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100 Radon Test Kit Challenge - Start Survey
Detector Serial Number ( 2 letters and 4 numbers ):
*
Second Detector Serial Number ( 2 letters and 4 numbers ; only if you received a DUPLICATE test)
Date Detector Placed
*
/
Day
/
Month
Year
Name
*
First Name
Last Name
Email
*
example@example.com
Email
*
example@example.com
Address of the Building being tested for Radon
*
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
Province of Building being tested for Radon
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
SK
QC
YT
Which Community Awareness Project or Information Webinar did you participate in?
*
Black Diamond, AB
Candiac, QC
Carleton-sur-Mer, QC
Chatham-Kent, ON
Lakeshore, MB
Leeds and the 1000 Islands, ON
Madawaska, NB
Mount Pearl, NL
RDCO, BC - Kelowna Region
Sicamous, BC
Silver Harbour, MB
St-Joseph-du-Lac, Qc
Stephenville, NL
Sundre, AB
Vernon, BC
Mailing Address Same as Building Address
Yes
No
Mailing Address
*
Street Address
City
Province
Postal Code
Mailing Address Province
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
SK
QC
YT
Would you be interested in receiving FUTURE information from Take Action on Radon or your host community about radon? You can unsubscribe anytime.
Yes
No
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'.
YES
NO
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?
Own
Rent
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)
Other
Please Specify
Types of openings in the lowest floor of the house or basement (check all that apply) - remove
Floor Drain
Sump
Cracks in Foundation
Furnace Condensate/Air Conditioner Drain
Walk-out basement (a full-size door that opens to the outdoors from your basement)
N/A
In what year was your home originally built? (if you know the exact year, feel free to type it into the last option)
1930s or earlier
1940 through 1959
1960-1969
1970-1979
1980-1995
1996-1999
2000-2010
2011
2012
2013
2014
2015 and Newer
Unknown
Are you aware of any renovations that have been carried out on the home? (click all that apply)
New windows
Attic insulation
Finished basement
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?
Yes
No
Describe the Energy Efficient Methods
Please specify your main heating system is used in your home.
Furnace (Forced Air)
Boiler (Radiators)
Electric Baseboards
Heat Pump
Wood Fireplace
Wood Stove / Pellet Stove
Gas Fireplace
Unknown
Geothermal
Please Specify
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
No
Not Sure
Is your house supplied by private well water?
Yes
No
Not sure
Submit
Should be Empty: