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Baseline Questionaire

Please fill out qestionaire to help evalute LAN effectiveness. Based on EnAct Baseline and Results Surveys.

Solid Waste:

Transportation:

 

Make Year Model Miles Driven/Yr MPG city MPG highway
Vehicle 1            
Vehicle 2            
Vehicle 3            
 Vehicle 4            

 

 

Household Member Vehicle Miles/Wk
1 alone  
 2 alone  
 3 alone  
 4 alone  
 Household carpool  
Total Vehicle Miles   

 

Other Modes of Transportation

Limousine

Taxi

USTAS bus

Work Shuttle bus

Energy:

Water:

Yard:

Is most of your yard a lawn?  ___ yes  ___ no

Is most of your yard trees and shrubs?  ___ yes  ___ no

What type of lawn mower do you or lawn service use?  ___ gas     ___ electric     ___ manual push mower

Number of native plant species in your yard ____. 

Household Information: How many people are in your household? ______

How many of these people are children (under 18 yrs. old)? _____

How long have you lived in Central Susquehanna Region? ____

How long have you lived at your current address? ____

How many neighbors (within 2 blocks) do you know? (i.e. say more than "hello") ___

What type of housing do you live in?  single family ___    apt. ____ condo ___ 

multifamily ( 6 units or fewer) ___   

Do you rent or own? ___

Thank you for completing this survey. Click here to send to LAN.

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