Lead poisoning is 100% preventable.  The Naugatuck Valley Health District wants to know what you know about lead poisoning. Please spare a few minutes of your time to complete this survey.
***Homes built after 1978 are not eligible for the Naugatuck Valley Health District's lead hazards grant***

* 1. Do you know about the dangers of lead poisoning?

* 2. Do children under age 6 live in your household?

* 3. Have your children below age 3 been tested for lead?

* 4. Have you or your child ever had high levels of lead in your blood?

* 5. Which town do you live in?

* 6. Was your house/apartment built before 1978?

* 7. How would you describe your home?

* 8. Are you the landlord, homeowner or a tenant?

* 9. Is there any chipping or peeling paint inside or outside your home?

* 10. Do your children play in areas exposed to lead paint chippings/peelings near your home?

* 11. Did you know that Naugatuck Valley Health District has funds to remove lead hazards? If yes, how did you hear about it?

* 12. Would like to know more lead poisoning and how to prevent it?

* 13. Would you like to be contacted by one of our staff members to determine eligibility or to learn more the about program?

* 14. If you answered "yes" to questions 12 and/or 13 above, please provide the following contact information:

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