Do you think your home is affecting your health?

Hayward Score will help you find out. Your answers to the survey will help us understand the important characteristics of your home and how you live in your home. From there we will generate a detailed report that will help you understand your indoor air quality and how you can improve your air and your health!

Climate Zone

Let’s get started.

Outdoor conditions can have a powerful influence on the inside of your house. Your climate – whether it is hot, humid, cool, or dry and how it changes seasonally - makes a big difference in how your home handles everything from excess moisture and dust to pets and pests, so it is important for us to know where you live. U.S. only, please.

Occupants

Although climate affects your home from the outside, you might be surprised how many other factors can affect your home from the inside. For example, the number of people and pets in a house, combined with the size of the house can make a difference in your indoor air quality!

  • Everyone, including children.


  • A: 1115.1, A: 1115.2, A: 115.3


General Home Information

The more we know about your house the better! Details about your home make a difference so if you are not sure about something, you should do some investigation before you answer. If you still are not sure, take your best guess.

  • A: 400.1, A: 400.4, A: 400.2, A: 400.3

  • Please include basements, but don’t include attics.

  • If you are not sure, just take your best guess.

    A: 410.1, A: 410.2, A: 410.3, A: 410.4, A: 410.5, A: 410.6, A: 410.7, A: 410.8, A: 410.9, A: 410.10, A: 410.11, A: 410.12, A: 410.13

  • A: 411.4, A: 411.3, A: 411.2, A: 411.1

  • A: 415.1, A: 415.2, A: 415.3, A: 415.4, A: 415.5, A: 415.6, A: 415.7

  • Please include your basement.

    A: 420.1, A: 420.2, A: 420.3, A: 420.4, A: 420.5, A: 420.6, A: 420.7, A: 420.8

  • Please include your basement.

  • What type of exterior walls (cladding) does your home have?Q: 435

    Please check all that apply.

  • Is the exterior of your house mostly in the sun or the shade? Q: 445

  • We now dig deeper into the structure and systems in your home. This is important because they interact with each other, and with other conditions that we’ll ask about later.

    Please select all of the features that are in your home? Q: 450
  • Do you have access to your mechanical room/HVAC system?Q: 451
  • What is the age of all/majority of your wall-to-wall carpeting?Q: 470

    A: 470.1, A: 470.2, A: 470.3, A: 470.4, A: 470.5, A: 470.6

  • Describe your crawlspace.Q: 455

    If you have a sealed crawlspace, please select one option below

    Please select only one.

  • Basements, whether finished or unfinished, are so common they are usually overlooked but they can impact your health, especially if they feel damp or wet, so it is important for us to know the details.

    Describe your basement – both what it looks like and if it is wet, damp, or dry. Q: 460

    Please select one.

    Please select one.

  • Describe your slab. Q: 464

    Please select one.

  • Heating and cooling systems are typically thought of as affecting only comfort and temperature, but you may not be aware of how much they impact your health.

    Please describe the primary heating system in your home.Q: 475
  • Where is/are your forced air heating unit(s) located?Q: 485

    Please check all that apply.

  • What type of fuel is used by the heat source?Q: 480
  • How often do you use your wood stove/fireplace. (If you have more than one, answer for the one you use most often)Q: 481
  • Please describe what kind of fireplace you have and how often you use it. (If you have more than one fireplace, answer for the one you use most often)Q: 465

    Please select one.

    Please select one.

  • Please describe the primary cooling system in your home.Q: 490
  • Does your cooling system regularly turn on/off frequently (after a few minutes of running)?Q: 492
  • Where is your forced air cooling system(s) located?Q: 491
  • Do you typically keep one or more windows open?Q: 495

    A: 495.1, A: 495.2, A: 495.3, A: 495.4

Renovations

When you renovate, you make more than cosmetic changes, you also change your indoor air. Even small projects can have a big impact by increasing dust throughout the house as well as off-gassing of new building materials, paint, furniture, and carpet. An energy retrofit, while cutting your power bill, tightens up your house, so less fresh air is available. Let us know how your home has changed over the years.

  • Is your house currently being remodeled or renovated?Q: 502
  • Has your home ever had a professional:Q: 500
      Yes No I don’t know
    Energy Retrofit (add insulation and/or air sealing)A: 510.1, A: 510.2, A: 510.3
    Major remodel/renovation (room addition, plumbing/electrical upgrades, kitchen/bath remodel)A: 500.1, A: 500.2, A: 500.3
    Lead remediationA: 515.1, A: 515.2, A: 515.3
    Asbestos abatementA: 520.1, A: 520.2, A: 520.3
    Radon mitigationA: 525.1, A: 525.2, A: 525.3

Proximity

According to the EPA outdoor pollutants can be 2-5x (and in some cases up to 100x) more concentrated indoors than outdoors where you spend 90% of your time. If you let us know what is going on outside your home, we can understand what may be getting inside your home.

