What Do You Think About the U.S. EPA’s Community 

Involvement Efforts at the ________ Site?

Purpose for this Questionnaire: This customer satisfaction survey is meant to help understand 

how well EPA staff are listening to community member concerns about the cleanup and how well 

EPA staff make it possible for community members to participate in the planning and decision 

making process. 

Instructions: You may be asked some or all of the questions on this questionnaire. This 

questionnaire should take no more than 15 minutes to complete. 

Burden Statement: The public reporting and recordkeeping burden for this collection of 

information is estimated to average 15 minutes per response. Send comments on the Agency’s 

need for this information, the accuracy of the provided burden estimates, and any suggested 

methods for minimizing respondent burden, including through the use of automated collection 

techniques to the Director, Collection Strategies Division, U.S. Environmental Protection 

Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB 

control number in any correspondence. Do not send the completed survey to this address. 

The U.S. Environmental Protection Agency (U.S. EPA) is cleaning up the contamination 

at the __________ Superfund site in your community. The U.S. EPA believes the active, 

meaningful involvement of community members is critical to the success of a cleanup effort. 

This survey is an opportunity for you to tell us how well we are doing at listening to your 

concerns about the cleanup and making it possible for you to participate in the planning and 

decision making process. Please take a few minutes to answer the questions. Your views are 

important and will help us to be more responsive to your needs and interests. 

This survey is being conducted in accordance with the Federal Paperwork Reduction Act 

Information Collection Request # 1487.13. You will need about 15 minutes to answer the 

questions.

*Note to surveyors: It is intended that each survey given will include the introductory 

paragraph, above, and Section G with the closing disclosure. Sections A-F are optional 

sections with questions that may be used as a specific situation dictates. This survey is 

NOT intended to be given in its entirety. The surveyor may also choose, in addition to 

paper copies, to provide the survey to participants online via commercially available 

software.
Section A: Assessing Overall U.S. EPA Community Involvement Efforts

A-1. How do you rate the U.S. EPA at each of the following? (Circle one choice for each 

question)

• Providing the information you need. Very 

Poor Poor Average Good Very Good

• Making the information easy to 

understand.

Very 

Poor Poor Average Good Very Good

• Making it easy to get involved. Very 

Poor Poor Average Good Very Good

• Listening to your concerns. Very 

Poor Poor Average Good Very Good

• Responding to your concerns. Very 

Poor Poor Average Good Very Good

• Treating you courteously. Very 

Poor Poor Average Good Very Good

• Using your input. Very 

Poor Poor Average Good Very Good

• Explaining decisions. Very 

Poor Poor Average Good Very Good

Section B: Assessing U.S. EPA Efforts at Keeping Communities Informed

B-1. How do you learn about the U.S. EPA’s work at the site? (Check all that apply)

_____ U.S. EPA mailings

_____ Newspaper articles

_____ Radio or TV news

_____ U.S. EPA’s web page

_____ Community members/family/friends

_____ Public meeting or information session held by the U.S. EPA

_____ Direct conversation with someone from the U.S. EPA

_____ Information about the site is “common knowledge”

_____ Know someone who worked at the site

_____ Through one or more community organizations, business associations, or advisory groups 

(CAG)

_____ Social Media (Facebook, Twitter, etc.)

_____ Other (Please specify): 

____________________________________________________________

B-2. How would you prefer to receive information from the U.S. EPA about the site? 

(Check up to 3 choices)

_____ Mailings—short (1-2 pages) very focused (issue-specific) sent frequently
_____ Mailings—longer, general information, sent periodically

_____ Emails—brief, very focused (issue-specific) sent frequently

_____ Emails—longer, general information, sent periodically

_____ Meetings—short, very focused, held frequently

_____ Meetings—longer, general informational meetings, held periodically

_____ Social media (Facebook, Twitter)

_____ Direct communication with an U.S. EPA representative

_____ The U.S. EPA website

_____ Presentations at local clubs and organizations

_____ Other (Please specify): 

____________________________________________________________

B-3. How interested are you in obtaining information about the following topics? (Circle 

one answer for each question)

• U.S. EPA’s Superfund Program. Not 

Interested

Somewhat 

Interested Interested Very Interested

• Contamination at the site. Not 

Interested

Somewhat 

Interested Interested Very Interested

• How the site might affect human health. Not 

Interested

Somewhat 

Interested Interested Very Interested

• How the site might affect the 

environment.

Not 

Interested

Somewhat 

Interested Interested Very Interested

• Site cleanup decisions. Not 

Interested

Somewhat 

Interested Interested Very Interested

• Site reuse or redevelopment. Not 

Interested

Somewhat 

Interested Interested Very Interested

• Other (Please specify):_____________ Not 

Interested

Somewhat 

Interested Interested Very Interested

B-4. In what ways do you prefer to participate at this site? (Check all that apply)

_____ Through opportunities to provide written comments on U.S. EPA documents.

_____ Through public meetings.

_____ Through opportunities to meet and talk informally with U.S. EPA staff.

_____ By attending community club/organization meetings that U.S. EPA staff have been invited to.

_____ By calling a toll-free telephone number.

_____ Through a community group.

_____ Through opportunities to talk with independent experts.

_____ Through a web site or social media.

_____ Other (Please specify): 

___________________________________________________________

_____ Not interested in being involved.

B-5. Please tell us whether you have ever:
• Provided information to the U.S. EPA about the site and its history. Yes No

• Expressed your concerns about the site to the U.S. EPA. Yes No

• Offered suggestions or advice about the site to the U.S. EPA. Yes No

• Given comments to the U.S. EPA on materials available for public 

review.

Yes No

• Requested information from the U.S. EPA about the site. Yes No

• Attended a U.S. EPA-sponsored meeting or event about the site. Yes No

• Visited the site’s information repository. Yes No

B-6. In a few words, what is your understanding of the cleanup work U.S. EPA plans to 

do at the site? 

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________

B-7. How concerned are you that the site may be harmful to each of the following: (Circle 

one answer for each question.)

• My or my family’s 

health.

Not

Concerned

Somewhat

Concerned Concerned VeryConcerned

Not 

Applicable

• The environment. Not

Concerned

Somewhat

Concerned

Concerned Very

Concerned

Not 

Applicable

• Property values. Not

Concerned

Somewhat

Concerned

Concerned Very

Concerned

Not 

Applicable

• Jobs in the community. Not

Concerned

Somewhat

Concerned

Concerned Very

Concerned

Not 

Applicable

• Business in the 

community.

Not

Concerned

Somewhat

Concerned

Concerned Very

Concerned

Not 

Applicable

• Community historical or 

cultural integrity.

Not

Concerned

Somewhat

Concerned

Concerned Very

Concerned

Not 

Applicable

• Site redevelopment or 

reuse.

Not

Concerned

Somewhat

Concerned

Concerned Very

Concerned

Not 

Applicable
Section C: Public Meeting Feedback Questions

These questions will help the U.S. EPA better understand what worked well and what 

improvements to consider making before holding future public meetings.

C-1. How did you learn about this public meeting? (Check all that apply)

_____ U.S. EPA mailings (other than this survey)

_____ Newspaper articles

_____ Radio or TV news

_____ Community organization

_____ Family or friends

_____ Email from U.S. EPA 

_____ U.S. EPA’s website

_____ Social media (Facebook, Twitter, etc.)

_____ Flyers in store windows/bulletin boards

_____ Direct conversation with someone from the U.S. EPA

_____ Other (Please specify): 

___________________________________________________________

C-2. Please give us your feedback on the following: (Circle one choice for each question)

a. Information about the meeting was 

available early enough to make plans to 

attend.

Strongly 

Disagree Disagree Agree Strongly Agree

b. Meeting location was convenient. Strongly 

Disagree Disagree Agree Strongly Agree

c. Meeting facility was comfortable. Strongly 

Disagree Disagree Agree Strongly Agree
d. Meeting time was convenient. Strongly 

Disagree Disagree Agree Strongly Agree

e. The length of the meeting was 

appropriate.

