Rose Park Environmental quality Issues Survey

1. Default Section

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* 1. Please complete the following information.

Age

Gender(Male/Female)

Race (please be specific)

Highest grade completed or Highest degree received (highschool, Associates, Bachelors, Masters, etc)

Language(s)spoken at home?

What is your yearly income?

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* 2. Do you live and/or work in Rose Park?

Live(Continue to Home Section below)

Work(Skip to Section III)

Live and Work(Continue to Home Section below)

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* 3. Are you aware of any environmental problems in your home or on your property?

Yes

Don't know

If you marked yes, please explain.

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* 4. As your family spends time in your house or yard, do you worry about their current or future health?

Yes

If you marked yes, please explain.

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* 5. Do you rent?

Yes

If no, do you own a house

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* 6. If you could change three things about your house/yard/apartment complex to make it a healthier place to live, what would these three things be?

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* 7. Are there environmental problems in your neighborhood that you don't think occur in other Salt Lake City neighborhoods?

Yes

I don't know

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* 8. As your family members spend time in your neighborhood, do you worry about their health?

Yes

If you marked yes, please explain.

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* 9. If you could change three things about your neighborhood to make it a healthier place to live, what would the three things be?

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* 10. Please rate how much you know about the following environmental topics:

	I know a lot	I know a little	I need more information
Air Pollution	Air Pollution I know a lot	Air Pollution I know a little	Air Pollution I need more information
Water Pollution	Water Pollution I know a lot	Water Pollution I know a little	Water Pollution I need more information
Pollution in the wetlands, rivers, lakes, streams	Pollution in the wetlands, rivers, lakes, streams I know a lot	Pollution in the wetlands, rivers, lakes, streams I know a little	Pollution in the wetlands, rivers, lakes, streams I need more information
Chemicals in the environment	Chemicals in the environment I know a lot	Chemicals in the environment I know a little	Chemicals in the environment I need more information
Flood plains or areas that may flood	Flood plains or areas that may flood I know a lot	Flood plains or areas that may flood I know a little	Flood plains or areas that may flood I need more information
Abandoned manufacturing sites	Abandoned manufacturing sites I know a lot	Abandoned manufacturing sites I know a little	Abandoned manufacturing sites I need more information
Household poisoning	Household poisoning I know a lot	Household poisoning I know a little	Household poisoning I need more information
Gas and Oil Refineries	Gas and Oil Refineries I know a lot	Gas and Oil Refineries I know a little	Gas and Oil Refineries I need more information
Mold	Mold I know a lot	Mold I know a little	Mold I need more information
Recycling	Recycling I know a lot	Recycling I know a little	Recycling I need more information
Indoor Tobacco Smoke	Indoor Tobacco Smoke I know a lot	Indoor Tobacco Smoke I know a little	Indoor Tobacco Smoke I need more information

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* 11. Please mark any of these if you believe that they are a problem in your area:

	Major Problem	Somewhat of a Problem	Not a problem	I don't know
Air Pollution	Air Pollution Major Problem	Air Pollution Somewhat of a Problem	Air Pollution Not a problem	Air Pollution I don't know
Water Pollution	Water Pollution Major Problem	Water Pollution Somewhat of a Problem	Water Pollution Not a problem	Water Pollution I don't know
Pollution in the wetlands, rivers, lakes, streams	Pollution in the wetlands, rivers, lakes, streams Major Problem	Pollution in the wetlands, rivers, lakes, streams Somewhat of a Problem	Pollution in the wetlands, rivers, lakes, streams Not a problem	Pollution in the wetlands, rivers, lakes, streams I don't know
Chemicals in the environment	Chemicals in the environment Major Problem	Chemicals in the environment Somewhat of a Problem	Chemicals in the environment Not a problem	Chemicals in the environment I don't know
Flood plains or areas that may flood	Flood plains or areas that may flood Major Problem	Flood plains or areas that may flood Somewhat of a Problem	Flood plains or areas that may flood Not a problem	Flood plains or areas that may flood I don't know
Abandoned manufacturing sites	Abandoned manufacturing sites Major Problem	Abandoned manufacturing sites Somewhat of a Problem	Abandoned manufacturing sites Not a problem	Abandoned manufacturing sites I don't know
Household poisoning	Household poisoning Major Problem	Household poisoning Somewhat of a Problem	Household poisoning Not a problem	Household poisoning I don't know
Gas and Oil Refineries	Gas and Oil Refineries Major Problem	Gas and Oil Refineries Somewhat of a Problem	Gas and Oil Refineries Not a problem	Gas and Oil Refineries I don't know
Mold	Mold Major Problem	Mold Somewhat of a Problem	Mold Not a problem	Mold I don't know
Recycling	Recycling Major Problem	Recycling Somewhat of a Problem	Recycling Not a problem	Recycling I don't know
Indoor Tobacco Smoke	Indoor Tobacco Smoke Major Problem	Indoor Tobacco Smoke Somewhat of a Problem	Indoor Tobacco Smoke Not a problem	Indoor Tobacco Smoke I don't know

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* 12. Please rate how much you know about the following health topics:

	I know a lot	I know a little	I need more information
Cancer	Cancer I know a lot	Cancer I know a little	Cancer I need more information
Asthma	Asthma I know a lot	Asthma I know a little	Asthma I need more information
Low birth weight	Low birth weight I know a lot	Low birth weight I know a little	Low birth weight I need more information
Heart Disease	Heart Disease I know a lot	Heart Disease I know a little	Heart Disease I need more information
Blood Lead in adults/children	Blood Lead in adults/children I know a lot	Blood Lead in adults/children I know a little	Blood Lead in adults/children I need more information
Household poisons	Household poisons I know a lot	Household poisons I know a little	Household poisons I need more information
Obesity	Obesity I know a lot	Obesity I know a little	Obesity I need more information
Allergies	Allergies I know a lot	Allergies I know a little	Allergies I need more information

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* 13. Which of these health issues could be caused by environmental problems?

	Can be caused	Can NOT be caused	I don't know
Cancer	Cancer Can be caused	Cancer Can NOT be caused	Cancer I don't know
Asthma	Asthma Can be caused	Asthma Can NOT be caused	Asthma I don't know
Low birth weight	Low birth weight Can be caused	Low birth weight Can NOT be caused	Low birth weight I don't know
Heart Disease	Heart Disease Can be caused	Heart Disease Can NOT be caused	Heart Disease I don't know
Blood Lead in adults/children	Blood Lead in adults/children Can be caused	Blood Lead in adults/children Can NOT be caused	Blood Lead in adults/children I don't know
Household poisons	Household poisons Can be caused	Household poisons Can NOT be caused	Household poisons I don't know
Obesity	Obesity Can be caused	Obesity Can NOT be caused	Obesity I don't know
Allergies	Allergies Can be caused	Allergies Can NOT be caused	Allergies I don't know

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* 14. Please answer the following questions.

	Yes	No	I don't know
Do you or anyone you know fish in the Jordan River?	Do you or anyone you know fish in the Jordan River? Yes	Do you or anyone you know fish in the Jordan River? No	Do you or anyone you know fish in the Jordan River? I don't know
Do you frequently eat fish from the Jordan River?	Do you frequently eat fish from the Jordan River? Yes	Do you frequently eat fish from the Jordan River? No	Do you frequently eat fish from the Jordan River? I don't know
Do you think this is a safe source of food?	Do you think this is a safe source of food? Yes	Do you think this is a safe source of food? No	Do you think this is a safe source of food? I don't know
Do you grow a garden at or near your home?	Do you grow a garden at or near your home? Yes	Do you grow a garden at or near your home? No	Do you grow a garden at or near your home? I don't know
Is the garden a major source of food supply for you and/or your family	Is the garden a major source of food supply for you and/or your family Yes	Is the garden a major source of food supply for you and/or your family No	Is the garden a major source of food supply for you and/or your family I don't know
Are there parks and play areas in your neighborhood?	Are there parks and play areas in your neighborhood? Yes	Are there parks and play areas in your neighborhood? No	Are there parks and play areas in your neighborhood? I don't know
Do you go to the park and play areas in your neighborhood?	Do you go to the park and play areas in your neighborhood? Yes	Do you go to the park and play areas in your neighborhood? No	Do you go to the park and play areas in your neighborhood? I don't know
Do you know of a community garden in Rose Park?	Do you know of a community garden in Rose Park? Yes	Do you know of a community garden in Rose Park? No	Do you know of a community garden in Rose Park? I don't know
Do you use garden in a Rose Park community garden?	Do you use garden in a Rose Park community garden? Yes	Do you use garden in a Rose Park community garden? No	Do you use garden in a Rose Park community garden? I don't know
Are there barriers that prevent you from using outdoor space-for instance transportation, access (fences or other barriers to entry) etc…	Are there barriers that prevent you from using outdoor space-for instance transportation, access (fences or other barriers to entry) etc… Yes	Are there barriers that prevent you from using outdoor space-for instance transportation, access (fences or other barriers to entry) etc… No	Are there barriers that prevent you from using outdoor space-for instance transportation, access (fences or other barriers to entry) etc… I don't know

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* 15. Are you interested in volunteering in your community?

Yes

If you marked no, please explain.

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* 16. Would you be interested in attending classes about fruit tree planting and maintenance?

Yes

If no, please explain

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* 17. What orchard tree related classes, if any, would you be interested in attending?

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* 18. Would you be interested in planting fruit trees in your own yard?

Yes

If you marked no, please explain.

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* 19. Please let us know of any other thoughts or concerns you may have below.

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* 20. If you would be willing to participate in a follow up focus group(you will be paid for your time), please fill out the following information:

Name:

City/Town:

State:

Country:

Email Address:

Phone Number: