Healthy Home Checklist
Please answer the following questions to help us as we assess the quality of air within your home.
How old is your home?
less than 5 years
6-20 years old
more than 20 years old
On a scale of 1-10 how would you rate the Indoor Air Quality in your home?
1 is Worst, 10 is Best
Has there been recent remodeling or have there been any changes in your work environment (e.g., painting, new carpet and/or furniture)?
What did you have done?
Does anyone in the home have allergies?
What are you allergic to?
What type of symptoms do you experience? (Check all that apply)
Shortness of Breath
Cough/ Scratchy Throat
Do you or someone in your home have Asthma?
Are there pets in your home?
Does anyone smoke in the home?
Do you dust regularly?
Do you have any house plants?
Do you ever use a humidifier or vaporizer in the house?
Yes, year round
Do you regularly use a dehumidifier in your home?
Yes, all year
Where do you have your dehumidifier?
Do you regularly use a bathroom exhaust fan?
How often do you/someone in your home get sick with the cold/flu?
Once a month
4 times a year
1-2 times a year
Do you find that your skin gets dry and itchy during winter?
Do you get shocked when you touch surfaces?
HVAC Air Flow
Is air conditioning present?
Are other house ventilation systems (i.e. attic fans, air-to-air heat exchangers) used?
Air-to-air heat exchangers
How often do you replace your filters in your HVAC system?
Every other Month
4 times a year
Once a year....Maybe?
How often do you get your HVAC unit serviced?
Once a year
Every other year
Once every 5 years
Who even knows?!
Have you had your Air ducts cleaned in the past 2 years?
What type of heating source is used in your home? (check all that apply)
Hot air circulation
Hot water baseboards
What is the primary type of fuel used?
Do you run an Air purifier in your home?
How often do you open your windows?
All the time
Do you use a kitchen exhaust fan?
How long are you home during the day?
Please fill in the below information so that we are able to connect with you about your results! Thanks so much!
Please enter a valid phone number.
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