**CHILDHOOD LEUKEMIA STUDY**

**[EMF AND RADON EXPOSURES]{.underline}**

Before I take the EMF measurements, I would like to ask you a few
questions about your residence. This interview should take about 5
minutes.

1.  What material or materials are the outside of this residence made
    of, not counting the roof? (CIRCLE ALL THAT APPLY)

#  [SHOW CARD A]{.underline}

a\. WOOD 1

b\. BRICK 2

c\. CEMENT BLOCK 3

d\. CONCRETE 4

e\. STONE 5

f\. ALUMINIUM OR VINYL SIDING 6

g\. ANYTHING ELSE (SPECIFY) 7

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2.  Is the lowest level, or the basement, partially or completely below
    ground?

YES 1

NO 2 (Q4)

DON'T KNOW 8 (Q4)

3.  What materials are your basement or lower level walls made of? Are
    they brick, cement block, cinder block, concrete, stone, or some
    other material? (CIRCLE ALL THAT APPLY)

a\. BRICK 1

b\. CEMENT BLOCK 2

c\. CINDER BLOCK 3

d\. CONCRETE 4

e\. STONE 5

f\. ANYTHING ELSE (SPECIFY) 6

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4.  Is there a crawl space under the house?

YES 1 (BOX A)

NO 2 (Q6)

## BOX A

**IF Q2 = 1, ASK Q5**

### IF Q2 = 2 OR 8, GO TO Q6 

5.  Is the crawl space open to the basement or lower level?

YES 1

NO 2

6.  What is the primary source of heat in this residence?

**[SHOW CARD B]{.underline}**

ELECTRIC 01 (Q7)

GAS FURNACE 02

OIL FURNACE 03

COAL STOVE 04

WOOD STOVE 05 (Q8)

KEROSENE HEATER 06

SOLAR POWER 07

OTHER (SPECIFY) 08

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7.  Do you have a heat pump?

YES 1

NO 2

8.  Is there more than one source of heat in this residence?

YES 1

NO 2 (Q11)

9.  What is the secondary source or other source or sources of heat?
    (CIRCLE ALL THAT APPLY)

**[SHOW CARD B]{.underline}**

ELECTRIC 01

GAS FURNACE 02

OIL FURNACE 03

COAL STOVE 04

WOOD STOVE 05

KEROSENE HEATER 06

SOLAR POWER 07

OTHER (SPECIFY) 08

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## BOX B

**CHECK Q9**

**IF 1 IS CIRCLED, ASK Q10**

### IF 1 IS NOT CIRCLED, GO TO Q11 

10. Do you have a heat pump?

YES 1

NO 2 (Q11)

11. Does this residence have...

[YES]{.underline} [NO]{.underline}

a\. Air ducts or vents? 1 2

b\. Radiators? 1 2

c.  Heating wires or pipes in the

> ceiling or floor? 1 2

d\. Built-in baseboard heaters 1 2

12. Do you cook with electric or gas stove top burners?

ELECTRIC 1

GAS 2

BOTH 3

OTHER (SPECIFY) 4

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

13. Do you use air conditioning?

YES 1

NO 2 (Q15)

14. When you use air conditioning, do you usually use central air
    conditioning or window units?

CENTRAL 1

WINDOW 2

BOTH 3

15. To the best of your knowledge, was this home ever tested for radon?

YES 1

NO 2 (Q18)

16. Was any work ever done to this home to correct radon problems?

YES (SPECIFY) 1

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NO 2 (Q18)

17. When was this work completed?

\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|

MONTH YEAR

CURRENTLY IN PROGRESS 9696

DON'T KNOW 9898

18. While residing at this home, have any shopping centers, housing
    developments, or any other large developments been built within a
    five-block or ¼-mile radius of this home?

YES 1

NO 2 (ENDING STATEMENT)

19. When was this construction completed?

\|\_\_\_\|\_\_\_\| - \|\_\_\_\|\_\_\_\|

MONTH YEAR

STILL UNDER CONSTRUCTION 9696

DON'T KNOW 9898

ENDING STATEMENT:

Thank you very much for your cooperation. Now I would like to take a few
measurements in your home.