Form 5800-040 HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFAC

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)

2434ss60 Healthier Survey_ 2021

Customer Satisfaction Survey for Healthier School Environments Workshops

OMB: 2030-0051

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Healthier School Environments Workshop

Customer Satisfaction Survey

(OMB Control Number: 2010-0042, Expiration Date: 3/31/21)


This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). Responses to this collection of information are voluntary 42 U.S.C.7401 Pub L. SEC 403. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.


The session met my expectations. Yes _____No _____

Comments:

____________________________________________________________________________________________________________________________________________________________


What I learned from the session:


______________________________________________________________________________


Because of this session I commit to:

  • Share information presented with others.

  • Download the School Indoor Air Quality (IAQ) Assessment Mobile App.

  • Complete the IAQ in Schools Master Class Webinar Series.

  • Schedule a free IAQ walkthrough with EPA staff.

  • Conduct regular building walkthrough inspections.

  • Establish a maintenance plan using EPA’s IAQ Preventative Maintenance Guidance

  • Maintain HVAC system.

  • Develop low-emitting products purchasing and use policies.

  • Implement an Integrated Pest Management policy.

  • Test for radon.

  • Establish an anti-idling policy.

  • Use the Energy Savings Plus Health Guidance.

  • Implement an IAQ Management Plan.

  • Other:__________________________________________________________________


The session can be improved by: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Please complete this survey before you leave. Thank You!

Healthy Homes Workshop

Customer Satisfaction Survey



The session met my expectations. Yes _____No _____

Comments:

____________________________________________________________________________________________________________________________________________________________


What I learned from the session:


______________________________________________________________________________


Because of this session I commit to:

  • Share information presented with others.

  • Use the Protocols Guidance.

  • Make my home and car smoke free.

  • Prevent water from entering my house.

  • Control the source of dust and contaminants.

  • Use the exhaust fan or open a window when cooking or showering.

  • Ventilate areas where there are strong odors or vapors.

  • Use Integrated Pest Management approach.

  • Use wet-cleaning approach to clean surfaces, floors and windows.

  • Change filters and maintain my Heating Ventilation and Air Conditioning system.

  • Test for radon.

  • Register as an Indoor airPLUS partner.

  • Other: _________________________________________________________________


The session can be improved by: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Please complete this survey before you leave. Thank You!


This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). Responses to this collection of information are voluntary 42 U.S.C.7401 Pub L. SEC 403. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.



ENERGY STAR Workshop

Customer Satisfaction Survey



The session met my expectations. Yes _____No _____

Comments:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


One thing I learned from the session is: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Because of this session I commit to:

  • Use ENERGY STAR Portfolio Manager measure and track energy use of a commercial building (If so, how many buildings _________)

  • Use one or more ENERGY STAR resources to support my energy efficiency efforts

  • Become an ENERGY STAR Partner

  • Apply for the ENERGY STAR Certification

  • Adopt ENERGY STAR latest version Residential Guidelines

  • Find out more about what energy efficiency programs my utility(ies) offer

  • Implement an energy efficiency project



The session can be improved by:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Please complete this survey before you leave. Thank You!


This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). Responses to this collection of information are voluntary 42 U.S.C.7401 Pub L. SEC 403. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.



make your house a healthy home workshop

Customer Satisfaction Survey



The session met my expectations. Yes _____No _____


Comments:


__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


What I learned from the session:


__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Because of this Session I commit to:

  • Share information with others.

  • Check the weather forecast.

  • Identify asthma triggers in my home and take action to eliminate or reduce them.

  • Make my home and car Smoke Free.


This session can be improved by:





Please complete this evaluation before you leave. Thank You!


This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). Responses to this collection of information are voluntary 42 U.S.C.7401 Pub L. SEC 403. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.








Indoor Air Quality and Asthma Workshop

Customer Satisfaction Survey


The session met my expectations. Yes _____No _____

Comments:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Have you learned something new today? Yes _____No _____

Comments: ____________________________________________________________________________________________________________________________________________________________


I will take the following actions to improve indoor air quality:

  • Reduce use of air fresheners indoors and other products with strong vapors. Incorporate less irritating cleaning products here or add another item related to cleaning?

  • Use the exhaust fan or open a window when cooking or showering.

  • Ventilate areas where there are strong odors or vapors.

  • Ensure that there is no smoking in my home and car.

  • Test my home for radon and mitigate if needed.

  • Properly maintain my HVAC system and change/upgrade filters.

  • Assess my home for asthma triggers.

  • Reduce asthma triggers indoors:

Mold

Pet dander

Dust mites

Secondhand smoke

Pest cockroaches, rodents

  • Other: _________________________________________________________________


The session can be improved by: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Please complete this survey before you leave. Thank You!


This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). Responses to this collection of information are voluntary 42 U.S.C.7401 Pub L. SEC 403. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Form # 5800-040

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMarrero, Jeanette
File Modified0000-00-00
File Created2021-10-16

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