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* 1. How would you describe your property?  Select the one that fits best:

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* 2. Which water sources do you rely on the most?  Number only the types that you use below, with 1 being the most important:

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* 3. In a bushfire, mains water pressure and electricity can be unreliable.  If you planned to defend your property or found you couldn’t evacuate, which water sources would you rely on?

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* 4. What have you installed or changed to reduce the amount of water you use on the property, or to improve water quality?  (If no changes, write N/A)

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* 5. If you have a groundwater bore, do you have concerns about any of the following? Select all that apply

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* 6. Have you had any of your water sources laboratory tested or used a home test kit?  How many years ago and what were the results?  (If no testing, write N/A)

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* 7. If you had concerns about a change in your water supply, where would you go for advice or information?  Select all that apply:

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* 8. Please enter your postcode below.  If you would be interested in participating in a water sampling trial, include the rest of your mailing address. Shire of Mundaring will compile the survey results and contact interested residents in late 2018. 

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