  • Do you live within 1/2 mile of any of the following?Q: 600

    Please select all that apply.

  • Are you within 1/2 mile of any of the following?Q: 601

    Please select all that apply.

  • Do you live 1 block from any of the following or can you smell any of the following inside your home?Q: 605

    Please select all that apply.

    A: 600.13

Moisture

  • HALF-WAY THERE!

    Excess or uncontrolled moisture is one of the most ignored and damaging events that can happen to your home – causing odors, mold, and structural damage, sometimes in as little as 24 hours.



    Moisture can also accumulate from routine, everyday activities - like cooking, bathing, even breathing - and combine with other factors in your home in surprising ways. Knowing how you use your home is really important.

  • How many meals do you or your family typically cook at home per week?Q: 610

    Please include breakfast, lunch, and dinner.

  • Please tell us a little bit more about your cooking habits.Q: 615
      Yes No
    Do you cook with a steamer 5+ times per week?A: 615.1.1, A: 615.1.2
    Do you boil, simmer, and/or use a wok 5+ times per week?A: 615.2.1, A: 615.2.2
    Do you cook with gas?A: 615.3.1, A: 615.3.2
    Do you have a working range hood fan?A: 615.6.1, A: 615.6.2
    Do you usually run the range hood while cooking?A: 615.4.1, A: 615.4.2
    Does your range hood blow back into the kitchen?A: 615.5.1, A: 615.5.2

Moisture

  • How many times a week do you and your family members take showers longer than 10 minutes?Q: 620

    A: 620.1, A: 620.2, A: 620.3

  • Do ALL bathrooms have working bath fans that exhaust outdoors?Q: 621
  • Please tell us a little more about moisture in your home. Do you/your family frequently:Q: 625
      Yes No
    Run the bath fan while showering?A: 625.1.1, A: 625.1.2
    Use a steam nozzle in your shower?A: 625.3.1, A: 625.3.2
    Use an indoor jacuzzi or spa tub?A: 625.4.1, A: 625.4.2
    Notice condensation on walls or ceilings?A: 625.5.1, A: 625.5.2
    Notice condensation in your laundry room?A: 625.6.1, A: 625.6.2
    Run a humidifier in one or more rooms?A: 625.2.1, A: 625.2.2

  • Leaks are common sources of moisture. Some, like broken pipes, leaky roofs, and flooded basements, are obvious and typically fixed quickly. Others are not as noticeable or small enough to be considered a nuisance and ignored. However, if left unfixed, these sources can be even more destructive to house and health over time. Help us understand the “leak” history of your house.

  • Have you had any leaks/water damage in your house?Q: 631

  • Please answer for the most recent leak/water damage you can remember. (You will be able to add additional leaks if needed)

    Leak 1

    [-] Remove Leak

    Where did the leak/water damage occur?Q: 632.1

    Choose only one.

    When did this leak occur?Q: 633.1
    What kind of leak was it?Q: 634.1
    About how long did the leak occur before the water flow was stopped?Q: 635.1
    How significant was the damage?Q: 636.1
    Did the area affected/damaged by water get completely dried out within 48 hours of the leak/water starting?Q: 637.1
    Who dried out the affected/damaged area?Q: 638.1

    Please select one.

    Leak 2

    [-] Remove Leak

    Where did the leak/water damage occur?Q: 632.2

    Choose only one.

    When did this leak occur?Q: 633.2
    What kind of leak was it?Q: 634.2
    About how long did the leak occur before the water flow was stopped?Q: 635.2
    How significant was the damage?Q: 636.2
    Did the area affected/damaged by water get completely dried out within 48 hours of the leak/water starting?Q: 637.2
    Who dried out the affected/damaged area?Q: 638.2

    Please select one.

    Leak 3

    [-] Remove Leak

    Where did the leak/water damage occur?Q: 632.3

    Choose only one.

    When did this leak occur?Q: 633.3
    What kind of leak was it?Q: 634.3
    About how long did the leak occur before the water flow was stopped?Q: 635.3
    How significant was the damage?Q: 636.3
    Did the area affected/damaged by water get completely dried out within 48 hours of the leak/water starting?Q: 637.3
    Who dried out the affected/damaged area?Q: 638.3

    Please select one.

