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Community Survey
Harris County Pollution Control is conducting research on your concern for pollution in your community. The survey should take approximately 20 minutes. You can only take the survey once. Questions marked with an asterisk (*) are required. If you have any questions about the survey, please email us: PCS-Communications@pcs.hctx.net
Please provide your email address if you would like to be added to our mailing list. If unwilling to provide, please write N/A.
*
Please provide your household zip code.
*
Please provide your work zip code.
*
At which location are you most concerned about regarding pollution?
*
Home
Work
Both
How long have you lived/worked at the location you have concerns with?
*
Less than 1 year
1 to 5 years
6 to 10 years
More than 10 years
Are you concerned about any of the following environmental issues in your community/work? Select all that apply.
*
Air pollution
Water pollution
Hazardous solid waste pollution
None of the above
Do you perceive any sources of pollution near your home/work? Select all that apply.
*
Air pollution
Water pollution
Hazardous solid waste pollution
None of the above
Have you or someone in your household been diagnosed with any of the following illness? Select all that apply.
*
No one in my household has been diagnosed with an illness
Cancer
Asthma
Respiratory disease
Heart disease
Other
Please select any health conditions that you or a member of your household have experienced without reasonable cause. Select all that apply.
*
No one in my household is experiencing a health condition without reasonable cause
Dizziness
Nausea
Tiredness
Irritation of eyes and nose
Sore throat
Coughing
Difficulty breathing
Wheezing
Other
Do you have any familiarity with Harris County Pollution Control Services Department (PCS)?
*
Yes
No
Are you aware that you can make any complaint related to potential harmful exposures to chemical pollutants, in your area, to the PCS?
*
Yes
No
Letter of Consent
Submit
Should be Empty: