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Draft WTC Hotline Questionnaire regarding Apartment Conditions, August 2003

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Draft questionnaire for the WTC hotline asking residents about apartment dust, cleaning history, and asbestos.

NYC-WTC_000138346–000138347
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NYC 9/11 Public Portal Document

CADocuments and Settings\MichaelGi\Local Settings\Temporary Internet FiIes\OLK5\WTC_questionnaire2.wpd August 7, 2003 (4:19pm)

DRAFT HOTLINE QUESTIONNAIRE

First Name: Last Name: Street Address: Apartment Number: Floor: ZIP Code: Cross Street #1: Cross street #2 Mailing Address (if different): Street/Box: ZIP Code Entry Information:: Telephone, Daytime: Telephone, Evening: Telephone, Fax: email: Confidentiality Code:

Number of rooms: Central air conditioning: Unit air conditioning (number and location of units): Carpets (number, location and type): Describe the dust situation when you first entered your apartment: Light: Write in it: Measurable depth (estimate): Color: Was your apartment first cleaned by: Certified asbestos contractor (name): Approximate date: Non-certified contractor: Approximate date: Housekeeper: Approximate date: Occupant: Approximate date: If contractor, hired by building owner/manager or you: Was your apartment tested before and/or after cleaning: Approximate date: Do you know the results: Were building common areas cleaned:

Do you want: Your apartment professionally cleaned and tested for asbestos in air (after cleaning): (This will take 2-3 days and will require you or your representative to be present)

NYC-WTC_000138346

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NYC-WTC_000138346Source: NYC Law Department, mirrored locally

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