Water Usage Questionnaire
Help us understand your water consumption habits and identify opportunities for conservation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Type of Property
*
Household
Business
Other
Number of People Regularly Using Water at This Location
*
Do you have a water meter installed?
*
Yes
No
Estimated Total Water Usage Per Month (liters or gallons)
How frequently do you use water for the following activities?
*
Rows
Daily
Several times a week
Weekly
Rarely/Never
Bathing/Showering
1
2
3
4
Laundry
5
6
7
8
Dishwashing
9
10
11
12
Gardening/Lawn Care
13
14
15
16
Car Washing
17
18
19
20
Which of the following water-saving devices or practices do you use? (Select all that apply)
Low-flow showerheads
Dual-flush toilets
Rainwater harvesting
Fixing leaks promptly
Efficient irrigation systems
None of the above
Other
How would you rate your household's/business's water use efficiency?
*
1
2
3
4
5
How important do you believe water conservation is?
*
Not important
1
2
3
4
Extremely important
5
1 is Not important, 5 is Extremely important
Would you like to receive tips or information about water conservation?
Yes
No
Additional Comments or Suggestions
Submit
Should be Empty: