NYC Water Quality Survey
Please take a few minutes to tell us more about your water concerns.
What is your gender?
Female
Male
Non-binary
Prefer not to answer
What is your racial identity?
White or Caucasian
Black or African American
Asian or Pacific Islander
Hispanic or Latino/Latina
Native American or Indigenous
Mixed race/Multiracial
Prefer not to answer
What is your age range?
0-17
18-24
25-34
35-44
45-54
55-64
65+
What is your marital status?
Single
Married
Divorced
Widowed
Prefer not to answer
What borough do you live in?
Brooklyn
Bronx
Manhattan
Queens
Staten Island
What is your annual income range?
$9,999 or less
$10,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000 or more
Prefer Not to Answer
In which do you reside?
House
Apartment
Condo
Shelter
Have you ever noticed a change in the taste, odor, or color of your water?
Yes
No
Not sure
Have you experienced any health issues or problems related to your water usage?
Yes
No
Not sure
Are you a pet owner?
Yes
No
If so, does your pet drink your tap water?
Yes
No
Has your pet experienced any health issues or problems related to your tap water usage?
Yes
No
Not sure
Are you aware of any potential sources of water pollution in your community?
Sources of Water Pollution
Do you use a filter or other water treatment device in your home, such as pitchers, filters or reverse osmosis systems?
Point of Use Filter
Point of Entry Filter
Water Pitcher Filter
Reverse Osmosis System
None
Other
Have you ever contacted your water utility company to report water quality issues or concerns?
Yes
No
Do you believe that your tap water is safe to drink?
Yes
No
Not sure
How satisfied are you with the quality of your tap water?
Very Unsatisfied
1
2
3
4
Very Satisfied
5
1 is Very Unsatisfied, 5 is Very Satisfied
Do you believe that your water bills are reasonable considering the quality of water you receive?
Too expensive
Reasonable
Inexpensive
N/A
Are you aware of any efforts to improve water quality in your community or beyond?
Yes
No
Would you be interested in participating in community-based efforts to address water quality issues in your neighborhood or city?
Please share your email address.
example@example.com
Submit
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