Purpose This questionnaire helps identify potential invisible health risks in your home environment. You can answer even if you are unsure about some details. 1. General Background Where is your home located? CitySmall townRural areaPrefer not to say What type of home is it? ApartmentTownhouseDetached houseOther When was the building originally constructed? Before 19701970-19901990-2010After 2010Don't know 2. Renovation History Has your home been renovated in the last 10 years? Yes, major renovationYes, partial renovationNoDon't know When was the most recent renovation? Within the last 6 months6-24 months agoMore than 2 years agoDon't know Were there noticeable odors after renovation? Yes, strong and long-lastingYes, but they faded quicklyNoDon't remember 3. Materials (Everyday Language) What type of flooring is used in main living areas? (select all that apply) Natural woodEngineered wood / laminateVinyl / PVCCarpetStone / tileDon't know Wall and ceiling finishes are mainly: PaintedWallpaperedWood panelsDon't know Do you know what kind of paints or finishes were used? Natural / ecological materialsStandard commercial materialsDon't knowNot sure 4. Furniture and Interior Has a lot of new furniture been added in recent years? Yes, a lot of new furnitureSome new itemsMostly older furnitureNot sure Did new furniture emit strong odors initially? Yes, and it lasted a long timeYes, but it faded quicklyNoDon't know 5. How Your Body Feels at Home How do you generally feel at home compared to being outdoors? Better at homeNo differenceWorse at homeNever thought about it While at home, do you experience more often: (select all that apply) HeadachesFatigueIrritabilityEye or skin irritationPoor sleepNone of the above 6. Children and Sensitivities Do children live in the home? Yes, under 3 years oldYes, 3-7 years oldYes, older childrenNo Does anyone in the household have allergies or sensitivities? YesSuspectedNoDon't know 7. Intuitive Question Based on your gut feeling, does this home support your health? Yes, completelyMostly yesMostly noDefinitely noNot sure 8. Your Expectations What would you most like to understand? Whether something in my home could affect long-term healthWhether my home is suitable for a childWhether I should change something before the next renovationPeace of mind and reassuranceSomething else If you selected "Something else", please specify:
