Home Activity Family Installation Survey

Thank you for participating in the energy efficiency education program and for completing the installation survey. Please complete the survey below with your family. Fill it out to the best of your ability. When finished, print the last page to return to your teacher. Your answers will be part of the statewide data collection. No individual student’s results will be tied back to the student or family. Questions with an asterisk must be completed.

Step 1 of 7

14%

School*
Teacher*
Password*
Your teacher should provide your class with a password. You cannot begin the survey without first providing the correct password.

Insulation
1. Did you install the weather stripping from the energy efficiency items provided in class?*
- Yes
- No
If No, briefly explain why not.
2. Did you install the door sweep from the energy efficiency items provided in class?*
- Yes
- No
If No, briefly explain why not.
3. Did you install the outlet and switch gaskets provided?*
- Yes
- No, but they were provided.
- No, I did not receive them.
If No, briefly explain why not.

Refrigerator and Freezer
1. Did you adjust the setting on your refrigerator to the setting recommended in the energy efficiency program (34°-40°F)?*
- Yes
- No
If No, briefly explain why not.
2. Did you adjust the setting on your freezer to the setting recommended in the energy efficiency program (0°-5°F)?*
- Yes
- No
If No, briefly explain why not.

Step 1 of 7

Compact Fluorescent Light bulbs (CFLs)

Insulation

Heating and Cooling Systems

Water Heater

Refrigerator and Freezer

Conclusion