Village Survey
This survey is an attempt to find out what we should do to make our village a safer place to live and bring up our children. The answers to these questions will help us make decisions on what to do with the everyday chemicals that we find so handy. Many of these chemicals are very helpful when used with reasonable care. Some of them can become very dangerous when mixed, and/or stored wrong. Help the task force help the village by filling out these questions.
1. Do you sort your trash? YES() NO()
2. Could you sort out valuable/dangerous items? YES() NO()
3. How many bags of trash do you take out each week?_____
4. What do you find wrong with the present trash disposal system?
5. Can you give some ideas on how to improve the disposal system?
Chemicals
6. Which of the following list do you buy for personal use? How many cans/packages per month?
Chemical # Per
Compound Yes No Month
-----------------------------------------
OIL___________________|______|____|______|
ANTIFREEZE____________|______|____|______|
BATTERIES_____________|______|____|______|
LAMP OIL______________|______|____|______|
PROPANE_______________|______|____|______|
AMMONIA CLEANERS______|______|____|______|
CHLORINE BLEACH_______|______|____|______|
LIQUID DISH SOAP______|______|____|______|
TOILET BOWL CLEANERS__|______|____|______|
DISHWASHER SOAP_______|______|____|______|
W-D 40________________|______|____|______|
LYSOL_________________|______|____|______|
PAINT_________________|______|____|______|
SOLVENTS______________|______|____|______|
7. What do you do with the left overs/remainders or empty cans?
Yes No
-----------------------------------
BURN BARREL___________|____________|
TAKE TO DUMP__________|____________|
STORE_________________|____________|
OTHER_________________|____________|
If other please explain:___________________________
___________________________________________________
___________________________________________________
8. How do you treat your used oil?
Yes No
-----------------------------------
BURN BARREL______________|_________
DUMP/LANDFILL____________|_________
USE FOR HEAT_____________|_________
DUMP ON GROUND___________|_________
USE FOR CHAINSAW_________|_________
STORE FOR RECYCLE________|_________
9. Do you recycle antifreeze? YES() NO()
10. Where do you store used batteries?
________________________________________________
11. What do you do with your unused medications?
________________________________________________
________________________________________________
12. What do you do with unused/unwanted beauty products?
________________________________________________
________________________________________________
13. If you are given the choice of products that may
be less harmful to your world, but may be more time
consuming to use, will you switch? YES() NO()
Recyclable
14. Will you support recycling? YES() NO()
15. Will you support the safe disposal of oil, batteries, and antifreeze?
YES() NO()
16. Please list those items you think may be recycled.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
17. If a recycling program were started in your village, would you help?
YES() NO()
Comments on Recycling:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Honeybuckets
18. What do you think is the biggest problem with your honeybucket system?
________________________________________________
________________________________________________
________________________________________________
________________________________________________
19. Give some examples of how to improve the honeybucket system.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Water
20. What is your main source of water?
IN SUMMER__________ IN WINTER____________
21. Does your family use the local well for drinking water?
YES() NO()
22. What question or comments do you have?
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
GENERAL HOUSEHOLD ITEM CHECKLIST
Stored Properly
-------------
Yes No Yes No
----------------------------------------------
AIR FRESHENER____________|______|_____|_____|
GLASS CLEANER____________|______|_____|_____|
HOUSE PLANT CARE | | | |
PRODUCTS______________|______|_____|_____|
PET CARE PRODUCTS | | | |
(flea collars | | | |
etc.)_________________|______|_____|_____|
SMOKE DETECTORS__________|______|_____|_____|
FLUORESCENT LIGHTS_______|______|_____|_____|
SMALL BATTERIES__________|______|_____|_____|
HERBICIDES (weed | | | |
killers, etc.)________|______|_____|_____|
INSECTICIDES (ortho, | | | |
daizinon, etc)________|______|_____|_____|
NO PEST STRIPS___________|______|_____|_____|
INSECT REPELLENT_________|______|_____|_____|
CLEANSER_________________|______|_____|_____|
TOILET BOWL | | | |
CLEANER________________|______|_____|_____|
STOVE OIL________________|______|_____|_____|
OTHER____________________|______|_____|_____|
Source: Needs assesment developed by the Alaska Health Project for Kuigpagmuit, Inc.