    Leak 4

    [-] Remove Leak

    Where did the leak/water damage occur?Q: 632.4

    Choose only one.

    When did this leak occur?Q: 633.4
    What kind of leak was it?Q: 634.4
    About how long did the leak occur before the water flow was stopped?Q: 635.4
    How significant was the damage?Q: 636.4
    Did the area affected/damaged by water get completely dried out within 48 hours of the leak/water starting?Q: 637.4
    Who dried out the affected/damaged area?Q: 638.4

    Please select one.

    Leak 5

    [-] Remove Leak

    Where did the leak/water damage occur?Q: 632.5

    Choose only one.

    When did this leak occur?Q: 633.5
    What kind of leak was it?Q: 634.5
    About how long did the leak occur before the water flow was stopped?Q: 635.5
    How significant was the damage?Q: 636.5
    Did the area affected/damaged by water get completely dried out within 48 hours of the leak/water starting?Q: 637.5
    Who dried out the affected/damaged area?Q: 638.5

    Please select one.

  • Moisture outdoors can also get indoors, depending on how close the water accumulates against the outside of the house.

    Are any of the following outside your home?Q: 645

    Please select all that apply.

Indoor Conditions

Most people equate a home that smells like cleaning products with a healthy home. That isn’t always true. If you are cleaning with chemical products, vacuuming without a HEPA filter, or even burning scented candles you may be making your air much less healthy and introducing allergy and asthma triggers.

The next few questions will provide important clues about what might need to be improved in your home.

  • Do you notice any of the following inside your home?Q: 750
      Yes No
    Unpleasant/musty odors or smellsA: 750.1.1, A: 750.1.2
    A lot of dust on surfacesA: 750.2.1, A: 750.2.2
    Dark/grey dirt or dust on windowsills or near windowsA: 750.3.1, A: 750.3.2
    Water stains on walls and/or ceilingsA: 750.4.1, A: 750.4.2
    Visible mold on walls and/or ceilingsA: 750.5.1, A: 750.5.2
  • Even though you don’t see it, do you think you have mold in your house?Q: 770
  • Does everyone usually take their shoes off when they enter the house?Q: 780
  • Does anyone in your home smoke tobacco (or vape) indoors regularly/routinely?Q: 790
  • What type of vacuum do you own?Q: 755
  • On average how often do you vacuum and/or clean your floors?Q: 760
  • Where do you store household/garden chemicals?Q: 765
      Inside the bedroom Inside the house (not in the bedroom) Inside an attached garage, crawlspace, or basement Outside the house/detached garage/shed N/A
    Cleaning supplies

    A: 765.1.1, A: 765.1.2, A: 765.1.3, A: 765.1.4, A: 765.1.5
    Personal care supplies

    A: 765.2.1, A: 765.2.2, A: 765.2.3, A: 765.2.4, A: 765.2.5
    Paint and art supplies

    A: 765.3.1, A: 765.3.2, A: 765.3.3, A: 765.3.4, A: 765.3.5
    Fertilizers and pesticides

    A: 765.4.1, A: 765.4.2, A: 765.4.3, A: 765.4.4, A: 765.4.5
  • Are all/most of your cleaning, laundry, and personal care products, “natural” and/or fragrance-free?Q: 791
  • How often is your water so brown/murky that you can’t drink from the tap or worry about bathing children?Q: 795

Pests

Almost every home has pests. But only some are of concern because they are allergens and only a few need extreme action. Often the use and storage of chemical pesticides puts your health at more risk than the pests themselves.

  • Please indicate any pests that you have inside your home (i.e., in attic, crawlspace, wall cavities)?Q: 800

    Please select all that apply.

  • Do you/landlord treat for pests indoors or outdoors?Q: 801
  • How often do you treat for pests?Q: 805
      Daily/Weekly Monthly/Quarterly Occasionally (1-3x per year)
    Indoor

    A: 805.1.1, A: 805.1.2, A: 805.1.3
    Outdoor

    A: 805.2.1, A: 805.2.2, A: 805.2.3
  • Do you treat for fleas?Q: 810
  • How do you treat for fleas?Q: 815
      Frequently/routine As needed/irregularly
    I treat my pet(s) directly

    A: 815.1.1, A: 815.1.2
    I treat my house (bombs)

    A: 815.2.1, A: 815.2.2
You will be able complete a set of questions for each person

Health Symptoms

Nearing the end!

The next set of questions aren’t medical or diagnostic – they explore what you are aware of in your personal experience. Your answers help us understand the possible impact that the conditions in your home might be having on your health, including allergies, asthma and other conditions.

Take your time and answer thoughtfully.

  • Does anyone in your household experience any health symptoms or complaints on a frequent or ongoing basis?Q: 930

    If multiple people in your household have health complaints we recommend that you answer for the person who is most seriously impacted.

  • Is this person?Q: 935
  • Is this person?Q: 936
  • How old is this person?Q: 940

    A: 940.1, A: 940.2, A: 940.3, A: 940.4, A: 940.5, A: 940.6, A: 940.7, A: 940.8, A: 940.9, A: 940.10, A: 940.11, A: 940.12

  • Please indicate respiratory complaints (these may be associated with asthma, allergies, copd, etc) you experience at home. Q: 945

    Please check all that apply.

      • How severe is this symptom? *Q: 945.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 945.3
      • How severe is this symptom? *Q: 945.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 945.3
      • How severe is this symptom? *Q: 945.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 945.3
      • How severe is this symptom? *Q: 945.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 945.3
    Please indicate non-respiratory complaints you experience at home. Q: 950

    Please check all that apply.

      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
      • How severe is this symptom? *Q: 950.2
      • Is this symptom relieved when you leave the house only to return when you come home? *Q: 950.3
  • Did any of your symptoms or complaints start or get worse after:Q: 905

    Please select all that apply.

  • Do you experience symptoms or complaints (like sneezing, coughing, or headaches) during or after: Q: 910

    Please select all that apply.

  • Do you feel sick when you are exposed to tobacco smoke, certain fragrances, nail polish/remover, engine exhaust, gasoline, air fresheners, pesticides, paint/thinner, fresh tar/asphalt, cleaning supplies, new carpet, or furnishings?Q: 912

    By sick we mean: headache, difficulty thinking, difficulty breathing, weakness, dizziness, upset stomach, etc.

  • Are you unable to tolerate or do you have adverse or allergic reactions to any drugs or medications (such as antibiotics, anesthetics, pain relievers, x-ray contrast dye, vaccines or birth control pills), or to an implant, prosthesis, contraceptive chemical or device, or other medical/surgical/dental material procedure?Q: 913
  • Are you unable to tolerate or do you have adverse reactions to any food such as dairy products, wheat, corn, eggs, caffeine, alcoholic beverages, or food additives (e.g., MSG, food dye)?Q: 914
  • Does the person you just provided symptom information for have:Q: 1120

    Please select all that apply.

    • When did your asthma symptoms begin?Q: 1405

      A: 1405.1, A: 1405.2, A: 1405.3, A: 1405.4, A: 1405.5

    • What kind of asthma do you have?Q: 1400

      Please select all that apply.

    • We realize that conditions like asthma can fluctuate over time based on many different factors but in general do you consider your asthma to be:Q: 1415

    • There are lots of things in your home that can impact air quality and trigger asthma. Understanding your personal triggers, helps us better address the conditions that may be impacting you.

      What are your primary asthma triggers?Q: 1410

      Please select all that apply.

    • Overall, do you feel better when you leave the house only to feel worse again when you return? Consider how you feel when you leave the house each day or go away for the weekend or on vacation.Q: 920
    • Do other members of your household also have health symptoms or complaints?:Q: 917

      A: 917.1, A: 917.2, A: 917.3

      Their complaints may be the same or different as those previously reported.

    • Does this person have?:Q: 1130

      Please select all that apply.

      • When did the asthma symptoms begin?Q: 1430

        A: 1430.1, A: 1430.2, A: 1430.3, A: 1430.4, A: 1430.5, A: 1430.6

      • What kind of asthma does this person have?Q: 1435

        Please select all that apply.

      • We realize that conditions like asthma can fluctuate over time based on many different factors, but in general is this person’s asthma?:Q: 1440
      • Are their symptoms:Q: 1445
      • If you feel better when you leave the house, what symptoms or complaints are relieved?Q: 925

      • There are lots of things in your home that can impact air quality and trigger asthma. Understanding your personal triggers, helps us better address the conditions that may be impacting you.

        What are this persons’ primary asthma triggers?Q: 1450

        Please select all that apply.

Impact

  • Do you suspect that there are health and safety hazards present in your home?Q: 1001
  • What are they?Q: 1002
  • To what extent do you believe your home is negatively impacting your health or the health of your family?Q: 1000
  • Do you have any other concerns about your home we should know about?Q: 1015

Last Step

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