Household Chemical Roundup Comment and Survey Form (2011)

Tri-County Health Department welcomes your comments and suggestions regarding the Household Chemical Roundups. Your feedback will help us improve our program to better serve you and other residents.

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.

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1. Which Roundup did you attend?

Which Roundup did you attend? May 7 - Water World / Federal Heights

May 14 - Joint Service Facility / Parker

August 13 - Shea Stadium / Highlands Ranch

September 17 - Town of Castle Rock Utilities / Castle Rock

September 24 - Thornton IMC Facility / Thornton

None / Other

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."

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

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

How did you hear about this Household Chemical Roundup? Please check all that apply. Website other than www.tchd.org

Flyers/Poster in in public building

Radio Public Service Announcements

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

Utility bill

City/Town newsletter

My waste hauling company

I called my local government

Someone I know

Email alerts

Advertisements in local newspapers

HOA newsletter

Flyers/Poster in a retail store

Other (please specify)

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

Why did you use the service? Please check all that apply. Prevent accidental poisoning of children or pets

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)

Protect the environment

Routine cleaning

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

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

Is this the first time you've participated in a Household Chemical Roundup? Yes

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

Other comments about your exerience at the Household Chemical Roundup: