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  • RentSafe

    RentSafe Connector (SAMPLE)

    Advance questionnaire for people participating in the RentSafe Connector exercise: Version 1.1

  • Section 1. Information about you:

  • Section 2. Information about the housing-relevant services your organization/department provides:

    8. For each type of housing condition, please check all of the services that your organization/department provides:

  • a. Structural issues (e.g., leaky roof, windows)

  • b. Mould

  • c. Indoor Air Quality (e.g., fumes, odour other than smoking)

  • d. Outdoor Sources impacting indoors (e.g. outdoor burning, industry, transportation corridors, road or construction dust)

  • e. Tobacco Smoke

  • f. Other Smoking

  • g. Pesticides

  • h. Radon (i.e., radioactive soil gas that gets into indoor air)

  • i. Asbestos

  • j. Lead (e.g., in old paint, in water service pipes)

  • k. Drinking water quality

  • l. Inadequate water supply

  • m. Plumbing / Sewage

  • n. Electrical wiring/safety

  • o. Flooding

  • p. Thermal Comfort (too hot)

  • q. Thermal Comfort (too cold)

  • r. Garbage

  • s. Hoarding

  • t. Pests (e.g., cockroaches, bed bugs, rodents, pigeons, raccoons)

  • u. Marijuana grow ops / Other drug labs

  • v. Pet-related issues

  • w. Noise

  • x. Utility costs (electricity, heating)

  • y. Concerns about exposure to electromagnetic fields (e.g., wifi, cell towers)

  • Section 3. Relevant contacts:

  • 9. Are you willing to be a representative of your organization/department in a local/regional RentSafe Roundtable (i.e., a network of people who are working together across sectors to improve coordination of services in support of healthy housing conditions for all)?

  • 10. If not, who from your organization would you recommend? Please provide:

  • 11. Are there other people in your organization whom it would be important to involve in a local/regional RentSafe Roundtable? (e.g., because they have different mandate, responsibilities or expertise than yours). If so, please provide names and contact information for up to 3 people:

     

  • 12. Are there people outside your organization whom you’d suggest that we invite to join the local/regional RentSafe Roundtable? If so, please provide

  • 13. Please provide the contacts via which the public can access your organization’s information and/or services:

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  • Should be Empty: