name and last initial when we show your datapoint on the WaterGoodness.org website]

*
2. If you're affiliated with a waterkeeper or riverkeeper group, indicate which one below, or choose NONE.

If you're affiliated with a waterkeeper or riverkeeper group, indicate which one below, or choose NONE.

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3. What is the EXACT name of the body of water you tested?

What is the EXACT name of the body of water you tested?

*
4. What kind of water body is it?

What kind of water body is it?

*
5. Was your test on freshwater or saltwater? [choose freshwater if you tested tap water inside your home or business]

Was your test on freshwater or saltwater? [choose freshwater if you tested tap water inside your home or business] Freshwater

Saltwater

Not Sure

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6. What day and about what time did you conduct the test?

	MM		DD		YYYY		HH		MM	AM/PM
Your Test Happened on:	What day and about what time did you conduct the test? Your Test Happened on: Month	/	Day	/	Year		Hour	:	Minute	AM or PM

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7. Where on/along the waterway was your test conducted?

Where on/along the waterway was your test conducted? Address if known:
City or Town:
State:
Latitude if known:
Longitude if known:
Country if not USA:
ZIP if known:

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8. From what company did your test kit or device come?

From what company did your test kit or device come?

9. What were the results? [Leave a blank if your test did not measure the indicated attribute. And you can answer with words like positive OR negative and/or with numbers]

What were the results? [Leave a blank if your test did not measure the indicated attribute. And you can answer with words like positive OR negative and/or with numbers] Bacteria
Chlorine
Copper
Conductivity
Dissolved Oxygen
Hardness
Iron
Lead
Pesticides
pH
Phosphates
Salinity
Temperature
Nitrates
Nitrites
Turbidity

10. Want us to email you to remind you to test again, periodically (If yes, you get to choose reminder-frequency)?

Want us to email you to remind you to test again, periodically (If yes, you get to choose reminder-frequency)? Yes

No

Report Water Quality Test Results Now

1. Default Section

1. What is your first and last name? [IMPORTANT: we will only indicate first name and last initial when we show your datapoint on the WaterGoodness.org website]

*2. If you're affiliated with a waterkeeper or riverkeeper group, indicate which one below, or choose NONE.

*3. What is the EXACT name of the body of water you tested?

*4. What kind of water body is it?

*5. Was your test on freshwater or saltwater? [choose freshwater if you tested tap water inside your home or business]

*6. What day and about what time did you conduct the test?

*7. Where on/along the waterway was your test conducted?

*8. From what company did your test kit or device come?