HOUSEHOLD TOXIC CHEMICALS & POLLUTION YESNO
1. Are there any lakes, streams or other water sources near your home?
   a. Do you consider these waters polluted or not?
   b. If you consider these waters polluted, how is this water being polluted?
   Answer here:
2. Check under your sink...are there any toxic cleaning supplies there?
   (make sure you read the back of the labels)
3. Check in your bathrooms...are there any toxic materials there?
4. Look in your garage...are there any toxic waste materials there? example: paint products
   a. Do you take this toxic waste to a local hazardous waste disposal site?
5. Do you know that used motor oil is a household hazardous waste?
   a. Do you change or help change the oil in your car at home?
   b. If so, how do you dispose of the used oil?
   Answer here:
   c. Are you aware of oil recycling programs in your community?
6. Do you have any storm drains near your house?
   a. If there is a storm drain near your house, does it have a sign on it stating,
   "Do not dump hazardous waste materials here."?
7. Does your family take your car in regulary to have the emissions tested for air pollution?
RECYCLING YESNO
1. Does your family practice recycling at home?
   a. Which materials does your family recycle the most?
   Answer here:
2. Does your family look to buy items packaged in recyclable materials
   when you do your grocery shopping?
3. Do you "reuse" anything in your house to keep from creating more waste?
   example: plastic or glass containers
   a. If so, what do you "reuse?"
   Answer here:
4. Does your school have a recycling program?
   a. If so, what does your school recycle?
   Answer here:
5. Do you know the difference between recycled products, and recyclable products?
6. Do you know the difference between pre-consumer waste, and post-consumer waste?
ENERGY CONSERVATION YESNO
  • Which of the following do you and your family do to help conserve energy?
    		•
       a. Turn down the thermostat at night and during the day when the house is unoccupied.
       b. Turn off the lights when you leave a room.
       c. Purchase appliances that state they are "energy efficient."
       d. Use the energy saver cycle on dishwashers if you have one.
       e. Change furnace filters regularly allowing furnace to run more efficiently.
       f. Close off heating vents to rooms not being used at home.
       g. Walk, bike, or take public transportation instead of driving.
    WATER CONSERVATION YESNO
  • Which of the following do you and your family do to conserve water?
    		•
       a. Wash only full loads of laundry.
       b. Turn off water when brushing your teeth.
       c. Use water saver faucets, shower heads, and toilets.
       d. Run the dishwasher only when it is full.
    GENERAL ENVIRONMENTAL QUESTIONS YESNO
    1. Have you ever picked up trash or litter someone else left behind?
       If yes which of the following places have you done this?
       a. In the lunchroom or in school classrooms/hallways.
       b. On the playground or school grounds.
       c. At the park, beach, or some other recreational area.
       d. At home.
    2. Is there somewhere you and your family go to enjoy the outdoors
       that needs to be cleaned up?
       a. If so, where and how could you help clean it up?
       Answer here:
    3. Does your family have a compost pile for yard waste and other biodegradable trash?
    4. Have you or your family ever planted any trees?
    5. Do you plan on being more active in caring for our environment as a result of
       participating in the EGBAR® "Clean Up Challenge" program?
    6. List one thing you plan on doing to make a difference in our environment.
       Answer here:

    or