Damp, Condensation and Mould Survey

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* 1. Do you have any issues with Damp, Mould and Condensation?

Yes

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* 2. Which room or rooms are affected by damp or mould growth? (tick all that apply)

Kitchen

Bathroom

Lounge

Bedroom 1

Bedroom 2

Bedroom 3

Other (please specify)

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* 3. Have you previously reported damp or mould to QCHA?

Yes

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* 4. If yes when did you report this?

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* 5. Which room is worst affected?

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* 6. In the worst affected room where is the damp or mould? (tick all that apply)

Patches on walls

Patches on ceiling

Around windows

Behind or under furniture

Other - Use the box below to explain

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* 7. Can you describe the biggest patch of mould in the worst affected room (shape and an idea of size)?

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* 8. Do you know how you to manage moisture in the air and condensation in your home?

Yes

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* 9. Do you have an extractor fan in your kitchen?

Yes

Don't Know

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* 10. Do you have an extractor fan in your bathroom?

Yes

Don't Know

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* 11. Do you have a window in your bathroom?

Yes

Don't Know

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* 12. Do you have air vents in your window frames?

Yes

Don't Know

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* 13. Energy costs are making it difficult for many people to keep their home warm. Are you able to put your heating on when you need to? tick one answer:


Yes	Yes
Sometimes	Sometimes
Never	Never

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* 14. Personal Details
(Note: we will only use this information for the purposes of this survey)

Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 15. Your Unique Property code (this can be found at the top of your letter)

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* 16. Please upload any photographs showing damp or mould here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 17. Please upload any photographs showing damp or mould here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 18. Please upload any photographs showing damp or mould here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

By providing this information, you agree to allow Queens Cross Housing Association to contact you to discuss your case.

All information is treated as confidential and will never be shared with any third party unless you specifically give us permission to do so.

Damp, Condensation and Mould Survey

Have Your Say - Your Views Will Make A Difference

Question Title

* 1. Do you have any issues with Damp, Mould and Condensation?

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* 2. Which room or rooms are affected by damp or mould growth? (tick all that apply)

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* 3. Have you previously reported damp or mould to QCHA?

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* 4. If yes when did you report this?

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* 5. Which room is worst affected?

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* 6. In the worst affected room where is the damp or mould? (tick all that apply)

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* 7. Can you describe the biggest patch of mould in the worst affected room (shape and an idea of size)?

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* 8. Do you know how you to manage moisture in the air and condensation in your home?

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* 9. Do you have an extractor fan in your kitchen?

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* 10. Do you have an extractor fan in your bathroom?

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* 11. Do you have a window in your bathroom?

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* 12. Do you have air vents in your window frames?

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* 13. Energy costs are making it difficult for many people to keep their home warm. Are you able to put your heating on when you need to? tick one answer:

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* 14. Personal Details(Note: we will only use this information for the purposes of this survey)

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* 15. Your Unique Property code (this can be found at the top of your letter)

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* 16. Please upload any photographs showing damp or mould here.

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* 17. Please upload any photographs showing damp or mould here.

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* 18. Please upload any photographs showing damp or mould here.

* 14. Personal Details
(Note: we will only use this information for the purposes of this survey)