Water Survey
This survey is exclusively used to gather local water usage information to see if further action is warranted. Conducting an in depth study of local water policies is expensive and time consuming and we want to use this little starting point to see if there's reason to do more. Your information will not be used for any other purpose. Your information will not be sold to any third party or intentionally made accessible to anyone outside of this survey. We want to encourage you to participate and thank you for adding value to this cause.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
1. May we contact you with any follow up questions?
Yes, email only
Yes, phone only
Yes, phone or email are both fine
No
2. Does Golden State Water supply your water?
Please Select
Yes
No
3. How many people in your household?
4. How many animals/pets in your household?
5. What are the ages of the members (people) of your household?
6. How long have you been living at your home?
7. How many people are usually home during the weekdays or work from home?
Zero to One
Two
Three
Four or more
8. Do you or anybody in your household work for Golden State Water?
Yes, I do
Yes, someone in my household does
No, but I know someone who does
No and I do not know anybody who does
9. Do you have a pool?
Please Select
Yes
No
10. How often do you fill the water in your pool on average?
Zero to once a week
At least twice a week
At least 3 times a week
I use an auto-filler
11. How often do you water your lawn?
Three times per week
Four to five times per week
At least five times per week
None or very seldom
12. How would you characterize your water usage?
Probably average
Probably below average useage
Probably above average useage
Probably heavy water usage
13. You may explain your water usage further here.
14. Which is closest to your usual 2 month water bill?
Under $120
$120 to $180
$180 to $240
$240 to $280
Over $280
15. How much has your water bill changed in the last 4 years?
Not much
A little
A lot
16. If you responded "A lot" in the previous question, please explain here.
17. How concerned were you about your water bill before this survey?
Not at all
A little
A lot
I knew there was a problem
18. If you want to explain your answer from the above question further or you simply have additional information you feel could be useful, please write it here. Thank you.
Submit
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