Time/Activity - mothers - Chinese

Green Housing Study Form Approved

OMB No. 0920-XXXX

Appendix D11 - Time/ Activity (Mother/ Primary Caregiver)

Household ID # ______________

Green Housing Study

綠色住房

Time /Activity Questionnaire

(Mother/ Primary Caregiver)

日程/活動問卷

（母親/主要照顧人）

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

這個數據收集所造成的回答負擔大約在5分鐘左右，其中包括閲讀指示，搜索現有信息庫，集合和保持所需數據，以及完成並檢查收集的數據。任何單位不能進行或贊助，任何人也沒有必要回答沒有國家管理和經費預算辦公室（OMB）批復編號的數據收集問卷。發送有關回答負擔的評論或者建議到美國疾病控制與方中心(CDC/ATSDR)信息收集審查辦公室：1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXX).

Interviewer Initials _______ Date: ___________

採訪員名字： 日期：

1. Observation point (Circle One):

1. Baseline

2. Baseline part 2

3. 6-month follow-up (post-remediation)

4. 12-month follow-up (post-remediation)

1. 觀察時間段（選一）

1. 基礎

2. 基礎第二部分

3. 跟蹤第6個月（翻新后）

4. 跟蹤地12個月（翻新后）

2. In the days that we were sampling your air inside your home, on average how many hours per day has the stove or oven been in use for cooking?

當我們在對你家裏的空氣進行檢測的日子裏，每天平均有多少小時爐竈或烤爐用於做飯？

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

If “NEVER” then skip to question 3

如果“從不，”跳到第五題

2.1. When cooking, did you use any of the following?

1. Range hood/ Exhaust fan Y N n/a

2. Opened windows or doors Y N

2.1。 你在做飯時，有用到以下的東西嗎？

1. 抽油煙機/排風扇 有 沒有 不適用

2. 打開窗戶或們 有 沒有

3. In the days that we were sampling your air inside your home, on average how many hours per day were windows open or window fan running?

3．當我們在對你家裏的空氣進行檢測的日子裏， 每天平均有多少小時窗戶是打開的或者窗戶風扇是運作的？

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

4. In the days that we were sampling your air inside your home, on average how many hours per day was the air conditioning on?

4．當我們在對你家裏的空氣進行檢測的日子裏， 每天平均有多少小時空調是開著的？

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

5. In the days that we were sampling the air inside your home, on average how many hours per day was the heat on?

5．當我們在對你家裏的空氣進行檢測的日子裏，每天平均多少小時暖氣是開著的？

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

If Question 5 > 1 (heat was on), then ask:

如果第七題的回答大於1(暖氣是開著的),繼續問：

Which types did you use?

(circle ALL that apply)

你用的是哪一种？ （選擇所有適用的）

1. Radiator

2. Baseboard

3. Forced hot air (vents)

4. Electric space heater

5. Kerosene space heater

6. Other type of space heater

7. Open oven

8. Fireplace/wood-burning stove

9. Other

5.1 暖氣片

5.2 地暖？

5.3 暖風

5.4 電子暖爐

5.5 煤油暖爐

5.6 其它種類的暖爐

5.7 打開的烤箱

5.8 壁爐/燒木頭的爐竈

5.9 其它

6. In the days that we were sampling your air inside your home, on average how many hours per day was someone smoking inside the home?

6．當我們在對你家裏的空氣進行檢測的日子裏，每天平均有多少小時有人在家裏吸煙?

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

7. In the days that we were sampling your air inside your home, on average how many hours per day did you smell tobacco smoke in your home coming from other apartments?

7．當我們在對你家裏的空氣進行檢測的日子裏，每天平均有多少小時你聞到有從其他公寓傳來的煙草味？　

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

8. In the days that we were sampling your air inside your home, on average how many hours per day was someone burning candles or incense in the home?

8。當我們在對你家裏的空氣進行檢測的日子裏，每天平均有多少小時有人在家裏點蠟燭？　

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

9. In the days that we were sampling your air inside your home, on average how many hours per day was someone using an air cleaner/purifier unit (like an air filter - not air freshener) inside the home?

9。當我們在對你家裏的空氣進行檢測的日子裏，每天平均有多少小時有人在家裏用空氣清潔／改善器（不是空氣清新劑）？　

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

10. In the days that we were sampling your air inside your home, on average how many hours per day was someone using an air freshener inside the home?

10。當我們在對你家裏的空氣進行檢測的日子裏，每天平均有多少小時有人在家裏用空氣清新劑？　

1. Never

2. Less than 1 hour/day

3. 1-3 hour/day

4. Over 3 hours a day

1. 從不

2. 每天小於一小時

3. 每天1到3小時

4. 每天3小時以上

11. In the days that we were sampling your air inside your home, on how many days did someone using spray cleaning products inside the home?

11。當我們在對你家裏的空氣進行檢測的日子裏，有多少天你在家裏用了噴霧狀的清潔劑？

Note: These answers are different than those above.

1. Never

2. Once

3. A few times

4. Every day

1. 從不

2. 一次

3. 幾次

4. 每天

12. Comments (If anything else could have influenced air sampling):

12。註解（如果有其它會影響空氣測量的情況）

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