HOME TOXICS SURVEY (Grade Level 4-6)

1. What do you think of when you hear the word TOXIC?

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2. Which of the following do you use? Which of the following do you consider toxic? (Leave blank if you don't use these products.)

Item and Use ToxicNon-Toxic
laundry detergent used to wash clothes
sink and bathtub cleaner
furniture polish
drain cleaner
glass cleaner
baking soda used in cooking
air freshener
ant spray
hair spray

3. When do you think it is okay to use something that is toxic?

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4. What room in your home do you think contains the most toxics?

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5. Which statement best describes your home?

Statement TrueFalse
There are no toxics in my home.
There are some toxics in my home.
I do not know if there are toxics in my home.

6. Would you want to be told if something you are about to buy might be toxic?

Yes
No
Sometimes

7. Do you think that people who work where there are toxics should be told this when they are hired?

Yes
No
Sometimes

8. Do you think individuals should decide whether to buy and use toxics, or do you think the government should make it illegal to sell toxics?

Individual should decide.
Government should make it illegal.
I don't know.

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