Form 6700-009 Filter Adoption Survey

WATER FILTER USE SURVEY
Denver Water recently sent you a water filter pitcher, and will continue
sending you replacement filters as part of our Lead Reduction Program.
We’d love to hear how we are doing.
The following short survey is voluntary and your responses will help

To complete your survey online please visit:
DenverWater.org/FilterSurvey
Enter your personal survey code,
or simply scan the QR code provided below.

Denver Water improve and continue its Lead Reduction Program.

Remember to submit your survey by Oct 31,

Your responses will help Denver Water gather information about how

for the gift card drawing.

you are using the pitcher in your home. Return your completed survey
by mail or online.
If you answer all the questions in this survey and return it by Oct. 31, 2020,

PERSONAL SURVEY CODE

SCAN FOR ONLINE

XXXXX

SURVEY ACCESS

you will be entered in a random drawing to win one of 20 $50 Visa™

OMB CONTROL NUMBER

gift cards. Denver Water will hold a drawing at noon on Dec. 31, 2020,

2008-XXXX

at Denver Water, 1600 W. 12th Ave., Denver, Colorado 80204. We will
use your contact information provided to notify you if you win.

EXPIRATION DATE
XX/XX/XXXX

INSTRUCTIONS
• Use a pencil or pen with blue or black ink.
• Fill in the circle next to your answer for each question.
• Choose only one answer for each question unless the instructions say otherwise.

• To change your answer, erase completely or clearly cross out unintended
response. See sample.

SURVEY QUESTIONS:

OPTIONAL QUESTIONS:

1. Do
 you always, or most of the time, use your pitcher provided by
Denver Water for drinking water?
Yes.

The questions below are optional. Denver Water will only use your
demographic information for research purposes and to better inform
our outreach and communication activities.

No – I use unfiltered tap water.

7a. Are you of Hispanic, Latino, or of Spanish origin?

  – I use bottled water, or a different type of filtration system
No
certified to remove lead in accordance with NSF/ANSI 53
standards (e.g., fridge, under the sink filter, sink-mounted filter).
2. Do
  you always, or most of the time, use your pitcher when you
are cooking foods where water is a base ingredient (examples:
making rice, beans, soup)?
Yes

No

2a.  If your answer to No. 2 above is no, why are you not using the
pitcher for cooking?

Yes
White

Black or African American
Native American or Alaska Native
Asian
Native Hawaiian and Other Pacific Islander
Multi-racial
Other (specify)

Prefer to use unfiltered tap water.

I do not know

Prefer to use bottled water for cooking food.

Prefer not to say

 
Prefer
to use a different type of filtration system certified to
remove lead in accordance with NSF/ANSI 53 standards (e.g.,
fridge filter, under the sink filter, sink-mounted filter).

No

7b. How would you describe yourself? (Check all that apply)

8. What is the age of the youngest person in your household?
Someone in the household is expecting

Do not cook.

Under 2 years old

Other

2-6 years old
7-17 years old
18-24 years old

3. Do
 you have a formula-fed infant (under 24 months of age)
in your household?
Yes

No

3a.  If yes, what water do you always use to mix the formula
(select all that apply)?
 Not applicable (I don’t feed formula to my infant, or use
pre-mix/ready mix)

25-34 years old
35-44 years old
45-54 years old
Over 55 years old
Prefer not to say
9. What

is the primary language of your household?
(Check all that apply)

Water from the pitcher filter

English

Bottled water

Spanish

 
Water
filtered by an alternative filter device (fridge filter, under
the sink filter, sink-mounted filter or other filter) certified to
remove lead in accordance with NSF/ANSI 53 standards

Other (specify) _________________________________

Unfiltered tap water
4. Have

you or will you be replacing the pitcher’s filter with the
Denver Water provided replacement filters as recommended by
the manufacturer?
Yes

No

If no, why not? (please describe)

Prefer not to say
10. How much total combined money did all members of your
household earn in 2018 (gross income)?
$0-$29,999
$30,000-49,999
$50,000-79,999
$80,000-99,999
$100,000 or more
Prefer not to say

5. The

filter manufacturer recommends hand-washing the pitcher
with a mild detergent. Are you cleaning your pitcher as
recommended by the manufacturer?
Yes

No

6. What

would make you more likely to use the pitcher provided?
(Check all that apply)

11. What is the highest level of school you have completed, or the
highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree

Larger pitcher

Bachelor’s degree

Lighter pitcher

Graduate degree

Pitcher that fits in the refrigerator

Prefer not to say

Pitcher that takes less time to fill
Pitcher that takes less effort to use
Not interested in filtering drinking water
Do not cook or use tap water for cooking
Other, please specify: (fill in the blank)

12. To which gender identity do you most identify?
Female
Male
Other
Prefer not to say

IMPORTANT REMINDERS:
•

Continue using your filter for drinking water, cooking food where water is a base
ingredient or absorbed into the food (recipes like rice, beans and soup) and preparing
infant formula.

• Maintain

and replace your pitcher and filter according to the manufacturer’s

instructions.
https://www.brita.com/wp-content/uploads/20180419-Magnolia_User-Guide_LL.pdf
• If

you want a chance to win a $50 Visa gift card, please provide your email

and mailing address for notification purposes only.
Email:

Mailing Address:

XXXXX

If you have any questions, please contact:
Denver Water Customer Care
Monday–Friday, 7:30 a.m. to 5:30 p.m.
303-893-2444
[email protected]

HELP GET THE LEAD OUT.
1600 W. 12th Ave.
Denver, CO 80204-3412

12 QUESTIONS MAY WIN YOU
A FREE $50 VISA™ GIFT CARD.