100 Radon Test Kit Challenge - Start Survey
Detector Serial Number:
Second Detector Serial Number: (only if you received a DUPLICATE test)
Date Detector Placed
Radon Test Building Information
Civic Number and Street Address of Building Tested for Radon
City of Building Tested for Radon
Province of Building Tested for Radon
Postal Code of Building Tested for Radon
Radon Test Building Information Province
Which Community Awareness Project/Evening did you participate in?
Harrison Park, MB (Onanole, Sandy Lake, Newdale)
North Grenville, ON
Mailing Address Same as Building Address
Mailing Address Province
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Please help us by answering some additional questions about your home which will be used for future research purposes. If you will provide some more details about your home, click 'YES', if not, click 'NO' and 'Submit'.
Number of Occupants
Under 10 Years Old
Between 10 and 18 Years Old
Between 19 and 30 Years Old
Between 31 and 55 Years Old
Over 55 Years Old
Do you own or rent the building?
Type of Building
Single Detached Home
Semi-Attached (Your home shares a wall - i.e. townhouse or duplex)
Condo/apartment on ground-floor or basement
Condo/apartment on second floor or above
Mobile home (on the ground or on a foundation and/or with well-sealed skirting)
Mobile home (raised, not in contact with the ground, or with loose skirting)
Types of openings in the lowest floor of the house or basement (check all that apply) - remove
Cracks in Foundation
Furnace Condensate/Air Conditioner Drain
Walk-out basement (a full-size door that opens to the outdoors from your basement)
In what year was your home originally built?
1930s or earlier
1940 through 1960
2015 and Newer
Are you aware of any renovations that have been carried out on the home? (click all that apply)
Sealing around or replacing an exterior door
Improving the sealing and caulking around doors or other cracks
No known renovations
Describe the renovations or energy efficiency measures, including the year completed and include any not mentioned above.
Are you aware of any energy efficiency improvements made to the home (replacing windows, improving attic insulation, improving the sealing and caulking around doors and/or cracks?
Describe the Energy Efficient Methods
Please specify your main heating system is used in your home.
Furnace (Forced Air)
Wood Stove / Pellet Stove
Does your home have a heat recovery ventilator (HRV), energy recover ventilator (ERV) or Air Exchanger?
Yes, and it is usually running
Yes, but I don't know whether it is running
Is your house supplied by private well water?
Should be Empty: