100 Radon Test Kit Challenge - End of test data

100 Radon Test Kit Challenge - End of test data
Detector Serial Number *
Second Detector Serial Number
If you received a duplicate test.
Email
example@example.com
Postal Code of the building tested *
Test End Date (day detector was returned to the collection box) *

Day Month Year
Where did you place the radon detector? *

Basement First/Ground Floor Second Floor Bi-level
In what room did you place the radon detector?

Bedroom Living Room Other Living Area Non-living area
Please Specify
Would you help us by answering a few additional questions about the conditions in your home during the test period?

Yes No
During the testing period, how often were the windows open in the room being tested?

Never or almost never (1 - 5 days) Once in a while (5 - 15 days) Frequently (30 - 60 days) Often (61+ days)
During the testing period, how often were windows open in other areas of the house?

Never or almost never (1 - 5 days) Once in a while (5 - 15 days) Frequently (30 - 60 days) Often (61+ days)
During the testing period, did you use the kitchen fan while cooking?

Always Sometimes Never N/A
Does someone in the household smoke?

Yes No Yes, but only outside Previous smoker, no longer smokes
Would you be interested in being contacted in future for a follow-up survey?

Yes No
By participating in the 100 Radon Test Kit challenge you have agreed to allow your data to be pooled with other participant data in your community for a community report. Your personal information will be protected no personally indentifying information will be shared.

PROTECTING HOMEOWNER’S PRIVACY
Take Action on Radon takes homeowner privacy seriously. Only individual homeowners
will receive their personal radon test results. At the end of the project, Take Action on
Radon will provide a community report to the Community Liaison with summarized data
void of any personally identifying information.
Should be Empty: