The Healthy Homes Screening Tool is a free, secure, and confidential tool to help you identify if there are any hazards in your home.

Once you complete the short survey, you will receive a report on the top hazards that likely exist in your home, tips to get rid of them, and contact information for organizations that can help you.


Q1: Have any adults (18 or older) living in the home been told by a doctor or other medical professional that they have asthma?

Q2: Have any children (under 18) living in the home been told by a doctor or other medical professional that they have asthma?

Q3: Do any persons in the home have breathing problems?

How often?

Q4: Does anyone in the home smoke tobacco products?

Do they smoke tobacco products inside of the home?

Q5: Do you keep any pets in the home?

How many?

Q6: Is there evidence of the following pests in the home?

Q7: Are there gaps that could allow insects or animals to enter the house?

Q8: Is refuse stored in or around the home in anything other than covered containers?

Q9: Do you use any of the following cleaning products in the home?

Q10: Do you use any of the following scented products in the home?

Q11: Is there evidence of any of the following?

Please specify

Q12: Is there evidence of any of the following ongoing leaks?

Q13: Is there chipping or peeling paint inside or outside the home?

Please specify

Q14: Has your home been tested for lead?

If yes, were lead hazards found?

Q15: Have any children in the home been tested for lead poisoning?

Have you been told by a medical professional that there is a problem with the child’s blood lead level?

Q16: Are all stairs and porches in good structural condition?

Q17: Are there working lights above or near all stairways?

Q18: Are there appropriate handrails present in all stairways?

Q19: Do bathtubs/showers have either of the following?

Q20: Are the following hot surfaces accessible to children?

Q21: Are there exposed electric wires or electric outlets without covers?

Q22: Are smoke detectors present?

How many?

Do they work?

Q23: Do you have a fire extinguisher?

Where is it located?

Do any adults living in the home know how to operate it?

Q24: Are there multiple exits from the building in the event of fire?

Q25: Are any of the following present?

Q26: Are locks missing on any of the following?

Q27: How many adults and children regularly sleep in the home?

Q28: Is there a carbon monoxide detector in the home?

Does it work?

Q29: Is there a working furnace or boiler in the home?

Is it vented to the outside of the house?

Q30: Are any of the following additional heating sources present within the home?

Q31: Is a gas stove present in the home?

Is it vented outside or is there a nearby window that opens?

Q32: Is a working dryer present in the home?

Is it vented to the outside of the house?

Has the lint trap been cleaned since its last use?

Q33: Are any of the following available to cool the home?

Q34: If any of the following items are present in the home, are they all stored out of the reach of children?

Q35: Has your home ever been tested for radon?

Was radon present?

Q36: Is there evidence of asbestos pipe wrap within the home?

Q37: Are any of the following kitchen appliances/amenities missing?

Are there any problems with these appliances/amenities?

Please specify

Q38: Are any of the following bathroom amenities missing?

Q39: Do all your sinks, toilets, bathtubs and showers drain properly?

Q40: Have you ever had problems with the following utilities due to:

Shut off:

Repair Issues:

Q41: Are there any structural hazards on ceiling, floors, or walls?

Please specify

Q42: Are there any other hazards identified within the home?

Please specify

The following questions are optional.

PA1: What year was the home built?

PA2: How many bedrooms are in the home?

PA3: How many bathrooms are in the home?

PA4: Does the resident own or rent the home?

PA5: Does anyone under the age of 18 live in the home?

Please enter their ages

PA6: Does anyone over the age of 65 live in the home?

Please enter their ages

PA7: Is there a pregnant woman living in the home?

PA8: Which of the following race identity categories best describe the residents of the home? Select all that apply.

PA9: What is the best estimate of the household’s PERSONAL annual earnings before taxes or other deductions for 2012?

Healthy Homes Screening Tool Summary Report

Based on your responses to the HHST survey, the following are the key healthy homes risks that may be present in your home *:

    In addition, the following healthy homes risks may also be present in your home based on your responses to the HHST survey *:

      The following pages of this report provide you with additional information about the five key healthy homes risks identified above including resources for assistance †.

      * The HHST is designed to be used as a screening tool by non-housing professionals to make observations about the home and is not intended to be used as a definitive analysis of housing conditions.

      † The primary purpose of the HHST is to educate residents about any risks that may be present within their home. GHHI Detroit-Wayne County does not guarantee that any work will be completed on the home. The tips suggested in the following pages are not guaranteed to eliminate the risk identified and assistance by a licensed housing professional may be required for complete hazard remediation. Assistance from the local organizations provided on the following pages is dependent upon program availability and eligibility requirements and may be subject to change as determined by the local organization.