Please take a few minutes to complete this survey. Your feedback is greatly appreciated! 

Sincerely, 
Will County Health Department Tobacco Control & Prevention Program

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1. What city do you live in?

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2. What type of housing do you live in?

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3. Including yourself, how many people live in your home?

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4. Of the people in your unit, how many smoke?

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5. Do you allow smoking inside your home?

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6. In the past year, how often has tobacco smoke entered your home from somewhere else in or around your home or building?

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7. If tobacco smoke has entered your home, did it bother you?

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8. If tobacco smoke were to enter your home in the future, would it bother you?

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9. Are you concerned about the effects of secondhand or thirdhand smoke on your health or the health of those you live with?

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10. Would you prefer to live in a home or building that is completely smoke-free, including units, balconies/patios, and 25 feet around the building?

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11. Additional Comments:

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12. Building Name and Address: (Required.)

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13. Your Name (optional):

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14. Contact Information (optional):

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