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pdf Appendix A: Prenotification Letter to Households
,,
Dear ,
The U.S. Consumer Product Safety Commission (CPSC) protects all of us against unreasonable risks of
injuries and deaths related to the products we buy and use. The CPSC has asked EurekaFacts, a survey
research company, to conduct a nationwide in-home survey about household fire and carbon monoxide
(CO) safety.
The survey is very important, and your participation will help the CPSC improve home safety and save
lives. When you take part in this research, you speak for thousands of people like you, and you help to
make homes safer. Participation in this survey is voluntary and your responses will be kept confidential.
We chose your household at random from a list of addresses across the country. These addresses
represent different regions of the country and types of homes. We are interested in talking with people
who have smoke detectors and people who do not have smoke detectors.
We would like to ask you to support this initiative by taking part in our survey.
To sign up for this study, complete the brief online form:
1. In your web browser, please go to
2. Enter your unique ID: [abc123]
Or you can call EurekaFacts at the toll-free-number to sign up.
After signing up, you may receive a phone call from EurekaFacts staff, from . During the call,
you will have an opportunity to schedule an appointment for an in-home interview. If you qualify and
complete the in-home interview, you will receive a $50 gift card from a major card company in
appreciation for completion of the survey.
Thank you for your willingness to participate in this important survey.
Sincerely,
EurekaFacts, LLC on behalf of the
U.S. Consumer Product Safety Commission
Appendix B: Follow Up Letter (For Respondents without Telephone Number)
,,
Dear ,
Recently, we sent you a notification of an upcoming study regarding home fire and carbon monoxide (CO)
safety. The study is now underway, and we are interested in hearing from you.
The U. S. Consumer Product Safety Commission (CPSC) has asked EurekaFacts, a survey research
company, to conduct a nationwide survey about household fire and CO safety. The survey is very
important and your participation will help the CPSC improve home safety and save lives.
We are interested in talking with people who have smoke detectors and people who do not have smoke
detectors. Participation in this survey is voluntary and your responses will be maintained confidential and
anonymous.
If you have already contacted EurekaFacts, thank you for your valuable input. If not, please contact us to
learn more about this study. Your experiences and thoughts on the topic are extremely valuable for this
effort.
To sign up for this study, complete the brief online form:
1. In your web browser, please go to
2. Enter your unique ID: [abc123]
After signing up, EurekaFacts may reach out to you from the contact information you provide. You will
have an opportunity to schedule an appointment for an in-home interview. If you qualify and complete the
in-home interview, you will receive a $50 gift card from a major credit card company in appreciation for
completion of the survey.
Thank you for your willingness to participate in this important survey.
Sincerely,
EurekaFacts, LLC on behalf of the
U.S. Consumer Product Safety Commission
Appendix C: In-Home Survey Scheduling Confirmation Email
IF SENT AS E-MAIL - Subject: CPSC Confirmation of Your In-Home Interview Session
Dear ,
Thank you for agreeing to participate in the national survey about household fire and carbon monoxide
(CO) safety conducted by EurekaFacts on behalf of the U.S. Consumer Product Safety Commission
(CPSC). The purpose of this survey is to gather information about the functionality of smoke detectors
and CO detectors in homes in the United States. Your experiences and thoughts on the topic are
extremely valuable for this effort.
Information collected from your participation will help CPSC improve home fire safety. We appreciate your
time and look forward to your participation.
Your appointment is scheduled for at , and will take place in your home for no
more than 60 minutes. Please make sure you are home and available for the interview during this time.
You will receive a $50 gift card from a major card company in appreciation for completion of the survey.
We look forward to having you participate in this very important research study. If you have any
questions, please contact me.
Sincerely,
Field Services Coordinator
EurekaFacts, LLC
(240) 403-1645
(301) 610-0640 - fax
www.eurekafacts.com
Appendix D: In-Home Informed Consent Form
Consumer Product Safety Commission (CPSC) Survey
on Usage and Functionality of Smoke Detectors and
Carbon Monoxide Detectors in Households
Informed Consent Form
Thank you for your interest in participating in the research study described below. This consent form
explains the research study. This study is conducted by EurekaFacts on behalf of the U.S. Consumer
Product Safety Commission (CPSC). We are conducting a nationwide survey on household fire and
carbon monoxide (CO) safety. The purpose of this survey is to gather information about the functionality
of smoke detectors and CO detectors in the U.S. households. Findings from this research will help CPSC
improve home safety.
This survey involves 60 minutes in-home interview. A qualified two-member survey team will ask you
questions related to smoke detectors and CO detectors, and then a team member who is trained and
certified to inspect and install smoke and carbon monoxide detectors will test the smoke detectors and
CO detectors installed in your home. You will receive a $50 gift card from a major card company in
appreciation for completion of the survey.
If the survey team finds any detectors to be non-functioning, arrangements can be made to provide you
with a new detector or batteries, free of charge. If you are renting your home, the property manager will
need to be contacted to arrange installation of the new detector at a later date. With your permission and,
if you are renting, with the property manager permission, we also want to collect any smoke or CO
detectors that don’t work and send them to CPSC’s lab to find out why they don’t work. In addition, a
member of the survey team may request your permission to take a photograph of your smoke and CO
detector(s).
Information collected from this survey will help CPSC improve household fire and CO safety across the
U.S. Your input will assist with developing standards and guidelines that will help protect property and
human life. This research does not involve any foreseeable risks, other than the potential for mild
boredom or fatigue.
Your participation in this research study is completely voluntary. You may stop at any time if you do not
want to continue with the study by notifying a member of the survey team. Your responses will be
maintained confidential, and will be used for research purposes only. At no time will any identifiable
information be linked to any of your answers. All information collected through our research process is
grouped and reported to CPSC anonymously.
Your signature below means that you have freely agreed to participate in this research study. You should
consent only if you have read this document and you understand its contents.
Signature______________________________________________
Date__________________________________________________
If you have any questions about this study please contact Andrea Ton at or . If you
have any ethical concerns regarding this research please contact Mila Sugovic, the Chair of the
Institutional Review Board, at 240-403-4800 ext. 218, or [email protected] .
Appendix E: Waiver, Release and Hold Harmless Agreement
Home Address:
____________________________________________________________
In consideration of the voluntary performance of my participation in the U.S. Consumer Product Safety
Commission (CPSC) Survey on Usage and Functionality of Smoke Detectors and Carbon Monoxide
Detectors in Households, which is being conducted at my residence, located at
______________________ I, on behalf of myself, and all members of family, as well as my heirs,
executors, administrators or successors, hereby waive any claim or cause of action of any nature that I
have, or in the future may have, against any and all individual or organizational participants in the CPSC
Survey on Usage and Functionality of Smoke Detectors and Carbon Monoxide Detectors in Households,
including but not limited to the [Partner Name], and EurekaFacts, LLC, its agents or employees, which
claim or cause of action grows out of or results from increased levels of carbon monoxide, a fire or other
damage, following the testing and inspection of one or more of the smoke and or carbon monoxide
detectors, in addition one or more of the following action(s):
Action(s) taken:
Replaced batteries
Provided new smoke detector(s)
Collected faulty smoke detector(s)
Obtained photograph of smoke/
carbon monoxide detector(s) (Device
only)
Provided new CO detector(s)
Collected faulty CO detector(s)
Took no additional action
I further hereby agree to release and hold harmless any and all organizational and individual participants
including the [Partner Name] and municipality in the CPSC Survey on Usage and Functionality of
Smoke Detectors and Carbon Monoxide Detectors in Households from and against all damages of any
kind, to persons or property, growing out of or resulting from a fire or increased levels of carbon
monoxide in my referenced home.
I acknowledge having read, understood, and agreed to the above waiver, and release.
Print name
Signature
Date
Witness (Print name)
Signature
Date
*This form generally indicates that the occupant or owner of the property agrees to waive his or her rights to sue any individual, any
municipality and any other organizations or individuals involved in the safety inspection of this home, if a fire or increased levels of
carbon monoxide occurs after the inspection. The purpose of the waiver is to protect the individual or any of the organizations involved
against liability arising from the home fire inspection. This statement is intended for information only, the terms of the waiver
themselves shall prevail if there are any questions. You should seek advice if you do not understand this waiver.
Appendix F: Thank You Email For Participating in In-Home Interview
IF SENT AS EMAIL - Subject: Thank you for your participation in the CPSC Research Study
Dear ,
Thank you for participating in the interview survey about smoke and carbon monoxide (CO) safety for the
U.S. Consumer Product Safety Commission (CPSC) on at . The information you
provided will be used to improve fire and carbon monoxide safety for millions of families across the U.S.
We truly value your input and appreciate your time.
Again, thank you very much and feel free to contact us with any questions.
Sincerely,
Field Services Coordinator
EurekaFacts, LLC
(240) 403-1645
(301) 610-0640 - fax
www.eurekafacts.com
Appendix G: Extended Explanation of Study
IF SENT AS EMAIL - Subject: Additional Information for a CPSC Research Study
Hello,
I am contacting you from EurekaFacts, a survey research company. You are receiving this email because
you have previously requested additional information about the in-home safety survey that we are
conducting on behalf of the U.S. Consumer Product Safety Commission (CPSC).
These interviews are an important part of the research process. The purpose of this survey is to inform
CPSC about the use of smoke detectors and CO detectors in homes in the United States. In addition,
information collected from this survey will improve household safety across the U.S. Your input will assist
with developing standards and guidelines that will help protect property and human life.
This study will require a qualified two-member survey team to visit your home to ask you a series of
questions about household fire safety and then test your smoke and carbon monoxide (CO) detectors to
make sure they work properly. A member of the team who is trained and certified to inspect and install
smoke detectors will test your smoke and carbon monoxide detectors to see if they are working properly.
If the batteries in the detectors need to be replaced, we can provide you with a replacement for free. If the
survey team during in-home interview finds any detectors to be non-functioning, new ones will be offered
at no cost. If you are renting your home and agree to participate in the study, the property manager will
need to be contacted to discuss arrangements regarding survey team visit and smoke dectectors testing.
The in-home interview session will last up to 60 minutes, and, at the end of the interview, we will provide
you with a $50 gift card from a major credit card company in appreciation for completion of the survey.
In instances where you may not have a smoke detector or CO detector, we are still interested in you
participating in the survey. If your home does not have a smoke detector or CO detector, we will conduct
the interview over the phone instead. The telephone interview will last up to 20 minutes. If you are eligible
for the telephone survey, you will receive a $25 gift card from a major credit card company in appreciation
for completion of the survey.
If you would like to participate in the study, please call EurekaFacts at the toll-free number
and mention you are calling for the CPSC Smoke and CO Detector study, or click here for
more information. Please have your unique ID ready when contacting our call center staff.
Thank you for your willingness to participate in this important survey.
Sincerely,
EurekaFacts, LLC on behalf of the
U.S. Consumer Product Safety Commission
Appendix H: Frequently Asked Questions (FAQs)
Frequently Asked Questions (FAQs)
About the study
The Survey on Usage and Functionality of Smoke Detectors and Carbon Monoxide Detectors in
Households is sponsored by the U.S. Consumer Product Safety Commission (CPSC). EurekaFacts, an
independent research firm, is conducting the study on behalf of CPSC.
What is the purpose of the study?
The purpose of this survey is to gather information on perceptions, usage and functionality of smoke and
carbon monoxide (CO) detectors in homes within the United States. Findings from this survey will be
helpful for establishing a baseline for measuring future progress, and for providing key information for
public safety education, code enforcement, and improving the technology.
Where will the interview be held?
If you qualify for the in-home interview, a qualified two-member survey team will schedule a time,
convenient for you, to meet at your residence.
What is involved in the in-home interview?
This study will require a qualified two-member survey team to visit your home to ask you a series of
questions about household fire and carbon monoxide safety. Both members will present their government
issued IDs and their official badges to confirm their identity and legitimacy. A member of the team who is
trained and certified to inspect and install smoke detectors will test your smoke and carbon monoxide
detectors to see if they are working properly. The in-home interview will last no longer than 60 minutes.
I do not have a smoke or CO detector. Am I still eligible?
Yes. We are still interested in speaking with households that do not have a smoke detector or CO
detector. However, instead of visiting your home, we will conduct the interviews over the phone. In these
instances, you will be eligible for a $25 gift card from a major credit card company in appreciation for
completion of the survey.
How was I selected for this study?
You’ve been specifically chosen as someone from whom we’d like to hear. Your household was selected
at random from a list of households across the country that represent different regions and types of
homes.
Can I recommend another household to complete the survey for me?
No. Your household was specifically chosen among a list of households that represent different regions
and different homes. Your responses are unique, and cannot be replaced.
Can I recommend a friend?
No. Households were specifically selected to participate in this study based on several factors. Unless the
household was selected for the study, we are unable to conduct the interview with them.
How long will the interview last?
The in-home interview is expected to last up to 60 minutes.The telephone interview is expected to last no
more than 20 minutes.
Will my information be kept confidential?
All responses are kept completely confidential. At no time will any identifiable information be linked to any
of your answers. All information collected through our research process is grouped and reported
anonymously.
What are the incentives for participating?
This will depend on if you participate in the in-home or telephone interview. If you are eligible to
participate in the in-home interview, you will received a $50 gift card from a major credit card company in
appreciation for completion of the survey. If, however, you are eligible to participate in the telephone
interviews, you will receive a $25 gift card from a major credit card company in appreciation for
completion of the survey.
What is the duration of this study?
We will be fielding this survey from to . After , we will stop collecting
responses.
Whom can I contact with additional questions?
If you have any questions about this study please contact Andrea Ton at or . If you
have any ethical concerns regarding this research please contact Mila Sugovic, the Chair of the
Institutional Review Board, at 240-403-4800 ext. 218, or [email protected] .
Appendix I: Telephone Screener, Scripts, and Verbal Assent
If in-bound call,
Thank you for expressing an interest in this study. Before we begin, could you please provide the unique
ID indicated on the letter you received?
Insert unique ID _______
Just to make sure we are talking with the correct household, could you please share with us your address?
Check to see that the address matches the address we have on file
If unique ID and address don’t match
END SCREENER SCRIPT: Unfortunately [that is an incorrect ID and we are/ we need the unique ID
and are/ we are], unable to locate the address on file. Please call back when you have the correct unique
ID.
If address matches,
Hello, this is [NAME] calling for the U.S. Consumer Product Safety Commission from EurekaFacts, a
survey research company in Rockville, MD. We are conducting an important nationwide survey about
household fire and carbon monoxide safety.
May I speak with _________________?
[REPEAT IF A DIFFERENT PARTICIPANT COMES TO THE PHONE: Hello, this is [NAME] calling
for the U.S. Consumer Product Safety Commission from EurekaFacts, a survey research company in
Rockville, MD. We are conducting an important nationwide survey about household fire and carbon
monoxide safety.]
We are not selling anything. Your answers will help the U.S. Consumer Product Safety Commission
improve home safety and save lives. Your own experiences and thoughts on the topic are extremely
valuable to this effort.
We are interested in talking with people who live in households which do and do not have smoke
detectors and carbon monoxide detectors. By answering just a few questions about your residence, you
will help this research study. You may even be eligible to take part in a longer interview for which you
could receive a $50 gift card from a major credit card in appreciation for completion of the survey.
I have just five brief questions to ask. It should only take a two minutes of your time
[If No] “Thank you very much for your time. Have a nice day/evening.”
[If Yes] “Great, thank you very much. Let’s begin….”
GO TO QUESTION 1
If out-bound call
Hello, this is [NAME] calling for the U.S. Consumer Product Safety Commission from EurekaFacts, a
survey research company in Rockville, MD. We are conducting an important nationwide survey about
household fire and carbon monoxide safety.
May I speak with _________________?
If unavailable,
“Is there another person I can speak to who may be considered one of the heads of the
household?”
If not at the moment,
“When would be a convenient time to reach them?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
If refused,
“Thank you for taking the time to talk with me today. Have a great day/evening.”
If available, reintroduce yourself and company again,
We are not selling anything. Your answers will help the U.S. Consumer Product Safety Commission
improve home safety and save lives. Your own experiences and thoughts on the topic are extremely
valuable to this effort.
We are interested in talking with people who live in households which do and do not have smoke
detectors and carbon monoxide detectors. By answering just a few questions about your residence, you
will help this research study.You may even be eligible to take part in a longer interview for which you
could receive a $50 gift card from a major credit card company in appreciation for completion of the
survey.
I have just five brief questions to ask. It should only take a two minutes of your time.
[If No] “Thank you very much for your time. Have a nice day/evening.”
[If Yes] “Great, thank you very much. Let’s begin… .”
Screener
[Interviewer: Determine recruitment needs in advance. Record all responses. End screener at whatever
point the participant gives a response that confirms that their group has already been sampled adequately.
End screener script: Based on the requirements of this study, we are not able to include you in the survey
at this time.]
NOTE: For each question on the screener and survey, only read the available response options if there are
instructions to do so. The instructions will appear at the end of the question usually as “(READ LIST).”
Otherwise, DO NOT read the possible response options to the respondent.
1. To make sure we are talking to a variety of people, what is your age?
a. Under 18 (Go to 1A)
b. 18-30
c. 31-40
d. 41-50
e. 51-60
f. 61-64
g. 65 +
1A. Is there another person available we may speak with, who is 18 years or older and may be
considered one of the heads of the household?
a. Yes
b. No (Terminate)
END SCREENER SCRIPT: Thank you for speaking with us today. Based on the requirements of this
study, we are not able to include you in the survey at this time.
2. Are you one of the heads of the household?
a. Yes (Go to Q3)
b. No (Go to Q2A)
2A. [IF NO] Is there another person I may speak to who might be considered one of the heads of
the household?
a. Yes (Start from beginning)
b. Yes, but they are currently unavailable
c. No (Terminate)
If Q2A = 2
If a head of the household is unavailable: We would like to speak with one of the heads of the
household. What would be the best day and time to reach them?
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
If Q2 = 2 and Q2A = 3
END SCREENER SCRIPT : “Thank you for your time. Have a nice day.”
3. What type of residence do you live in?
a. Single Family Detached Home
b. Single Family Attached Housing, such as a townhouse or row house
c.
d.
e.
f.
Apartment/Condominium
Mobile/Other Manufactured Home
Trailer/RV
Other (Specify) _________________________________________________
4. Do you have any smoke detectors in your home? When considering whether you do, please
do not include any uninhabited outbuildings or apartment hallways.
a. Yes
b. No (SKIP TO SCRIPT 2)
c. Don’t know (ASK RESPONDENT TO INSPECT, IF NO SKIP TO SCRIPT
2, ELSE CONTINUE)
Don’t know: “If you don’t mind, could you please take a quick look around your home to see if you
have a smoke detector?”
If needed:
•
•
Smoke detectors are typically installed on the ceilings or high on the walls of:
o Kitchens
o Bedrooms
o Hallways
They are housed in white plastic enclosures, usually shaped like a disk about 6 inches in
diameter.
4A. Are any of your smoke detectors connected to a central alarm or security system
that notifies the police or fire department?
[If apartment/condominium: Only consider the smoke detectors in your unit. Are
these connected to a central alarm or security system that notifies the police or fire
department?]
[If needed: What we mean by this is if the smoke detector detected smoke, it
would automatically notify the police or fire department.]
a. Yes (SKIP TO SCRIPT 3)
b. No (SKIP TO SCRIPT 1)
c. Don’t know (GO TO Q4B)
4B. Thinking of all fire or smoke related incidents, has the police or fire department
ever arrived at your residence in response to a notification from a central alarm or
security system? (READ ALL OPTIONS BEFORE SELECTING A RESPONSE)
a. Yes (SKIP TO SCRIPT 3)
b. No (GO TO SCRIPT 1)
c. Never had a fire or smoke related incident (SKIP TO SCRIPT 3)
If Q4 = 2 SKIP TO SCRIPT 2
If Q4a = 1 OR Q4b = 1 or 3 SKIP TO SCRIPT 3
ELSE, GO TO SCRIPT 1
SCRIPT 1
QUALIFY FOR IN-HOME SURVEY
Confirmation: Thank you for answering these questions, and congratulations! You are eligible to help
with this important research effort.
The purpose of this survey is to gather information about the functionality of smoke detectors and carbon
monoxide (CO) detectors in homes in the United States. Findings from this research will help U.S.
Consumer Product Safety Commission improve home safety.
If you agree, a qualified two-member team will visit your home to ask you a series of questions about
household fire and carbon monoxide safety. Both members will present their government issued IDs and
their official badges to confirm their identity and legitimacy. A member of the team who is trained and
certified to inspect and install smoke detectors will test your smoke and carbon monoxide detectors to see
if they are working properly. If your batteries are not working, we will replace them free of charge. If any
detectors are not working, new ones will be offered at no cost. We will give you a $50 gift card from a
major credit card company in appreciation for completion of the survey.
Your responses to this survey will be kept completely confidential and your information will not be
shared with anyone other than the EurekaFacts research team. Any information provided to the U.S.
Consumer Product Safety Commission will be reported as group data with no identifying information
5. Would you be interested in participating in this research study?
a. Yes (Go to Q 5A)
b. No (Terminate)
END SCREENER SCRIPT: “Thank you for taking the time to talk with me today. Have a great
day/evening.”
5A. IF YES, “Thank you so much for your willingness to help us. We are looking to schedule
people for interviews between and . Is there a day of the week or a time
of day that works best for you?” (Schedule the participant based on the available times and
the participants’ availability).
If Q3 = 3 (c. Apartment/Condo), Go to Q6
ELSE, SKIP to Closing
6. Before we finish, I have a couple questions to help the survey team when they arrive at your home.
As I recall, you live in an apartment or condominium, so we need to obtain approval from the
property manager before you can participate in this study. Additionally, if the survey team determines
any detectors to be non-functioning, arrangements can be made to provide you with a new detector or
batteries. However, at the discretion of you and your property manager, either the survey team or
property manager can arrange installation. Do you have the contact information for the property
manager of your apartment building or condominium?
a. Yes (Go to Q 6A)
b. No (Go to Q 6B)
6A. IF YES, “Could you provide their name and phone number?”
Name
_________
Phone number
_________
6B. IF NO, “That is okay, do you have the-building name so we can find their contact
information?”
Name
_________
Closing: Just to confirm, we have you scheduled for at . Again, thank you for your
time today and your willingness to help us with this study.
SCRIPT 2
QUALIFY FOR PHONE SURVEY - Group Without Smoke Detector
Thank you for answering these questions. Since you do not have a smoke detector, you are not eligible for
the in-home interview; you are, however, eligible for the shorter telephone interview and will receive a
$25 gift card from a major credit card company in appreciation for completion of the survey.
We are talking with residents about household fire and carbon monoxide safety. The interview lasts about
20 minutes, and will be completed over the phone. We will send you a $25 gift card from a major credit
card company in appreciation for completion of the survey.
All your responses to this survey will be kept completely confidential and your information will not be
shared with anyone other than the EurekaFacts research team. Any information provided to the U.S.
Consumer Product Safety Commission will be reported as group data with no identifying information.
The survey is very important and will help CPSC improve home safety and save lives.
Are you interested in participating?
[If No] “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Okay.”
As I previously mentioned, this survey will take about 20 minutes to complete. Would you like to take the
survey now, or reschedule it for another time?
[If now] – CONTINUE To Assent Script
[If at a later time]
“When would be a convenient time for us to call back?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
Verbal Assent Script
All information provided will remain confidential and will only be reported as group data with no
identifying information. Identifying information will be kept separately from the survey responses, and
your name will not be disclosed in any way. Instead, your responses will be marked with a random ID
number. All survey responses will be kept in a secure location. If any information is stored on the
computer, it will be password-protected. This conversation is not being recorded but notes will be taken.
Your participation does not involve any risks other than what you would encounter in daily life. By
participating, you will help researchers learn more about use and functionality of smoke and carbon
monoxide detectors in households. The survey should take about 20 minutes to complete, and you will
receive a $25 gift card from a major credit card company in appreciation for completion of the survey.
Your participation in this research study is completely voluntary. You do not have to respond to any
questions that you do not want to answer. You can withdraw at any time.
If you have questions regarding this study, you may contact Andrea Ton at [NUMBER] or [EMAIL
ADDRESS].
7a. Do you agree to participate in this survey?
a. Yes
b. No
[If No] “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Great. Let’s begin.” GO TO Telephone Survey for Group Without Smoke Detectors
[Appendix J].
SCRIPT 3
QUALIFY FOR PHONE SURVEY- Group with Central Alarm
Thank you for answering these questions. Since your smoke detector is attached to a central system, you
are not eligible for the in-home interview; you are, however, eligible for the shorter telephone interview
and will receive a $25 gift card from a major credit card company in appreciation fo completion of the
survey.
We are talking with residents about household fire and carbon monoxide safety. The interview lasts about
20 minutes, and will be completed over the phone. We will send you a $25 gift card from a major credit
card company in appreciation for completion of the survey.
