Clean Air Advocacy Engagement Survey

Have you or someone in your household experienced health impacts you believe were caused or worsened by poor air quality?

Yes

No

Not Sure

If yes, please briefly describe: e.g., asthma flare-up, COPD symptoms, missed work/school, etc.

How strongly do you agree with this statement: "Air quality directly affects my health and daily life."

Strongly agree

Somewhat agree

Neutral

Somewhat disagree

Strongly disagree

Do you currently use any tools or resources to monitor local air quality (such as AirNow, PurpleAir, a weather app, etc.)?

Yes

No

If yes, please list which one(s):

When you know air quality is unhealthy, what actions (if any) do you take to protect yourself or your family?

Would you be willing to share your story with us to use on our website, social media, newsletters, and/or other storytelling efforts as needed?

Yes

No

FirstName

LastName

Email

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