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date: 15 December 2019

(p. 380) Home Environment Index

(p. 380) Home Environment Index

Please circle the answer that best fits the current situation in the home.

To what extent are the following situations present in the home?

  1. 1. Fire hazard

    1. 0 = No fire hazard

    2. 1 = Some risk of fire (e.g., lots of flammable material)

    3. 2 = Moderate risk of fire (e.g., flammable materials near heat source)

    4. 3 = High of fire (e.g., flammable materials near heat source; electrical hazards, etc.)

  2. 2. Moldy or rotten food

    1. 0 = None

    2. 1 = A few pieces of moldy or rotten food in kitchen

    3. 2 = Some moldy or rotten food throughout kitchen

    4. 3 = Large quantity of moldy or rotten food in kitchen and elsewhere

  3. 3. Dirty or clogged sink

    1. 0 = Sink empty and clean

    2. 1 = A few dirty dishes with water in sink

    3. 2 = Sink full of water, possibly clogged

    4. 3 = Sink clogged; evidence that it has overflowed onto counters, and so forth.

  4. 4. Standing water (in sink, tub, other container, basement, etc.)

    1. 0 = No standing water

    2. 1 = Some water in sink/tub

    3. 2 = Water in several places, especially if dirty

    4. 3 = Water in numerous places, especially if dirty

  5. 5. Human/animal waste/vomit

    1. 0 = No human waste, animal waste, or vomit visible

    2. 1 = Small amount of human or animal waste (e.g., unflushed toilet, on bathroom or other floor)

    3. 2 = Moderate animal or human waste or vomit visible in more than one room

    4. 3 = Substantial animal or human waste or vomit on floors or other surfaces

  6. 6. Mildew or mold

    1. 0 = No mildew or mold detectable

    2. 1 = Small amount of mildew or mold in limited amounts and expected places (e.g., on edge of shower curtain or refrigerator seal)

    3. 2 = Considerable, noticeable mildew or mold

    4. 3 = Widespread mildew or mold on most surfaces

  7. 7. Dirty food containers

    1. 0 = All dishes washed and put away

    2. 1 = A few unwashed dishes

    3. 2 = Many unwashed dishes

    4. 3 = Almost all dishes are unwashed

  8. 8. Dirty surfaces (floors, walls, furniture, etc.)

    1. 0 = Surfaces completely clean

    2. 1 = A few spills, some dirt or grime

    3. 2 = More than a few spills, may be a thin covering of dirt or grime in living areas

    4. 3 = No surface is clean; dirt or grime covers everything

  9. (p. 381) 9. Piles of dirty or contaminated objects (bathroom tissue, hair, toilet paper, sanitary products, etc.)

    1. 0 = No dirty or contaminated objects on floors, surfaces, and so forth.

    2. 1 = Some dirty or contaminated objects present around trash cans or toilets

    3. 2 = Many dirty or contaminated objects fill bathroom or area around trash cans

    4. 3 = Dirty or contaminated objects cover the floors and surfaces in most rooms

  10. 10. Insects

    1. 0 = No insects are visible

    2. 1 = A few insects visible; cobwebs and/or insect droppings present

    3. 2 = Many insects and droppings are visible; cobwebs in corners

    4. 3 = Swarms of insects; high volume of droppings; many cobwebs on household items

  11. 11. Dirty clothes

    1. 0 = Dirty clothes placed in hamper; none are lying around

    2. 1 = Hamper is full; a few dirty clothes lying around

    3. 2 = Hamper is overflowing; many dirty clothes lying around

    4. 3 = Clothes cover the floor and many other surfaces (bed, chairs, etc.)

  12. 12. Dirty bed sheets/linens

    1. 0 = Bed coverings very clean

    2. 1 = Bed coverings relatively clean

    3. 2 = Bed coverings dirty and in need of washing

    4. 3 = Bed coverings very dirty and soiled

  13. 13. Odor of house

    1. 0 = No odor

    2. 1 = Slight odor

    3. 2 = Moderate odor; may be strong in some parts of house

    4. 3 = Strong odor throughout house

During the last month, how often did you (or someone in your home) do each of the following activities?

  1. 14. Do the dishes

    1. 0 = Daily or every 2 days; 15 to 30 times per month

    2. 1 = 1–2 times a week; 4 to 10 times per month

    3. 3 = Every other week; 2 to 3 times per month

    4. 3 = Rarely; 0 times per month

  2. 15. Clean the bathroom

    1. 0 = Daily or every 2 days; more than 10 times per month

    2. 1 = 1–2 times a week; 4 to 10 times per month

    3. 2 = Every other week; 2 to 3 times per month

    4. 3 = Never; 0 times per month