Your responses to this survey will be kept completely confidential and your information will not be
shared with anyone other than the EurekaFacts research team. Any information provided to the U.S.
Consumer Product Safety Commission will be reported as group data with no identifying information.
The survey is very important and will help CPSC improve home safety and save lives.
Are you interested in participating?
[If No] “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Okay.”
As I previously mentioned, this survey will take about 20 minutes to complete. Would you like to take the
survey now, or reschedule it for another time?
[If now] – CONTINUE To Assent Script
[If at a later time]
“When would be a convenient time for us to call back?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
Verbal Assent Script
All information provided will remain confidential and will only be reported as group data with no
identifying information. Identifying information will be kept separately from the survey responses, and
your name will not be disclosed in any way. Instead, your responses will be marked with a random ID
number. All survey responses will be kept in a secure location. If any information is stored on the
computer, it will be password-protected. This conversation is not being recorded but notes will be taken.
Your participation does not involve any risks other than what you would encounter in daily life. By
participating, you will help researchers learn more about use and functionality of smoke detectors and
carbon monoxide detectors in households. The survey should take about 20 minutes to complete, and you
will receive a $25 gift card from a major credit card company in appreciation for completion of the
survey.
Your participation in this research study is completely voluntary. You do not have to respond to any
questions that you do not want to answer. You can withdraw at any time.
If you have questions regarding this study, you may contact Andrea Ton at [NUMBER] or [EMAIL
ADDRESS].
7b. Do you agree to participate in this survey?
c. Yes
d. No
[If No] “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Great. Let’s begin.” GO TO Telephone Survey for Group With Smoke Detectors as Part of
Central Alarm [Appendix K].
Appendix J: Telephone Survey for Group Without Smoke Detectors
TELEPHONE SURVEY FOR NATIONAL SMOKE AND CARBON MONOXIDE DETECTOR
SURVEY [WITHOUT SMOKE DETECTOR]
Continuation of Script 2 from Appendix I above.
9a.
Do you have any carbon monoxide detectors in your home? When considering
whether you do, please do not include any uninhabited outbuildings or apartment
hallways.
Yes
No (SKIP TO Q10)
Don’t know (ASK TO INSPECT. IF YES CONTINUE, BUT IF NO TREAT AS
“NO” CO DETECTOR)
9b.
Are any of your carbon monoxide detectors connected to a central detector
or security system that notifies the police or fire department?
[If needed: What we mean by this is if the carbon monoxide detector detected carbon
monoxide, it would automatically notify the police or fire department.]
Yes (SKIP TO Q9d)
No (SKIP TO Q9d)
Don’t Know (CONTINUE)
9c.
Thinking of all carbon monoxide related incidents, has the police or fire
department ever arrived at your residence in response to a notification from
a central alarm or security system? (READ ALL OPTIONS BEFORE
SELECTING A RESPONSE)
Yes
No
Never had a carbon monoxide related incident
IF 9b = 1 or 9c = 1 or 3, CONTINUE
ELSE, SKIP TO 10
9d.
Please tell me to what extent do you believe your home is safe with your
current carbon monoxide detectors? Would you say... (READ LIST)
NOTE: Read the descriptors, but do not read the numbers.
Not at Slightly Moderately Mostly
all safe
safe
safe
safe
(1)
(2)
(3)
(4)
Very
safe
(5)
DK
RF
10.
Do you or another member of your household own or rent your home?
Own
Rent
Don’t know
Refused
Other
11.
How long have you lived in this (apartment/ house)? Would that be… (READ LIST)
Less than 6 months
6 to 11 months
1 to 5 years
6 to 10 years
11 years or more
Don’t know (DON’T READ)
Refused (DON’T READ)
12.
Please tell me to the best of your knowledge, in what year was this (apartment/
house) built? Was it… (READ LIST)
2010 or later
Between 2000 and 2009
Between 1990 and 1999
Between 1980 and 1989
Before 1980
Don’t know (DON’T READ)
Refused (DON’T READ)
If Q3 = 1 or 2, CONTINUE
ELSE, SKIP TO 14
13a.
What type of fuel-burning appliances, if any, do you own or have in your home? By
fuel burning appliances, we mean appliances that use gas, propane, oil, wood, wood
pellets, coal, or kerosene. Do not include electric-powered appliances. (READ LIST,
SELECT ALL THAT APPLY)
Gas powered generator
Furnace or boiler
Water heater
Charcoal grill
Gas Dryer
Wood or pellet burning fireplace or stove
Kitchen applicances (e.g., stove, oven)
Other (Specify) ________________________
Do not own any fuel-burning appliances
Don’t know (DON’T READ)
Refused (DON’T READ)
13b.
Does this residence have an attached garage unit?
Yes
No (SKIP TO Q14)
Don’t know (SKIP TO Q14)
Refused (SKIP TO Q14)
13c.
14.
For what purposes is the attached garage used? Would you say… (READ
LIST, SELECT ALL THAT APPLY)
Workshop/ workspace
Store tools or lawn/ sports equipment
Store vehicle(s) (e.g., motorcycle, car, SUV, van, etc.)
Fuel burning appliances (e.g., furnace, water heater, etc.)
Other (Specify:)___________________________
Don’t know (DON’T READ)
Refused (DON’T READ)
Do you know how to…
Yes
No
Don’t
know
Refused
a. Install a smoke detector?
b. Maintain a smoke detector
in good working order?
FIRE HISTORY
15a.
In the past 12 months, have you had any accidental fires – that is unintended or
unwanted smoke or flames - in your home? Please include fires that were too small
to call the fire department.
Yes
No
Don’t know
Refused
CO DETECTORS
16.
How would you know if high levels of carbon monoxide, or CO, were present in
your home? (DO NOT READ LIST, SELECT ALL THAT APPLY).
You can smell it
You can taste it
You can see it
You can feel it
Carbon monoxide detector
Other (Specify:)___________________________
Respondent does not believe there is a way to know if CO is present
Don’t know
Refused
17.
How familiar are you with carbon monoxide detectors? (READ LIST)
Not at all familiar
Not very familiar
Somewhat familiar
Very familiar
Don’t know(DON’T READ)
Refused (DON’T READ)
18.
In the past 12 months, have any of your friends, relatives, neighbors, or coworkers
experienced…
Yes
No
Don’t
know
Refused
a. An accidental fire?
b. A carbon monoxide incident?
(e.g., effects of carbon
monoxide poisoning)
19. On a scale of 1 to 5, where 1 is Not at All Necessary, and 5 is Extremely
Necessary, how necessary do you feel it is to have a smoke detector installed in
your home?
1
2
3
4
5
DK
RF
20. Can you tell me some of the reasons you don’t have a smoke detector installed in
your home? (DO NOT READ LIST, SELECT ALL THAT APPLY)
Don’t think I need one
Did not come with residence
They are a nuisance
They did not or don’t work
Never got around to replacing previous detectors
It is the landlord’s responsibility
Other reason ____________________________________________
Don’t know
Refused
21. Please tell me how you would evaluate your home fire safety. Would you say it is…
(READ LIST)
NOTE: Read the descriptors, but do not read the numbers.
Not at Slightly Moderately Mostly
all safe
safe
safe
safe
(1)
(2)
(3)
(4)
Very
safe
(5)
DK
RF
NO CO DETECTORS PRESENT
IF Q9a = 2 CONTINUE
ELSE, SKIP TO Q24a
If no CO detectors present, ask:
22. On a scale of 1 to 5, where 1 is Not at All Necessary, and 5 is Extremely
Necessary, how necessary do you feel it is to have a carbon monoxide detector
installed in your home?
1
2
3
4
5
DK
RF
23. Can you tell me some of the reasons you don’t have a carbon monoxide detector
installed in your home?
(Open ended, Probe: Anything else?)
________________________________________________________________________
________________________________________________________________________
24a.
In the past 12 months, have you looked for any information about fire and carbon
monoxide safety?
o Yes
o No (SKIP to Q26)
o Don’t know (DON’T READ)
o Refused (DON’T READ)
IF Q24a = 1, CONTINUE
ELSE, SKIP TO Q26
25a.
Where do you obtain information about fire safety? (READ LIST ONE AT A
TIME)
Sources of information
TV news or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Fire safety
Local fire department
Other (SPECIFY) _________________
None of these (DON’T READ)
Don’t know (DON’T READ)
Refused (DON’T READ)
25b.
Where do you obtain information about carbon monoxide safety? (READ LIST
ONE AT A TIME)
Sources of information
Carbon
monoxide safety
TV news or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) _________________
None of these (DON’T READ)
Don’t know (DON’T READ)
Refused (DON’T READ)
26.
How often do you or any other member of the household cook at home using a stove
or oven? Does a member of this household cook… (READ LIST)
o Never,
o Less than once a month,
o A few times per month,
o A few times per week,
o Or every day?
o Don’t know (DON’T READ)
o Refused (DON’T READ)
DEMOGRAPHICS
Great! To ensure that we interview a broad mix of residents, I have a few brief demographic
questions to ask about you and others within this household. It should only take a few minutes of
your time.
27.
How many people live or stay in your household? This can include:
• Anyone who is living or staying there for the last 2 months or longer
• Yourself, if you are living there for the last 2 months or longer
•
Anyone else staying there who does not have another place to stay, even if they are
here for the last 2 months or less
Please do not include anyone who is living somewhere else for more than 2 months,
such as a college student living away or someone in the Armed Forces on deployment.
Enter number of people
28.
__________
Thinking of the individual(s) who live here, is there anyone …
Yes
No
Don’t
know
Refused
Under 5 years old?
5 - 17 years old?
18 – 64 years old?
65 years old or older?
29.
What is the highest level of education you have completed?
o Less than high school, no diploma
o High school diploma, or high school equivalent (GED)
o Trade or Vocational school degree
o Some college, no degree
o Associate’s degree
o Bachelor’s degree
o Master’s degree or higher
o Don’t know
o Refused
30.
Is anyone in the household of Hispanic or Latino origin or descent?
o Yes
o No
o Don’t know
o Refused
31.
What is your race?
(SELECT ALL THAT APPLY)
o White
o Black or African American
o Asian
o American Indian or Alaska Native
o Native Hawaiian or other pacific islander
o Other (Specify) ___________________________________________
o Don’t know
o Refused
If yes,
how
many?
32.
Is anyone in the household deaf or hard of hearing?
o Yes
o No
o Don’t know
o Refused
33.
Does anyone in the household have a physical, mental, or other health condition that
has lasted 6 or more months which makes it difficult for them to carry out day to
day activities?
o Yes
o No
o Don’t know
o Refused
34.
Do any people in the home smoke any products such as cigarettes, cigars, or pipes?
Please do not include e-cigarettes.
o Yes
o No
o Don’t know
o Refused
35.
What is the approximate combined annual income for all people who live or stay in
the home? (If necessary read)
o Less than $25,000
o $25,000 - $49,999
o $50,000 - $99,999
o $100,000 - $149,999
o $150,000 or more
o Don’t know (DON’T READ)
o Refused (DON’T READ)
INCENTIVE VERIFICATION
Thank you so much for participating in this survey. Your answers will help CPSC with improving
household fire and CO safety across the U.S.
As appreciation for completing the survey, we would like to send you a $25 gift card from
a major credit company. Could you please provide your full name and mailing address?
Interviewer: Fill in the blank with the respondent’s name and address, and
verify it. If needed, assure the respondent of the confidentiality of the
information provided.
Full Name:_________________________________
Street _________________________________
Apt/Suite/Other__________________
City_____________________ State____________ Zip/ Postal
Code____________
You will receive your gift card in the mail in the next few weeks.
EurekaFacts, LLC
January
Page 52
Appendix K: Telephone Survey for Group With Smoke Detectors as Part of
Central Alarm
TELEPHONE SURVEY FOR NATIONAL SMOKE AND CARBON MONOXIDE DETECTOR
SURVEY [WITH SMOKE DETECTOR AS PART OF CENTRAL ALARM]
Continuation of Script 3 from Appendix I above.
8. You had previously mentioned that you have one or more smoke detectors. Please tell me
to what extent do you believe your home is safe with your current smoke
detectors? Would you say... (READ LIST)
NOTE: Read the descriptors, but do not read the numbers.
Not at
all safe
(1)
9a.
Slightly
safe
(2)
Moderately
safe
(3)
Mostly
safe
(4)
Very
safe
(5)
DK
RF
Do you have any carbon monoxide detectors in your home? When considering
whether you do, please do not include any uninhabited outbuildings or apartment
hallways.
Yes
No (SKIP TO Q10)
Don’t know (ASK TO INSPECT. IF YES CONTINUE, BUT IF NO TREAT AS
“NO” CO DETECTOR)
9b.
Are any of your carbon monoxide detectors connected to a central detector
or security system that notifies the police or fire department?
[If needed: What we mean by this is if the carbon monoxide detector detected carbon
monoxide, it would automatically notify the police or fire department.]
Yes (SKIP TO Q9d)
No (SKIP TO Q9d)
Don’t Know (CONTINUE)
9c.
Thinking of all carbon monoxide related incidents, has the police or fire
department ever arrived at your residence in response to a notification from
a central alarm or security system? (READ ALL OPTIONS BEFORE
SELECTING A RESPONSE)
Yes
No
Never had a carbon monoxide related incident
IF 9b = 1 or 9c = 1 or 3, CONTINUE
ELSE, SKIP TO 10
EurekaFacts, LLC
January
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9d.
Please tell me to what extent do you believe your home is safe with your
current carbon monoxide detectors? Would you say... (READ LIST)
NOTE: Read the descriptors, but do not read the numbers.
Not at Slightly Moderately Mostly
all safe
safe
safe
safe
(1)
(2)
(3)
(4)
Very
safe
(5)
DK
RF
10.
Do you or another member of your household own or rent your home?
Own
Rent
Don’t know
Refused
Other
11.
How long have you lived in this (apartment/ house)? Would that be… (READ LIST)
Less than 6 months
6 to 11 months
1 to 5 years
6 to 10 years
11 years or more
Don’t know (DON’T READ)
Refused (DON’T READ)
12.
Please tell me to the best of your knowledge, in what year was this (apartment/
house) built? Was it… (READ LIST)
2010 or later
Between 2000 and 2009
Between 1990 and 1999
Between 1980 and 1989
Before 1980
Don’t know (DON’T READ)
Refused (DON’T READ)
If Q3 = 1 or 2, CONTINUE
ELSE, SKIP TO 14
13a.
What type of fuel-burning appliances, if any, do you use in your home? By fuel
burning appliances, we mean appliances that use gas, propane, oil, wood, wood
pellets, coal, or kerosene. Do not include electric-powered appliances. (READ LIST,
SELECT ALL THAT APPLY)
Gas powered generator
Furnace or boiler
EurekaFacts, LLC
Wood or pellet burning fireplace or stove
Kitchen applicances (e.g., stove, oven)
January
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Water heater
Charcoal grill
Gas Dryer
13b.
Does this residence have an attached garage unit?
Yes
No (SKIP TO Q14)
Don’t know (SKIP TO Q14)
Refused (SKIP TO Q14)
13c.
14.
Other (Specify) ________________________
Do not own any fuel-burning appliances
Don’t know (DON’T READ)
Refused (DON’T READ)
For what purposes is the attached garage used? Would you say… (READ
LIST, SELECT ALL THAT APPLY)
Workshop/ workspace
Store tools or lawn/ sports equipment
Store vehicle(s) (e.g., motorcycle, car, SUV, van, etc.)
Fuel burning appliances (e.g., furnace, water heater, etc.)
Other (Specify:)___________________________
Don’t know (DON’T READ)
Refused (DON’T READ)
Do you know how to…
Yes
No
Don’t
know
Refused
a. Install a smoke detector?
b. Maintain a smoke detector
in good working order?
FIRE HISTORY
15a.
In the past 12 months, have you had any accidental fires – that is unintended or
unwanted smoke or flames - in your home? Please include fires that were too small
to call the fire department.
Yes
No
Don’t know
Refused
EurekaFacts, LLC
January
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CO DETECTORS
16.
How would you know if high levels of carbon monoxide, or CO, were present in
your home? (DO NOT READ LIST, SELECT ALL THAT APPLY).
You can smell it
You can taste it
You can see it
You can feel it
Carbon monoxide detector
Other (Specify:)___________________________
Respondent does not believe there is a way to know if CO is present
Don’t know
Refused
17.
How familiar are you with carbon monoxide detectors? (READ LIST)
Not at all familiar
Not very familiar
Somewhat familiar
Very familiar
Don’t know(DON’T READ)
Refused (DON’T READ)
18.
In the past 12 months, have any of your friends, relatives, neighbors, or coworkers
experienced…
Yes
No
Don’t
know
Refused
a. An accidental fire?
b. A carbon monoxide incident?
(e.g., effects of carbon
monoxide poisoning)
NO CO DETECTORS PRESENT
IF Q9a = 2 CONTINUE
ELSE, SKIP TO Q24a
If no CO detectors present, ask:
22. On a scale of 1 to 5, where 1 is Not at All Necessary, and 5 is Extremely
Necessary, how necessary do you feel it is to have a carbon monoxide detector
installed in your home?
1
2
3
4
5
DK
RF
EurekaFacts, LLC
January
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23. Can you tell me some of the reasons you don’t have a carbon monoxide detector
installed in your home?
(Open ended, Probe: Anything else?)
________________________________________________________________________
________________________________________________________________________
24a.
In the past 12 months, have you looked for any information about fire and carbon
monoxide safety?
o Yes
o No (SKIP to Q26)
o Don’t know (DON’T READ)
o Refused (DON’T READ)
IF Q24a = 1, CONTINUE
ELSE, SKIP TO Q26
25a.
Where do you obtain information about fire safety? (READ LIST ONE AT A
TIME)
Sources of information
TV news or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) _________________
None of these (DON’T READ)
Don’t know (DON’T READ)
Refused (DON’T READ)
25b.
Fire safety
Where do you obtain information about carbon monoxide safety? (READ LIST
ONE AT A TIME)
Sources of information
Carbon
monoxide safety
TV news or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) _________________
EurekaFacts, LLC
January
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None of these (DON’T READ)
Don’t know (DON’T READ)
Refused (DON’T READ)
26.
How often do you or any other member of the household cook at home using a stove
or oven? Does a member of this household cook… (READ LIST)
o Never,
o Less than once a month,
o A few times per month,
o A few times per week,
o Or every day?
o Don’t know (DON’T READ)
o Refused (DON’T READ)
DEMOGRAPHICS
Great! To ensure that we interview a broad mix of residents, I have a few brief demographic
questions to ask about you and others within this household. It should only take a few minutes of
your time.
27.
How many people live or stay in your household? This can include:
• Anyone who is living or staying there for the last 2 months or longer
• Yourself, if you are living there for the last 2 months or longer
• Anyone else staying there who does not have another place to stay, even if they are
here for the last 2 months or less
Please do not include anyone who is living somewhere else for more than 2 months,
such as a college student living away or someone in the Armed Forces on deployment.
Enter number of people
28.
__________
Thinking of the individual(s) who live here, is there anyone …
Yes
No
Don’t
know
Under 5 years old?
5 - 17 years old?
18 – 64 years old?
65 years old or older?
29.
Refused
If yes,
how
many?
What is the highest level of education you have completed?
o Less than high school, no diploma
o High school diploma, or high school equivalent (GED)
EurekaFacts, LLC
January
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o
o
o
o
o
o
o
Trade or Vocational school degree
Some college, no degree
Associate’s degree
Bachelor’s degree
Master’s degree or higher
Don’t know
Refused
30.
Is anyone in the household of Hispanic or Latino origin or descent?
o Yes
o No
o Don’t know
o Refused
31.
What is your race?
(SELECT ALL THAT APPLY)
o White
o Black or African American
o Asian
o American Indian or Alaska Native
o Native Hawaiian or other pacific islander
o Other (Specify) ___________________________________________
o Don’t know
o Refused
32.
Is anyone in the household deaf or hard of hearing?
o Yes
o No
o Don’t know
o Refused
33.
Does anyone in the household have a physical, mental, or other health condition that
has lasted 6 or more months which makes it difficult for them to carry out day to
day activities?
o Yes
o No
o Don’t know
o Refused
34.
Do any people in the home smoke any products such as cigarettes, cigars, or pipes?
Please do not include e-cigarettes.
o Yes
o No
o Don’t know
o Refused
EurekaFacts, LLC
January
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35.
What is the approximate combined annual income for all people who live or stay in
the home? (If necessary read)
o Less than $25,000
o $25,000 - $49,999
o $50,000 - $99,999
o $100,000 - $149,999
o $150,000 or more
o Don’t know (DON’T READ)
o Refused (DON’T READ)
INCENTIVE VERIFICATION
Thank you so much for participating in this survey. Your answers will help CPSC with improving
household fire and CO safety across the U.S.
As appreciation for completing the survey, we would like to send you a $25 gift card from
a major credit company. Could you please provide your full name and mailing address?
Interviewer: Fill in the blank with the respondent’s name and address, and
verify it. If needed, assure the respondent of the confidentiality of the
information provided.
Full Name:_________________________________
Street _________________________________
Apt/Suite/Other__________________
City_____________________ State____________ Zip/ Postal
Code____________
You will receive your participation gift card in the mail in the next few weeks.
EurekaFacts, LLC
January
Page 60
Appendix L: Property Manager Calling Script
Script to call Property Manager:
Hello, this is [NAME] calling for the U.S. Consumer Product Safety Commission from EurekaFacts, a
survey research company in Rockville, MD. We are conducting an important nationwide survey about
household fire and carbon monoxide safety. The survey will help CPSC improve home safety and save
lives.
Is this the company that manages the [APARTMENT OR CONDOMINIUM COMPLEX NAME]?
[If needed: We are conducting a study that will require entering one of the apartments or condominiums
listed under this complex. We’d like to obtain permission from the property manager, prior to entering the
building.]
UNAVAILABLE- Property Manager Name
If name of property manager is unavailable
May I speak with the property manager of this apartment or condominium?
If individual is unavailable,
When would be a convenient time to reach them?
If participant rescheduled, please fill out the following information:
Contact number
Date
Time
AVAILABLE- Property Manager Name
If name of property manager available
May I speak with [PROPERTY MANAGER]?
If individual is unavailable
1. Is there another individual who is responsible for the property [COMPLEX NAME]?
a. Yes (CONTINUE)
b. No (RESCHEDULE)
2. Is he/she available to speak with me regarding this important study?
a. Yes (REINTRODUCE COMPANY AND STUDY)
b. No (TERMINATE)
When would be a convenient time to reach him/her?”
If participant rescheduled, please fill out the following information:
Contact number
Date
Time
EurekaFacts, LLC
January
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If available, reintroduce yourself and company again,
We are conducting a nationwide in-home survey that will require entering one of the apartments or
condominiums listed under this complex. We’d like to obtain permission from the property manager,
prior to entering the building.
We are not selling anything. The purpose of this survey is to gather information about the functionality of
smoke detectors and carbon monoxide detectors in homes in the United States. Findings from this
research will help CPSC with improving home safety.
This study will require a qualified two-member survey team to visit the apartment or condominium to ask
the tenant a series of questions about household fire and carbon monoxide safety. A member of the team
who is trained and certified to inspect smoke detectors would like then to perform some simple tests on
the smoke and carbon monoxide detectors to see if they work properly. If the batteries in the detectors
need to be replaced, we can provide you with a replacement for free. The interview will last no more than
60 minutes.
3. The tenant has agreed to participate in this study, but we would like to ask for your
permission to enter the apartment or condominium and conduct the in-home interviews
on your property. Do we have your permission to enter the building?
a. Yes
b. No (Go to End Script)
c. Need more information/Need to consult with the bulding management team (Go
to Q4)
d. Other:_____________
[If needed: All responses will be kept completely confidential and no information or findings will be
linked to any identifiable information such as an apartment or condominium complex.]
4. We can provide additional information regarding the survey and letter from CPSC - the
agency supporting this research effort. Would you like us to send you this additional
information?
a. Yes
b. No (Go to End Script)
If respondent requested additional information, please ask for the email and mailing address to send
survey materials.
Interviewer: Fill in the blank with the respondent’s name and address, and verify it.
First and Last Name:______________________________________
Email Address:____________________________________________
Mailing Address:___________________________________________
If participant rescheduled, please fill out the following information:
EurekaFacts, LLC
January
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Contact number
Date
Time
If refused entry,
End script: “Thank you for taking the time to talk with me today. We will call the respondent
back and cancel the appointment. No one from our organization will contact you again. Have a
great day/evening.” Then, refer to Script 1 to call back resident of cancellation.
If entry is granted,
Great, thank you very much. If you don’t mind, I have a couple of questions about the detectors in your
building; this shouldn’t take more than 2 minutes of your time. As previously mentioned, part of this
survey will involve testing and examining the smoke and carbon monoxide detectors. This will require
setting off the detectors within the individual unit to see if they are working properly. To ensure that
setting off the detector does not notify the police or fire department, we want to ask some questions about
your detectors.
5. Do you have any smoke detectors inside the individual units of the apartment or
condominium? When considering whether you do, please do not include any uninhabited
outbuildings, any hallways outside of the individual units, or common areas, such as the
lobby.
a. Yes
b. No (TERMINATE)
Terminate script: “Thank you for taking the time to talk with me today. Have a great
day/evening.” Then, refer to Script 2 to call back resident of their eligibility for the phone survey
instead.
6. Are any of the smoke detectors in the individual units of apartments or condominiums
connected to a central alarm or security system that automatically notifies the police or
fire department when it detects smoke?
a. Yes (TERMINATE)
b. No
c. Don’t know (TERMINATE)
Terminate script: “Thank you for taking the time to talk with me today. Have a great
day/evening.” Then, refer to Script 2 to call back resident of their eligibility for the phone survey
instead.
7. Do you have any carbon monoxide detectors inside the individual units of the apartment
or condominium? When considering whether you do, please do not include any
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uninhabited outbuildings, any hallways outside the individual units or common areas,
such as the lobby.
a. Yes
b. No (TERMINATE)
Terminate script: “Great. Those are all the questions I have. The in-home interview is scheduled
to be conducted within the next month. Again, thank you very much for your permission. Have a
great day/evening.”
8. Are any of the carbon monoxide detectors inside the individual units of the apartments or
condominiums connected to a central alarm or security system that automatically notifies
the police or fire department when it detects carbon monoxide?
a. Yes
b. No
c. Don’t know
If no central alarm or security system, (“No,”above)
End script: “Great. The in-home interview is scheduled to be conducted within the next month.
Those are all the questions I have. Again, thank you very much for your permission. Have a great
day/evening.”
If a central alarm or security system present, (“Yes” or “Don’t know,” above)
End script: “Thank you for taking the time to talk with me today. We will call the respondent
back and cancel the appointment. No one from our organization will contact you again. Have a
great day/evening.” Then, refer to Script 2 to call back resident of their eligibility for the phone
survey instead.
Script 1
Call back resident to cancel interview
Hello. My name is [NAME] from EurekaFacts, and I am calling in reference to a CPSC study we recently
discussed with someone from this residence.
May I speak with [NAME]?
If unavailable, ask to leave a message
After speaking with the property manager, we are unable to proceed with the in-home interview. The
property manager did not grant us permission to enter the apartment/condo in your building.
Unfortuntely, this means that we will not be able to conduct the in-home survey with you. We appreciate
your willingness to participate in this nationwide survey. Thank you for your time. Have a nice
day/evening.
Script 2
Call back resident to participate in the phone survey
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Hello. My name is [NAME] from EurekaFacts, and I am calling in reference to a CPSC study we recently
discussed with someone from this residence.
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May I speak with [NAME]?
If unavailable,
“When would be a convenient time to reach them?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
After speaking with the property manager, we were informed that your apartment or condominium
includes a central alarm or security system that would automatically notify the police or fire department if
the detector is activated. Unfortunately, this means that we will not be able to conduct an in-home
interview at your residence. However, you are eligible to participate in the shorter telephone survey.
The interview will last no more than 20 minutes, and can be done over the phone. We will send you a $25
gift card from a major credit card company in appreciation for completion of the survey.
Are you interested in participating?
[If No] End script: “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Okay.” CONTINUE
As I previously mentioned, this survey will take about 20 minutes to complete. Would you like to take the
survey now, or reschedule it for another time?
[If now] - “Great. Let’s begin.”
[If at a later time]
“When would be a convenient time for us to call back?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
EurekaFacts, LLC
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Appendix M: Newspaper Advertisement/Newsletter (long and short form ads)
Long form ad: Newspaper/Newsletter
CPSC Smoke and Carbon Monoxide Detector Survey
A household fire and carbon monoxide (CO) safety survey is being conducted in . EurekaFacts, on behalf of the U.S. Consumer Product Safety Commission
(CPSC), is recruiting participants from all types of households. If we contact your residence, we
want to hear from you, whether or not if your home has smoke detectors and CO detectors. Your
participation in this research project will help us to improve home fire safety! Monetary
compensation will be provided.
To learn more about this survey, please visit our website
CPSC Smoke and Carbon Monoxide Detector Survey
A small, independent survey research company is conducting an important nationwide survey
for the U.S. Consumer Product Safety Commission (CPSC). The purpose of this survey is to
gather information about the functionality of smoke and carbon monoxide (CO) detectors
safety in homes in the United States.
We strongly encourage you to participate in this nationwide effort to improve home safety and
save lives. Anyone contacted is encouraged to respond. Whether or not your home has smoke
detectors or CO detectors, we still want to hear from you! Households that meet criteria may
be eligible for a monetary incentive in appreciation for completion of the survey.
To learn more about this survey, please visit our website
Short form ad: Tweet/ Brief Newspaper Mention
A paid research opportunity on smoke detectors in all types of residences is being conducted in
. Anyone contacted is encouraged to respond. To learn more visit:
.
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Appendix N: EurekaFacts Press Release/ EF website and LinkedIn
Rockville, MD. (DATE) - 25 years after the last major report on U.S. households use of smoke
detectors, EurekaFacts and the Consumer Product Safety Commission (CPSC) are embarking on
a new nationwide survey. The original 1992 study is still considered the gold standard for smoke
detector research, but updated statistics are needed to reflect changes in technology and standards
as well as the increased use of CO detectors.
In 1992, CPSC found that 28% of U.S. households did not have a working smoke detector. Many
of those non-working smoke detectors were the result of non-functioning power sources such as
dead batteries while over a third of respondents had intentionally disconnected the power
source.
What makes this research project unique is that it includes the general population, not just highrisk groups or people who had fires. Participating households will be visited by a member of the
research team and a representative from the local fire department. A free smoke detector and CO
detector audit will be conducted, and any non-functioning detectors will be offered for
replacement at no cost. Participants will also complete a survey and in turn receive monetary
compensation for their time.
Similar to the 1992 survey and subsequent report, the new National Smoke and CO Detector
survey will provide data to inform codes and standards, and fire prevention organizations and
agencies with the information needed to efficiently and effectively target the areas for improving
life safety and saving lives.
Those interested in participating, whether they have a smoke detector or not, are encouraged to
learn more at .
To express interest in participating, please complete the form below.
First Name:
Last Name:
Phone Number:
Email Address:
Unique ID (found on the letter you received in the mail):
If you are interested in knowing more about CPSC, please visit https://www.cpsc.gov/.
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Appendix Q: Intake Form Auto Response
IF SENT AS E-MAIL - Subject: Paid Research Study Opportunity
Dear ,
Thank you for your interest in this important research effort!
We are currently conducting a nationwide survey about household fire and carbon monoxide
safety. The purpose of this survey is to gather information about the functionality of smoke
detectors and CO detectors in homes in the United States.
Households are being selected at random from a list of households across the country that
represent different regions and types of homes. Your household may be one of the homes chosen
to participate in this important study. Participation in this survey is voluntary and your responses
will be maintained confidential and anonymous.
If your household is selected to participate, we will contact by phone with more details regarding
this study.
If you should have any questions about this study, please contact EurekaFacts LLC at or , or visit
EurekaFacts, LLC
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Appendix R: Consumer Product Safety Commission’s (CPSC) Survey on Usage
and Functionality of Smoke Alarms and Carbon Monoxide Alarms in Households
Interviewer:
Do not read aloud the “Don’t know” or “Refused” options at any time during the interview. Only
record this option if the respondent provides it him or herself. If the respondent indicates that
they don’t know the answer to a question, mark the appropriate answer or fill in “DK” in the
space provided.
Section A should be completed by the surveyor, prior to entering the residence. Once contact has
been made with the resident, the surveyor should begin collecting information from the
respondent.
A. RESPONDENT INFORMATION
Date of visit: _________________________
Name of surveyors making the visit: ________________________________________________
Name of occupant: ______________________________________________________________
Street address: ____________________________________ Apt. #: _______________________
City and state: ______________________________________ ZIP ________________________
Home phone: _________________________
IF THE ANSWER TO A QUESTION IS “0” OR “NONE”, ENTER “0”.
Do not leave it blank, please.
Time visit started: ____________________
1a.
What is the type of home in which the resident resides?
Single Family Detached Housing
Single Family Attached Housing (e.g., townhouse, rowhouse)
Apartment/Condo (GO TO 1b)
Mobile/Other Manufactured Housing
Trailer/RV
Other (specify) _____________________________________________________
Code to enter building
If Q1a = 3, CONTINUE
ELSE, SKIP TO PREAMBLE
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Introduction to get into apartment building
The following script is to be read in the instances where there is a front desk concierge. If there is
no front desk concierge present, skip script and proceed to appointment.
“Hello. We are with EurekaFacts, an independent research firm, conducting research on behalf
of the Consumer Product Safety Commission (CPSC).”
Show them your EurekaFacts provided identification and credentials.
“Part of our research requires us to interview a resident of this building. We spoke with the
property manager prior to coming here.”
1b.
Do we have permission to enter the building?
Yes (PROCEED TO RESIDENCE)
No
(SKIP TO Q3a)
If refused entry, say thank you and terminate.
B. SURVEY INFORMATION
Suggested Preamble to get in the door- surveyors can alter as applicable):
“Hello. I am firefighter/ Red Cross volunteer [First and Last Name] from [your [XYZ] fire
department/ [Organization], and this is [First and Last Name] from an independent research firm,
EurekaFacts.”
Show them a fire department or American Red Cross credentials, preferably not a badge. Have
copies of letters endorsing the survey from the local fire department, CPSC, and/or American
Red Cross, to show if needed.
“We are conducting a nationwide survey on household safety for the U.S. Consumer Product
Safety Commission (CPSC). The survey is very important and will help the CPSC improve home
safety. We called earlier and discussed this study with [Name] from this residence, and
scheduled a visit for today.”
2a.
Is [Name of respondent previously contacted] available to speak with us?
Yes (CONTINUE WITH PREAMBLE)
No
2b.
Is there another person available we may speak with, who is 18 years or
older and may be considered one of the heads of the household?
Yes
No
(TERMINATE)
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If respondent is not available: When would be a good time to reach them?
Terminate: Thank you for speaking with us today. Unfortunately, we need to speak with an
adult who can answer questions regarding the home. Have a nice day.
“We are asking people in your community a few questions about their smoke and carbon
monoxide detectors, and doing some simple tests to make sure the detectors work properly. If the
batteries in your detector need to be replaced, we have new batteries to give out, free of charge.
Also, if any of your detectors do not work, we have new ones to replace them, again free of
charge. As you probably know, properly operating smoke detectors can help protect you and
your family in the event of a fire. Additionally, properly operating carbon monoxide detectors
can help protect you in the event of carbon monoxide poisoning. We would like to collect any
detectors that don’t work and send them to the Consumer Product Safety Commission’s lab to
find out why they don’t work. This interview will take up to 60 minutes, and at the end of the
interview we will provide you with a $50 gift card in appreciation for your participation.
“Before we begin, we’d like for you to review a consent form with information about the study.”
Pull up the informed consent form, and hand the tablet to the respondent.
“This is the informed consent form. It explains the reason for our visit today. Could you please
read this, and if you agree to allow this interview to proceed, please sign the bottom. Let me
know if you have any questions.
If participant refused, say thank you and terminate
3a.
If entry to residence was not possible, what was the main reason?
Participant refused (TERMINATE)
Participant rescheduled (GO TO Q3b)
Refused entry to building (TERMINATE)
No one home (TERMINATE)
Only a minor was home (TERMINATE)
Vacant/commercial home/lot—bad address (TERMINATE)
Language barrier (TERMINATE)
Occupant refused entry (Why?_______________________________)
Other (specify) _____________________________________________________
3b.
If participant rescheduled, please fill out the following information
Date
Time
Contact information
____________
____________
____________
“Let’s begin.”
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4a.
Do you have any smoke detectors in your home? When considering whether you do,
please do not include any uninhabited outbuildings or apartment hallways.
Yes
No (SKIP To 5a)
Don’t know (ASK TO INSPECT. IF YES CONTINUE, BUT IF NO TREAT AS
“NO” SMOKE DETECTOR)
4b.
Are any of your smoke detectors connected to a central alarm or security
system that notifies the police or fire department?
[If needed: What we mean by this is if the smoke detector detected smoke, it would
automatically notify the police or fire department.]
Yes (SKIP TO 4d)
No (SKIP TO 5a)
Don’t Know (CONTINUE)
4c.
