Does your house have:

• Active and/or recent leaks? Q: m30
  Yes A: m30.1 No A: m30.2 I don't know A: m0.3
• Visible or suspected mold? Q: m40
  Yes A: m40.1 No A: m40.2 I don't know A: m40.3
• Wall-to-wall carpet? Q: m50
  Yes A: m50.1 No A: m50.2 I don't know A: m50.3
• A crawlspace? Q: m10
  Yes A: m10.1 No A: m10.2 I don't know A: m10.3
• Forced air heating/cooling? Q: m20
  Yes A: m20.1 No A: m20.2 I don't know A: m20.3
• Frequent indoor or outdoor pest treatment? Q: m60
  Yes A: m60.1 No A: m60.2 I don't know A: m60.3
• Overdue repairs or maintenance? Q: m70
  Yes A: m70.1 No A: m70.2 I don't know A: m70.3

Do you have?

• Fragranced cleaning/laundry products? Q: m80
  Yes A: m80.1 No A: m80.2 I don't know A: m80.3
• Odors from outdoor pollution? Q: m90
  Yes A: m90.1 No A: m90.2 I don't know A: m90.3
• Visible condensation when cooking/bathing? Q: m100
  Yes A: m100.1 No A: m100.2 I don't know A: m100.3
• Health complaints? Q: m110
  Yes A: m110.1 No A: m110.2 I don't know A: m110.3

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