MAKE A CALL & HELP MAKE LIFE SAFER FOR CHILDREN
IN YOUR AREA!
1. Who in your town is responsible for the maintenance of:
A. Schoolyards or outdoor play areas? ____________________________________
B. Athletic fields?
_____________________________________________________
C. Parks?
___________________________________________________________
(Examples: Schools, town recreation or parks
departments, sports associations, lawn care companies)
2. Based on a phone
call, personal contact, E-Mail or letter correspondence with any of the above:
A. Are
lawn chemicals (herbicides/fertilizers, pesticides, etc.) used on these
properties?__________
B. If so, at which facilities, which chemicals
are being applied, and by who?
(List by brand name and/or by specific chemicals).
children are present or will be on the premises
soon?
3. List phone
numbers & E-Mail addresses for any persons with whom you spoke, or for
appropriate decision makers in your town.
(We will provide information to them on the hazards of these chemicals
and on alternative lawn care practices that are healthier and can save money.)
4. Have you, your
child, or anyone you know ever noticed a negative reaction to any lawn
application?
Yes No Some Not
Sure
5. If so, which
product or chemical, and what kind of reaction did you have?
YOUR NAME: PHONE:
TOWN: E-MAIL:
REASON FOR INTEREST IN THIS CONCERN:
COPY AND PASTE THIS SURVEY'S TEXT INTO A DOCUMENT, ADD YOUR ANSWERS AND EMAIL BACK TO: Liberty Goodwin, Director, Toxics
Information Project (TIP), P.O. Box 40572, Providence, RI 02940. Tel. 401-351-9193. E-Mail: liberty@toxicsinfo.org Website:
www.toxicsinfo.org