Thinking of all fire or smoke related incidents at your residence, has the
police or fire department ever arrived in response to a notification from a
central alarm or security system? (READ ALL OPTIONS BEFORE
SELECTING A RESPONSE)
Yes
No
Never had a fire or smoke related incident
IF 4b = 1 or 4c = 1 or 3 CONTINUE
ELSE, SKIP TO 5a
4d.
Please tell me to what extent do you believe your home is safe with your current
smoke detectors? Would you say... (READ LIST)
Interviewer: Read the descriptors but do not read the numbers. Circle the descriptor and
its associated number. If participant is experiencing difficulty during in-home interview,
show them the scale.
Not at Slightly Moderately Mostly
all safe
safe
safe
safe
(1)
(2)
(3)
(4)
5a .
Very
safe
(5)
DK
RF
Do you have any carbon monoxide detectors in your home? When considering
whether you do, please do not include any uninhabited outbuildings or apartment
hallways.
Yes
No (SKIP TO Q6)
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Don’t know (ASK TO INSPECT. IF YES CONTINUE, BUT IF NO TREAT AS
“NO” CO DETECTOR)
5b.
Are any of your carbon monoxide detectors connected to a central alarm or
security system that notifies the police or fire department?
[If needed: What we mean by this is if the carbon monoxide detector detected carbon
monoxide, it would automatically notify the police or fire department.]
Yes (SKIP TO Q5d)
No (SKIP TO Q6)
Don’t Know (CONTINUE)
5c.
Thinking of all carbon monoxide related incidents at your residence, has the
police or fire department ever arrived in response to a notification from a
central alarm or security system? (READ ALL OPTIONS BEFORE
SELECTING A RESPONSE)
Yes
No
Never had a carbon monoxide related incident
IF 5b = 1 or 5c = 1 or 3, CONTINUE
ELSE, SKIP TO 6
5d.
Please tell me to what extent do you believe your home is safe with your current
carbon monoxide detectors? Would you say... (READ LIST)
Interviewer: Read the descriptors but do not read the numbers. Circle the descriptor and
its associated number. If participant is experiencing difficulty during in-home interview,
show them the scale.
Not at Slightly Moderately Mostly
all safe
safe
safe
safe
(1)
(2)
(3)
(4)
Very
safe
(5)
DK
RF
6.
Do you or another member of your household own or rent your home?
Own
Rent
Don’t know
Refused
7.
How long have you lived in this (apartment/ house)? Would that be… (READ LIST)
Less than 6 months
6 to 11 months
1 to 5 years
6 to 10 years
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11 years or more
Don’t know (DON’T READ)
Refused (DON’T READ)
8.
Please tell me to the best of your knowledge, in what year was this (apartment/
house) built? Was it… (READ LIST)
2010 or later
Between 2000 and 2009
Between 1990 and 1999
Between 1980 and 1989
Before 1980
Don’t know (DON’T READ)
Refused (DON’T READ)
If Q1a = 1, CONTINUE
ELSE, SKIP TO 10a
9a.
What types of fuel-burning appliances, if any, do you own or have in your home? By
fuel burning appliances, we mean appliances that use gas, propane, oil, wood, wood
pellets, coal, or kerosene. Do not include electric-powered appliances. (READ LIST,
SELECT ALL THAT APPLY)
Gas powered
Wood or pellet burning fireplace or stove
generator
Furnace or boiler
Kitchen applicances (e.g., stove, oven)
Water heater
Other (Specify) ________________________
Charcoal grill
Do not own any fuel-burning appliances
Gas Dryer
Don’t know (DON’T READ)
Refused (DON’T READ)
9b.
Does this residence have an attached garage unit?
Yes
No (SKIP TO Q10a)
Don’t know (SKIP TO Q10a)
Refused (SKIP TO Q10a)
9c.
For what purposes is the attached garage used? Would you say… (READ
LIST, SELECT ALL THAT APPLY)
Workshop/ workspace
Store tools or lawn/ sports equipment
Store vehicle(s) (e.g., motorcycle, car, SUV, van, etc.)
Fuel burning appliances (e.g., furnace, water heater, grill, etc.)
Other (Specify:)___________________________
Don’t know (DON’T READ)
Refused (DON’T READ)
IF Q4a = 2 or 3 SKIP TO Q12
ELSE, CONTINUE
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SMOKE DETECTOR
10a.
11a.
About how often do you use the test button to test the smoke detector or detectors in
your home? Would you say… (READ LIST)
Never
Once every few years (SKIP TO Q11a)
Once every year (SKIP TO Q11a)
Once every 6 months (SKIP TO Q11a)
Once every 3 months (SKIP TO Q11a)
Once every month (SKIP TO Q11a)
Once every week (SKIP TO Q11a)
Other (specify)___________________________ (SKIP TO Q11a)
Don’t know(SKIP TO Q11a) (DON’T READ)
Refused (SKIP TO Q11a) (DON’T READ)
10b.
Please tell me, what are some of the reasons that you have not tested your
smoke detector or detectors? (DO NOT READ LIST, SELECT ALL THAT
APPLY):
Did not know you should test
Did not think it was important enough
Did not know how to test (SKIP Q10c)
Don’t need to test because they go off occasionally
Physically unable to reach
Other (Specify) _______________________________
Don’t know
Refused
10c.
Do you know how to test your smoke detector or detectors?
Yes
No
Don’t know
Refused
Do you think most or all of your smoke detectors are working? By working, I mean
they would make a sound if they detected smoke right now.
Yes (SKIP to 12a)
No
Don’t know (SKIP TO Q12a)
Refused (SKIP TO Q12a)
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11b.
What are some of the reasons your smoke detectors may not be working?
Again, by working, I mean they would make a sound if it detected smoke
right now. (DO NOT READ LIST, SELECT ALL THAT APPLY)
Did not get around to fixing it
Do not know how to fix or replace it
Unable to install or fix it
Unable to afford new ones
Disconnected it (GO TO Q11c)
It is the landlord’s responsibility
Removed battery (GO TO Q11d)
Batteries never installed
Batteries not working and not yet replaced
Other reason ____________________________________________
Don’t know
Refused
11c.
You mentioned that one or more of your smoke detectors was disconnected.
For what reason(s) were the smoke detectors disconnected? (DO NOT READ
LIST, SELECT ALL THAT APPLY)
Nuisance when they go off
Detector frequently went off
Would not stop beeping/ chirping
No longer worked
No reason in particular
Other reason __________________________________________
Don’t know
Refused
11d.
You mentioned that the batteries were removed from one or more of your
smoke detectors. For what reason(s) were the batteries removed from the
smoke detector or detectors? (DO NOT READ LIST, SELECT ALL THAT
APPLY)
Batteries no longer worked
Batteries were leaking/ discharge
Batteries expired
Detector would not stop beeping/chirping
Intended to replace batteries, but forgot to install new ones
Installed wrong type of batteries
Needed batteries for another device
Other reason __________________________________________
Don’t know
Refused
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12.
Do you know how to…
Yes
a. Install a smoke detector?
b. Maintain a smoke detector
in good working order?
No
Don’t
know
Refused
IF Q4a = 2 or 3 SKIP TO Q14a
ELSE, CONTINUE
13.
To the best of your knowledge, how often should you replace your old smoke
detector with a new smoke detector in your home? Would you say… (READ LIST)
Never, unless the detector stops working
Once every 6 months
Once a year
Once every 2 – 5 years
Once every 6 – 9 years
Once every 10 years
Once every 10+ years
Don’t know (DON’T READ)
Refused (DON’T READ)
FIRE HISTORY
14a.
In the past 12 months, have you had any accidental fires – that is unintended or
unwanted smoke or flames - in your home? Please include fires that were too small
to call the fire department.
Yes (CONTINUE)
No (SKIP TO Q15a)
Don’t know (SKIP TO Q15a)
Refused (SKIP TO Q15a)
IF Q4a = 2 or 3 SKIP TO Q16
ELSE, CONTINUE
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If Yes:
14b. Thinking of the most recent accidental fire(s), how did you become alerted to
the incident? (DO NOT READ LIST, SELECT ALL THAT APPLY)
Saw the fire
Smelled the fire
Heard the fire
Felt the heat of the fire
Smoke detector (SKIP Q14c)
Someone notified me
Other (Specify) _________________________________________
Don’t remember
Don’t know
Refused
15a.
14c.
Thinking of the most recent accidental fire(s), did any of the smoke detectors
go off during the fire(s)?
Yes (SKIP TO Q15a)
No
Don’t know (SKIP TO Q15a)
Refused (SKIP TO Q15a)
14d.
Thinking of the most recent accidental fire(s), do you think that enough
smoke reached the smoke detector that it should have sounded?
Yes
No
Don’t know
Refused
In the past 12 months, have any of your smoke detectors gone off when there was no
fire, other than when the smoke detector was being tested?
Yes
No (SKIP TO Q16)
Don’t know (SKIP TO Q16)
Refused (SKIP TO Q16)
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15b.
Why do you think the smoke detector went off when there was no fire? (DO NOT
READ LIST, SELECT ALL THAT APPLY).
Cooking
Fireplace
Tobacco
Steam from bathroom
Low battery
Other (Specify:) _________________
No apparent reason
Don’t know
Refused
CO DETECTORS
16.
How would you know if high levels of carbon monoxide (CO) were present in your
home? (DO NOT READ LIST, SELECT ALL THAT APPLY).
You can smell it
You can taste it
You can see it
You can feel it
Carbon monoxide detector
Other (Specify:)___________________________
Respondent does not believe there is a way to know if CO is present
Don’t know
Refused
17.
How familiar are you with carbon monoxide detectors? (READ LIST)
Not at all familiar
Not very familiar
Somewhat familiar
Very familiar
Don’t know(DON’T READ)
Refused (DON’T READ)
IF Q5a =2 or 3, SKIP TO Q21
ELSE, CONTINUE
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18a.
If CO detectors present (Yes in 5a), ask:
About how often do you use the test button to test your carbon monoxide detector or
detectors? Would you say… (READ LIST)
Never
Once every few years (SKIP TO Q19a)
Once every year (SKIP TO Q19a)
Once every 6 months (SKIP TO Q19a)
Once every 3 months (SKIP TO Q19a)
Once every month (SKIP TO Q19a)
Once every week (SKIP TO Q19a)
Other (specify) _______________________________ (SKIP TO Q19a)
Don’t know (SKIP TO Q19a) (DON’T READ)
Refused (SKIP TO Q19a) (DON’T READ)
18b.
What were the reasons that you have not tested your carbon monoxide
detector or detectors? (Open ended, capture their response)
________________________________________________________________________
________________________________________________________________________
19a.
Do you think most or all of your carbon monoxide detectors are working? By
working, I mean they would make a sound if it detected carbon monoxide right now.
Yes (SKIP TO 20)
No
Don’t know (SKIP TO Q20)
Refused (SKIP TO Q20)
If No:
19b. What are some of the reasons your carbon monoxide detectors may not be
working? Again, by working, I mean they would make a sound if it detected
carbon monoxide right now. (DO NOT READ LIST, SELECT ALL THAT
APPLY)
Did not get around to fixing it
Do not know how to fix or replace it
Unable to install or fix it
Unable to afford new ones
Disconnected it (GO TO 19c)
It is the landlord’s responsibility
Removed battery (GO TO 19d)
Batteries never installed
Batteries not working and not yet replaced
Other reason ____________________________________________
Don’t know
Refused
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20.
19c.
You mentioned that one or more of your carbon monoxide detectors was
disconnected. For what reason(s) were the carbon monoxide detectors
disconnected? (DO NOT READ LIST, SELECT ALL THAT APPLY)
Nuisance when they go off
Detector frequently went off
Would not stop beeping/ chirping
No longer worked
No reason in particular
Other reason __________________________________________
Don’t know
Refused
19d.
You mentioned that the batteries were removed from one or more of your
carbon monoxide detectors. For what reason(s) were the batteries removed
from the carbon monoxide detector or detectors? (DO NOT READ LIST,
SELECT ALL THAT APPLY)
Batteries no longer worked
Batteries were leaking/ discharge
Batteries expired
Detector would not stop beeping/chirping
Intended to replace batteries, but forgot to install new ones
Installed wrong type of batteries
Needed batteries for another device
Other reason __________________________________________
Don’t know
Refused
For what reasons do you have a carbon monoxide detector? (DO NOT READ LIST,
SELECT ALL THAT APPLY)
It is required by law
It makes me feel safe
It is helpful in detecting carbon monoxide
It came with the residence
I own generators/ fuel-burning appliances
Other (Specify:)___________________________
Don’t know
Refused
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21.
To the best of your knowledge, how often should the carbon monoxide detectors in
your home be replaced? Would you say… (READ LIST)
Never, unless the detector stops working
Once every 6 months
Once a year
Once every 2 – 5 years
Once every 6 – 9 years
Once every 10 years
Once every 10+ years
Don’t know (DON’T READ)
Refused (DON’T READ)
IF Q5a = 2 or 3, SKIP TO Q24
ELSE, CONTINUE
CO History
22a. In the past 12 months, has your carbon monoxide detector or detectors ever gone
off, other than when the carbon monoxide detector was being tested?
Yes
No (SKIP TO Q23)
Don’t know(SKIP TO Q23)
Refused (SKIP TO Q23)
If Yes:
22b. Thinking of the last time your carbon monoxide detector went off, how did
you react when you heard the detector? (DO NOT READ LIST, SELECT ALL
THAT APPLY)
Left the house
Called the fire department
Ventilated home (opened windows, door, used fan, etc.)
Unplugged or disconnected it
Reset it
Removed battery
Other action (specify)_____________________________________
Don’t remember
Don’t know
Refused
EurekaFacts, LLC
January
Page 85
23.
Do you know how to…
Yes
No
a. Install a carbon monoxide
detector?
b. Maintain a carbon monoxide
detector in good working
order?
24.
Don’t
know
Refused
In the past 12 months, have any of your friends, relatives, neighbors, or coworkers
experienced…
Yes
No
a. An accidental fire?
b. A carbon monoxide incident?
(e.g., effects of carbon
monoxide poisoning)
Don’t
know
Refused
-TESTING DETECTORSNow we’d like to test your detector(s) to make sure that they are working properly.
25.
How many floors (levels) are there in your home? Please include the basement and
finished attic, if you have one.
_____________
(NOTE: For an apartment, treat the entire apartment as one floor unless more than one
level. Do NOT report the number of floors in the apartment building.)
Would you show me the first detector? (Then ask to see the next one)
For each detector, fill in the following data. The computer will automatically cue up another set
of these questions for the second, third, etc. detector. The first smoke detector data elements will
be numbered 26-1a, 26-1b, 26-1c, etc. The second smoke detector data elements will be 26-2a,
26-2b, etc. The third detector will be 26-3a, 26-3b, etc.
EurekaFacts, LLC
January
Page 86
The questions in this section to be addressed and answered by the survey team
26-1a. What level of the home are you currently on?
Detector #
Basement
First level
Second level
Third level
Finished Attic
Other ______________
#1
1
2
3
4
5
6
#2
1
2
3
4
5
6
#3
1
2
3
4
5
6
#4
1
2
3
4
5
6
#5
1
2
3
4
5
6
#6
1
2
3
4
5
6
(NOTE: For an apartment, treat the entire apartment as first level unless more than one
level. Do NOT report what floor of the building it is on.)
26-1b. What area or room of home are you currently in?
Detector #
Inside the bedroom
Hallway outside of bedrooms
Hallway - other
In Family room/Living room
In Kitchen
In Dining area
In Bathroom
In Closet
In Stairwell
In Laundry room /Storage room
Other area
______________
#1
1
2
3
4
5
6
7
8
#2
1
2
3
4
5
6
7
8
#3
1
2
3
4
5
6
7
8
#4
1
2
3
4
5
6
7
8
#5
1
2
3
4
5
6
7
8
#6
1
2
3
4
5
6
7
8
9
9
9
9
9
9
26-1c. (READ) What type of detector is this? Would you say it is a smoke detector, carbon
monoxide detector, both a smoke and CO detector, or you don’t know?
Detector #
Smoke detector
CO detector
Smoke/CO Combined
Don’t know or other (INSPECT)
#1
1
2
3
4
#2
1
2
3
4
#3
1
2
3
4
#4
1
2
3
4
#5
1
2
3
4
#6
1
2
3
4
(NOTE: IF Q26c = 3, test the smoke and CO portions of the detector separately.)
EurekaFacts, LLC
January
Page 87
IF Q26c = 4
[If “Don’t Know or other”] – Please follow the following steps:
1. Inspect back of detector for manufacturer information- look for name/ type of detector.
2. If unclear, refer to your Detector reference sheet. Use either the UL number or model
number to identify the type of detector.
Please select correct type of detector, if still unknown, continue.
26-1d. (READ) For quality control purposes, we’d like to collect three photographs of this
detector. Do we have your permission?
Detector #
Yes
No
Could not take picture
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
[If yes] – Please obtain three photographs including the following items:
• Front of detector (to capture image of detector)
• Back of detector (UL and Manufacturer information)
• Side of detector (may have a install/replacement sticker)
[If no] “Okay. No problem.”
IF Q26c = 1, 3, or 4 CONTINUE
ELSE IF Q26c = 2, GO TO INSTRUCTION SET B
26-1e. (OBSERVE) Approximately, what is the horizontal distance between the stove or
cooktop in the kitchen and the closest smoke detector on the same floor?
Detector #
Less than 6 feet
6 – 10 feet
11 – 20 feet
More than 20 feet
No detector on the same
floor
Don’t know
#1
1
2
3
4
5
#2
1
2
3
4
5
#3
1
2
3
4
5
#4
1
2
3
4
5
#5
1
2
3
4
5
#6
1
2
3
4
5
6
6
6
6
6
6
IF Q26c = 1, 3, or 4, SHOW INSTRUCTION SET A
ELSE IF Q26c = 2, SKIP 26f, AND GO TO INSTRUCTION SET C
EurekaFacts, LLC
January
Page 88
A. INSTRUCTIONS ON TESTING SMOKE DETECTOR WITH AEROSOL
PROCEED TO FIRST/NEXT DETECTOR – SMOKE TEST
Warn consumer of loud noise when the smoke detector sounds.
Use hearing protection, if needed.
•
Using aerosol spray and wand, point tube at detector from a distance of 1 – 2 feet.
•
Spray a three second burst of aerosol, and wait 10 seconds,
•
If detector sounds, testing is complete. Collect identification data.
(Spray short burst of canned air to accelerate and clear smoke detector)
•
If no detector sounds:
o Brush to lightly clear the grille and surface of detector.
o Spray again for 5 seconds, and wait 10 seconds.
•
If detector does not sound, proceed to instructions on testing using Test Button.
26-1f. (OBSERVE) Did smoke detector sound in response to this smoke test?
Detector #
#1
#2
#3
#4
Yes
1
1
1
1
No
2
2
2
2
Could not test
3
3
3
3
IF SMOKE DETECTOR SOUNDS, SKIP TO INSTRUCTION SET D
ELSE, CONTINUE TO BUTTON TEST
EurekaFacts, LLC
January
#5
1
2
3
#6
1
2
3
Page 89
B. INSTRUCTIONS ON TESTING USING TEST(S) BUTTON
IF NO IN Q26f – (SMOKE) BUTTON TEST
Warn consumer of loud noise when the smoke detector sounds.
Use hearing protection, if needed.
•
Press and hold the “Test” button.
o Read directions on the detector – some models’ “test” function requires push and
release, others require push and hold.
•
If detector sounds, testing is complete.
o However, label for collection due to inoperative sensor.
o Collect identification data.
•
If no detector sound, proceed to instructions on replacing batteries/ restoring power.
PROCEED TO INSTRUCTION SET D
EurekaFacts, LLC
January
Page 90
C. INSTRUCTIONS ON TESTING CO DETECTOR
CO BUTTON TEST
Warn consumer of loud noise when the smoke detector sounds.
Use hearing protection, if needed.
•
Press and hold the “Test/ Reset” until the detector sounds:
o Place your fingers over the sounder opening and check the power and detector
by depressing the “Test/Reset” button.
•
If detector sounds, testing is complete. Collect identification data.
•
If no detector sounds, proceed to instructions on replacing batteries/ restoring power.
26-1g1. (OBSERVE) Did detector sound in response to the smoke test button?
Detector #
Yes
No
No test button on unit
Could not test
#1
1
2
3
4
#2
1
2
3
4
#3
1
2
3
4
#4
1
2
3
4
#5
1
2
3
4
#6
1
2
3
4
IF COMBINATION DETECTOR , CONTINUE (IF Q26c = 3, continue to 26-1g2)
ELSE, SKIP TO INSTRUCTION SET D
26-1g2. (OBSERVE) Did detector sound in response to the second (CO) test button?
Detector #
Yes
No
No additional button on
unit
EurekaFacts, LLC
#1
1
2
3
#2
1
2
3
January
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
Page 91
D. INSTRUCTIONS ON HOW TO PROCEED (SMOKE DETECTOR)
•
•
•
If smoke detector sounded in response to Q26f, continue collecting identification data.
If smoke detector did not sound in response to Q26f, but did sound in response to Q26g,
label for collection (due to inoperative sensor), and continue with collecting
identification data.
If smoke detector did not sound in response to Q26f and Q26g, continue with Q26h.
E. INSTRUCTIONS ON HOW TO PROCEED (CO DETECTOR)
•
•
If CO detector sounded in response in response to Q26g, continue collecting
identification data.
If CO detector did not sound in response to Q26g, continue with Q26h.
IF DETECTOR FAILS TO SOUND, ATTEMPT TO REPLACE/ INSTALL BATTERY
ELSE, SKIP TO INSTRUCTIONS ON HOW TO PROCEED
If the smoke detector uses a 10-year seal battery, the battery cannot be replaced. A smoke
detector that uses a 10-year seal battery can be identified if:
• The unit does not have any battery door or compartment.
• The label states “10-year seal battery” or similar.
26-1h. (READ) May I put a new battery in this detector to determine whether the detector
needs to be replaced?
Detector #
Yes
No (Label)
No – 10-year Seal Battery Present
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
IF BATTERY REPLACED/ INSTALLED, CONTINUE WITH RESTESTING
ELSE, SKIP TO INSTRUCTIONS ON HOW TO PROCEED
F. INSTRUCTIONS ON RETESTING SMOKE DETECTOR
After replacing battery/ restoring battery, repeat SMOKE TEST using up to 3 one second
sprays, ten seconds apart with tube positioned against the grill.
EurekaFacts, LLC
January
Page 92
26-1i. (OBSERVE) Did the detector sound in response to this smoke test?
Detector #
Yes
No (label)
#1
1
2
#2
1
2
#3
1
2
#4
1
2
#5
1
2
#6
1
2
IF DETECTOR SOUNDS, SKIP TO INSTRUCTIONS ON HOW TO PROCEED
ELSE, CONTINUE
G. INSTRUCTIONS ON RETESTING SMOKE DETECTOR TEST BUTTON
IF NO IN Q26i –BUTTON TEST
•
Press and hold the “Test” button.
o Read directions on the detector – some models’ “test” function requires push and
release, others require push and hold.
•
If detector sounds, testing is complete.
o However, label for collection due to inoperative sensor.
o Collect identification data.
IF DETECTOR SOUNDS, SKIP TO INSTRUCTIONS ON HOW TO PROCEED
ELSE, SKIP TO Q26j
H. INSTRUCTIONS ON RETESTING CO DETECTOR TEST BUTTON
IF NO in Q26g – CO BUTTON TEST
•
Press and hold the “Test/ Reset” until the detector sounds:
o Place your fingers over the sounder opening and check the power and detector
by depressing the “Test/Reset” button.
•
If detector sounded in response to test in, testing is complete. Collect identification data.
•
If no detector sounds, label for collection, and collect identification data.
EurekaFacts, LLC
January
Page 93
26-1j1. (OBSERVE) Did detector sound in response to this button test?
Detector #
Yes
No (Label)
#1
1
2
#2
1
2
#3
1
2
#4
1
2
#5
1
2
#6
1
2
IF SMOKE DETECTOR, SKIP TO INSTRUCTION SET I
ELSE IF, CO DETECTORS, SKIP TO INSTRUCTION SET J
ELSE, COMBINATION DETECTOR, CONTINUE
26-1j2. (OBSERVE) Did detector sound in response to the second test button?
Detector #
Yes
No (Label)
No additional button on
unit
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
I. INSTRUCTIONS ON HOW TO PROCEED (SMOKE DETECTOR)
•
•
•
If smoke detector sounded in response to Q26i, continue collecting identification data.
If smoke detector did not sound in response to Q26i, but did sound in response to Q26j,
label for collection (due to fault inoperative sensor), and continue with collecting
identification data.
If smoke detector did not sound in response to Q26e and Q26f, label for collection, and
continue collecting identification data.
J. INSTRUCTIONS ON HOW TO PROCEED (CO DETECTOR)
•
•
If CO detector sounded in response to Q26j, continue collecting identification data.
If CO detector did not sound in response to Q26j, label for collection, and continue with
collecting identification data.
26-1k. If could not test, why not?
Detector #
Could not reach
Homeowner would not
allow
No time
Other
______________
EurekaFacts, LLC
#1
1
2
#2
1
2
#3
1
2
#4
1
2
#5
1
2
#6
1
2
3
3
3
3
3
3
4
4
4
4
4
4
January
Page 94
IF Q26c = 1, 3, or 4 CONTINUE
ELSE IF Q26c = 2, GO TO Q26i
26-1l. (OBSERVE) What type of smoke detector is this?
Detector #
Photoelectric
Ionization
Combined photo/ion
Combined ion with CO
Combined photo with CO
Don’t know
Other ________
#1
1
2
3
4
5
6
7
#2
1
2
3
4
5
6
7
#3
1
2
3
4
5
6
7
#4
1
2
3
4
5
6
7
#5
1
2
3
4
5
6
7
#6
1
2
3
4
5
6
7
IF Q26l = 2 or 4 CONTINUE
ELSE IF Q26c = 1 or 3, GO TO Q26j
26-1m. (OBSERVE) What type of CO detector is this?
Detector #
Electrochemical
Metal Oxide
Biomimetic
Don’t know
Other
______________
#1
1
2
3
4
#2
1
2
3
4
#3
1
2
3
4
#4
1
2
3
4
#5
1
2
3
4
#6
1
2
3
4
5
5
5
5
5
5
#5
1
2
3
4
5
#6
1
2
3
4
5
#5
_____
1
#6
_____
1
26-1n. (OBSERVE) What type of power source does the detector have?
Detector #
Replaceable battery
Sealed battery
AC Only
AC with battery
Don’t know
#1
1
2
3
4
5
#2
1
2
3
4
5
#3
1
2
3
4
5
#4
1
2
3
4
5
26-1o. (OBSERVE) What is the manufacture date of the detector?
Detector #
Year
Don’t know
EurekaFacts, LLC
#1
_____
1
#2
_____
1
January
#3
_____
1
#4
_____
1
Page 95
26-1p. (OBSERVE) What is the model number of the detector?
Detector #
Model number
Don’t know
#1
_____
1
#2
_____
1
#3
_____
1
#4
_____
1
#5
_____
1
#6
_____
1
26-1q. (OBSERVE) Is the detector (wired or wireless) interconnected with other detectors?
Detector #
Yes
No
Don’t know
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
#5
1
2
3
#6
1
2
3
26-1r. (OBSERVE) Is the detector part of a private detector system?
Detector #
Yes
No
Don’t know
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
26-1s. (OBSERVE) Did the detector have strobe lighting for hearing impaired?
Detector #
Yes
No
Don’t know
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
IF Q26c = 1, 3, or 4 CONTINUE
ELSE IF Q26c = 2, SKIP TO Q26u
26-1t. (OBSERVE) Is this detector connected to a tactile notification device (bed shaker or
pillow shaker) for the hearing impaired or blind?
Detector #
Yes
No
Don’t know
EurekaFacts, LLC
#1
1
2
3
#2
1
2
3
January
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
Page 96
FOR BATTERY ONLY
26-1u. (OBSERVE) Was this detector found to have a dead battery, that is, the old battery
was connected but the detector responded to aerosol smoke after battery replacement?
Detector #
Yes
No
IF Q26u = 2, CONTINUE
ELSE, SKIP TO Q26w
#1
1
2
#2
1
2
#3
1
2
#4
1
2
#5
1
2
#6
1
2
FOR EITHER BATTERY OR AC DETECTORS:
26-1v. (OBSERVE) Was the detector found without a battery, with battery disconnected,
or AC power disconnected?
Detector #
Yes
No
#1
1
2
#2
1
2
#3
1
2
#4
1
2
#5
1
2
#6
1
2
26-1w. (READ): How old do you think this detector is? Would you say…
Detector #
Less than 1 year old
1 – 5 years old
6 – 10 years old
More than 10 years old
Don’t know (DON’T READ)
Refused (DON’T READ)
#1
1
2
3
4
5
6
#2
1
2
3
4
5
6
#3
1
2
3
4
5
6
#4
1
2
3
4
5
6
#5
1
2
3
4
5
6
#6
1
2
3
4
5
6
IF DETECTOR DOES NOT WORK, CONTINUE
ELSE, SKIP TO POST INSPECTION
IF DETECTOR DOES NOT WORK
(READ) It is important that we determine why detectors don’t work.
I would like to collect this detector and send it to the U.S. Consumer Product Safety
Commissions lab for analysis to find out why it does not work properly. We will provide you
with a free replacement detector.
EurekaFacts, LLC
January
Page 97
26-1x. (READ) May I collect this detector?
Detector #
Yes
No
#1
1
2
#2
1
2
#3
1
2
#4
1
2
#5
1
2
#6
1
2
IF Q26x = 2, CONTINUE
ELSE, SKIP TO PACKAGING INSTRUCTIONS
IF NO
(READ) That is fine. You may keep the detector. However, I will still provide you with a
new detector, and give you this box so you may send your old detector to the U.S.
Consumer Product Safety Commission’s lab for analysis, if you may choose to do so.
IF Q26x = 1, CONTINUE
ELSE, SKIP TO Q26z
CAREFULLY PACKAGE
DETECTOR
(AFTER DETECTOR HAS BEEN REMOVED/BOX GIVEN) Here is a replacement
(smoke/CO) detector. I’m going to test it now to be sure it works.
PERFORM BUTTON TEST:
• If detector sounded, give respondent replacement detector.
• If detector does not sound, select & test another detector.
26-1y. (OBSERVE) Post inspection actions taken: (SELECT ALL THAT APPLY)
Detector #
No action required
Battery replaced
Installed missing battery
Refused battery
installation/ replacement
Collected detector
Advised replacement (AC/
hard wired)
Could not replace
detector/ Refused
EurekaFacts, LLC
#1
1
2
3
#2
1
2
3
#3
1
2
3
#4
1
2
3
#5
1
2
3
#6
1
2
3
4
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
7
7
7
7
7
7
January
Page 98
26-1z. (READ) Are there any other detectors on this floor? This could include smoke
detectors or carbon monoxide detectors.
Yes (GO BACK to Q26-b)
No
Don’t know (ASK TO INSPECT. IF YES, INSPECT FLOOR, IF “NO”, TREAT
AS NO AND CONTINUE
IF Q25 = 1, SKIP TO NEXT SECTION
ELSE, CONTINUE
26-1aa. (READ) What about other floors? Are there any smoke or carbon monoxide
detectors on any other floors in this (apartment/house)?
Yes (GO BACK to Q26-a)
No
Don’t know (ASK TO INSPECT ADDITIONAL FLOORS. IF YES, GO TO
THE OTHER FLOOR, IF NO, TREAT AS “NO”, AND CONTINUE)
DETECTORS
IF Q4a = 1, CONTINUE
ELSE, SKIP TO Q28
27.
Did the occupant know the location of the smoke detectors?
Knew all
Knew at least one but not all
Knew none
IF Q5a = 1, CONTINUE
ELSE, SKIP TO NEXT SECTION
28.
Did the occupant know the location of the CO detectors?
Knew all
Knew at least one but not all
Knew none
EurekaFacts, LLC
January
Page 99
NO SMOKE DETECTORS PRESENT
IF Q4a = 2 CONTINUE
ELSE, SKIP TO NEXT SECTION
If no smoke detectors are present, ask:
29. On a scale of 1 to 5, where 1 is Not at All Necessary, and 5 is Extremely
Necessary, how necessary do you feel it is to have a smoke detector installed in
your home?
1
2
3
4
5
DK
RF
30. Can you tell me what are some of the reasons you don’t have a smoke detector
installed in your home? (DO NOT READ LIST, SELECT ALL THAT APPLY)
Don’t think I need one
Did not come with residence
They are a nuisance
They did not or don’t work
Never got around to replacing previous detectors
It is the landlord’s responsibility
Other reason ____________________________________________
Don’t know
Refused
NO CO DETECTORS PRESENT
IF Q5a = 2 CONTINUE
ELSE, SKIP TO Q32a
If no CO detectors present, ask:
31. On a scale of 1 to 5, where 1 is Not at All Necessary, and 5 is Extremely
Necessary, how necessary do you feel it is to have a carbon monoxide detector
installed in your home?
1
2
3
4
5
DK
RF
32. Can you tell me what are some of the reasons you don’t have a carbon monoxide
detector installed in your home?
(Open ended, Probe: Anything else?)
________________________________________________________________________
________________________________________________________________________
EurekaFacts, LLC
January
Page 100
IF Q4a = 2 or 3 or Q5a = 2 or 3 SKIP TO Q34a
ELSE, CONTINUE
Post-inspection Follow up Questions with Respondent
Now I would like to ask a few additional questions about your detectors.
33a.
34a.
After we contacted you to arrange for this visit, did you buy any additional smoke
or carbon monoxide detectors, or replace any batteries in your detectors? (SELECT
ALL THAT APPLY)
Yes
No (SKIP TO Q34a)
Don’t Know (SKIP TO Q34a)
Refused (SKIP TO Q34a)
If Yes:
33b. How many new smoke detectors?
____________
33c.
How many new carbon monoxide detectors?
____________
33d.
How many detectors were installed with new batteries?
____________
In the past 12 months, have you sought out any information about either fire safety
or carbon monoxide safety?
Yes
No
Don’t know
Refused
IF Q34a = 1, CONTINUE
ELSE, SKIP TO Q35
EurekaFacts, LLC
January
Page 101
34b.
Where do you obtain information about fire safety? (READ LIST ONE AT A
TIME)
Sources of information
TV news, or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) ______________________
None of these (DON’T READ)
Don’t know (DON’T READ)
Refused (DON’T READ)
34c.
Where do you obtain information about carbon monoxide safety? (READ LIST
ONE AT A TIME)
Sources of information
TV news, or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) ______________________
None of these (DON’T READ)
Don’t know (DON’T READ)
Refused (DON’T READ)
35.
Fire safety
Carbon
monoxide safety
How often do you or another member of the household cook at home using a stove
or oven? Does a member of this household cook… (READ LIST)
Never
Less than once a month
A few times per month
A few times per week
Every day
Rarely
Don’t know (DON’T READ)
Refused (DON’T READ)
EurekaFacts, LLC
January
Page 102
DEMOGRAPHICS
Great! To ensure that we interview a broad mix of residents, I have a few brief demographic questions to
ask about you and others within this household. It should only take a few minutes of your time.
36.
How many people live or stay in your household? This can include:
• Anyone who is living or staying here for more than 2 months
• Yourself, if you are living here for more than 2 months
• Anyone else staying here who does not have another place to stay, even if they are
here for 2 months or less
Please do not include anyone who is living somewhere else for more than 2 months,
such as a college student living away or someone in the Armed Forces on deployment.
Enter number of people
37.
__________
Thinking of the individual(s) who live here, is there anyone…
Yes
No
Don’t
know
Refused
Under 5 years old?
5 - 17 years old?
18 – 64 years old?
65 years old or older?
38.
What is the highest level of education you have completed?
Less than high school, no diploma
High school diploma, or high school equivalent (GED)
Trade or Vocational school degree
Some college, no degree
Associate’s degree
Bachelor’s degree
Master’s degree or higher
Don’t know
Refused
39.
Is anyone in the household of Hispanic or Latino origin or descent?
Yes
No
Don’t know
Refused
EurekaFacts, LLC
January
If yes,
how
many?
Page 103
40.
What is your race?
(SELECT ALL THAT APPLY)
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or other pacific islander
Other (Specify) ___________________________________________
Don’t know
Refused
41.
Is anyone in the household deaf or hard of hearing?
Yes
No
Don’t know
Refused
42.
Does anyone in the household have a physical, mental, or other health condition that
has lasted 6 or more months which makes it difficult for them to carry out day to
day activities?
Yes
No
Don’t know
Refused
43.
Do any people in the home smoke cigarettes, cigars, or pipes? Please do not include
e-cigarettes.
Yes
No
Don’t know
Refused
44.
What is the approximate combined annual income for all occupants in the home? (If
necessary read)
Less than $25,000
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $149,999
$150,000 or more
Don’t know (DON’T READ)
Refused (DON’T READ)
EurekaFacts, LLC
January
Page 104
Thank you so much for participating in this survey. You can call us if you have any questions
about fire or CO safety.
Time visit ended: _____________________
EurekaFacts, LLC
January
Page 105
File Type application/pdf Author lglatz File Modified 2018-06-29 File Created 2018-06-29