USVI Public Records

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We would like to take this opportunity to say Thank you! For participating in this Home & Farm Water Quality Assessment Project. The experience we gain from this project will be very helpful in organizing the V.I. Home & Farm Water Quality Assessment , as well as in the United States and other countries all over the world. In order to make improvements to this program, we would like to know what you think of this assessment and we invite you to share any ideas you may have for improving it. Please take the time to answer the following questions in this survey. You do not need to provide personal information like your name or address – your assessments and worksheets will be kept confidential. 1. When was your Home & Farm Water Quality Assessment completed? (month/year) _______________ 2. Were you able to complete your Home & Farm Water Quality Assessment without help? Yes ______________ No ________________ If you answered no, who helped you? __________________________________ 3. Was the Home & Farm Water Quality Assessment easy to follow? Yes ______________ No ________________ 4. Approximately how much time did you spend completing your Home & Farm Water Quality Assessment? ____________ (hours) 5. Did you learn something new from completing your Home & Farm Water Quality Assessment? On a scale of 1 to 10, with 1 being not helpful and 10 being extremely helpful, circle the number that most closely describes your feeling about this Assessment. 1 2 3 4 5 6 7 8 9 10 Not Helpful Extremely Helpful Helpful 6. Would you recommend that others complete a Home & Farm Water Quality Assessment? ______ Yes ______ Maybe ______ No 7. As a result of your Home & Farm Water Quality Assessment, do you plan to make changes on your property and/or around your home? ______ Yes ______ Maybe ______ No 8. What type of changes are you planning to make? ______ Structural ______Management ______ None 9. Please circle Yes or No in the following table to indicate which sections of the Assessment you completed; and indicate whether any changes are planned and/or completed. Worksheet Completed Changes Planned Home & Farm Water Quality Assessment Y/N Y/N Assessing the Condition and Location of Your Drinking Water Well Y/N Y/N Assessing the Condition of Your Rain Water Collection System (Cistern) Y/N Y/N Assessing Your Site Y/N Y/N Assessing Your Household Waste Water Disposal System Y/N Y/N Assessing Your Household Hazardous Waste Management Practices Y/N Y/N Assessing Your livestock and Poultry Operations Y/N Y/N Assessing Your Fertilizer Storage and Handling Practices Y/N Y/N Assessing Your Pesticide Storage and Handling Practices Y/N Y/N Assessing Your Petroleum Product Storage Practices Y/N Y/N 10. If you plan to make changes, please check the type of assistance you may need. _____ No assistance needed _____ Cost share assistance _____ Technical assistance _____ Engineering or design _____ Other (specify) _____________________________________________ _______________________________________________________________ 11. If you do not plan to make changes in situations that may threaten your drinking water supply, please indicate why (check all that apply). _____ Too expensive _____ Too time consuming _____ Do not feel it will make a difference _____ Need more information and/ or assistance _____ Other (please specify) ________________________________________ 12. How can this Home & Farm Water Quality Assessment be improved? Please list your suggestions and comments below. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________