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***

Do you know about the dangers of lead poisoning?

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

Do children under age 6 live in your household?

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

Have your children below age 3 been tested for lead?

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

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

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

Which town do you live in?

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* 5. Which town do you live in?

Was your house/apartment built before 1978?

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

How would you describe your home?

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* 7. How would you describe your home?

Are you the landlord, homeowner or a tenant?

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

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

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

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

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

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

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

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

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

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

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

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

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

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