Childhood Lead Poisoning Prevention Survey

These questions are general and can be answered for the setting you live in if you are a Parent/Guardian/Caregiver/Community Member, or if you are a clinician answering regarding the patients you serve, or a child care setting if you are a child care provider/licensor, or low-incoming housing if you are a low-income housing staff member.

Question Title

* 1. Date Survey Completed

Today's date

Date

Question Title

* 2. City where you live/work

Question Title

* 3. ZIP Code

Question Title

* 4. I am a...

Parent/Guardian/Caregiver/Community Member

Clinician

Low-Income Housing Staff

Child Care Provider

Child Care Licensor

Other (please specify)

Question Title

* 5. I live in the Everett Smelter Site Area

Yes

I don't know

Question Title

* 6. Race

White

Black or African American

Native American or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Multiracial

Prefer not to answer

Other (please specify)

Question Title

* 7. Ethnicity

Hispanic

Non-Hispanic

Prefer not to answer

Question Title

* 8. Type of insurance

Private insurance

Medicaid/Medicare/Apple Health

No insurance

Question Title

* 9. What do you know about lead and children?

Question Title

* 10. If you do not feel know you much about lead and children, what may have helped you to become informed about lead and children?

Question Title

* 11. If you do know information about lead and children, how did you learn that information? What was helpful? What was NOT helpful?

Question Title

* 12. What else would you like to know about lead and children?

Question Title

* 13. Are you concerned about the effects of lead on children?

Yes

Question Title

* 14. If you answered "Yes," to question 13, what have you done differently, if anything, to prevent the effects of lead on children, and what additional support do you need or have you needed to help you prevent the effects of lead on children?

Question Title

* 15. Children should be tested for lead. What do you think may make it difficult for children to get tested?

Question Title

* 16. Do you know where lead can be found in our environment in Snohomish County?

Yes

Question Title

* 17. If you answered "Yes" to question 16, what do you know as the main sources of lead in Snohomish County?

Question Title

* 18. If you answered "Yes" to question 16, what do you know as the main sources of lead in the settings where children play or live?

Question Title

* 19. Are you aware of any work being done in our communities to prevent lead exposure?

Yes

Childhood Lead Poisoning Prevention Survey

Question Title

* 1. Date Survey Completed

Question Title

* 2. City where you live/work

Question Title

* 3. ZIP Code

Question Title

* 4. I am a...

Question Title

* 5. I live in the Everett Smelter Site Area

Question Title

* 6. Race

Question Title

* 7. Ethnicity

Question Title

* 8. Type of insurance

Question Title

* 9. What do you know about lead and children?

Question Title

* 10. If you do not feel know you much about lead and children, what may have helped you to become informed about lead and children?

Question Title

* 11. If you do know information about lead and children, how did you learn that information? What was helpful? What was NOT helpful?

Question Title

* 12. What else would you like to know about lead and children?

Question Title

* 13. Are you concerned about the effects of lead on children?

Question Title

* 14. If you answered "Yes," to question 13, what have you done differently, if anything, to prevent the effects of lead on children, and what additional support do you need or have you needed to help you prevent the effects of lead on children?

Question Title

* 15. Children should be tested for lead. What do you think may make it difficult for children to get tested?

Question Title

* 16. Do you know where lead can be found in our environment in Snohomish County?

Question Title

* 17. If you answered "Yes" to question 16, what do you know as the main sources of lead in Snohomish County?

Question Title

* 18. If you answered "Yes" to question 16, what do you know as the main sources of lead in the settings where children play or live?

Question Title

* 19. Are you aware of any work being done in our communities to prevent lead exposure?

Question Title

* 20. If you answered "Yes" to question 19, what specific work are you aware of?