Strongly 

Disagree Disagree Agree Strongly Agree

f. Language interpreters were available 

 (if needed).

Strongly 

Disagree Disagree Agree Strongly Agree

g. Provisions were made to accommodate 

the needs of persons with disabilities

Strongly 

Disagree Disagree Agree Strongly Agree

• Meeting facility was well-equipped for all 

planned activities (enough seats, work 

space, supplies, etc.).

Strongly 

Disagree Disagree Agree Strongly Agree

C-3. What topics were of most interest to you at the meeting?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________

______________________________________________________________________________

___

C-4. How was the meeting useful to you? 

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________

______________________________________________________________________________

___

C-5. How can U.S. EPA improve the next public meeting?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________

______________________________________________________________________________

___
Section D: Questions for Use During Site Cleanup-Removal/Relocation 

These questions will help the U.S. EPA better understand what worked well and what 

improvements to consider when implementing future removals requiring temporary relocation 

of residents.

Introduction: You were recently relocated while removal and restoration activities were 

completed at your property. These activities were designed to remove significant potential 

sources of _[contaminant]_ from your property, thereby reducing any potential _[contaminant]_-

related health exposures. We would appreciate it if you could take a few moments to provide 

feedback on your relocation experience and the removal/restoration work that was completed on 

your property.

D-1. Relocation (Circle one choice for each question)

a. U.S. EPA staff were friendly and 

helpful.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

b. The relocation handouts I was given 

were useful and understandable.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

c. U.S. EPA staff responded to my 

questions in a timely manner.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

d. I was treated with courtesy and 

respect by U.S. EPA staff.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

e. U.S. EPA staff contacted me as often 

as I would have liked:

• Before my relocation. Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

• While I was relocated. Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

• After my property was cleaned up 

and I was back in my home.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

f. I was well-informed of my choices 

for relocation (hotel, friend’s home, 

etc.).

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

g. I was well-informed about the 

expected length of my relocation and 

was kept informed of any changes.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

h. I was told when I needed to relocate 

with enough time to plan my move.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

i. The reimbursement paperwork was 

understandable.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable
j. I received my reimbursement within 

30 days.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

D-2. U.S. EPA’s Work on My Property: Removal and Restoration (Circle one choice for each 

question)

a. I was well-informed about the 

extent of the work U.S. EPA 

would do on my property.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

b. The specifics of the property 

restoration were explained in 

writing and provided to me.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

c. I was informed of the landscape 

options for my property.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

d. I understood what I had to do 

following the removal at my 

property in order for the 

landscaping to be successful.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

e. The on-site workers were 

courteous and respectful.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

f. I was kept informed about any 

changes in the schedule for the 

work on my property.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

g. I was informed if any of my 

possessions could NOT be 

decontaminated.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

h. My property was restored to a 

condition at least equal to its 

previous condition (recognizing 

that it may take time and 

water/aerating on my part for the 

seed to take or plants to grow).

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

i. The work done on my property 

met my expectations.

Strongly 

Disagree Disagree Agree StronglyAgree

Not 

Applicable

D-3. Do you have any additional comments/feedback regarding your relocation or the 

removal/restoration work on your property? (Use the space below)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_________ 

______________________________________________________________________________

___
Section E: Questions for Use at Sites with Institutional Controls 

These questions will help the U.S. EPA better understand whether community members are 

aware of, or interested in, information about any institutional controls (ICs) at the site, which 

are administrative and legal controls, including limitations on land use or resource use, deed 

restrictions, or building codes. An example of an IC might be building code restrictions to 

prevent vapor intrusion, or preventing development on a landfill cap to avoid damage to the 

integrity of the cap surface. Community input can be essential to selecting, using, and 

monitoring ICs that are the best fit for the community and the protectiveness of the remedy.

E-1. Are you aware of any restrictions (institutional controls) in place at the site 

including limitations on land and/or resource use, building code requirements or 

deed restrictions? 

___Yes ___ No

E-2. Would you like more information about restrictions (institutional controls) on the 

use of land or resources or any deed restrictions in place at the site?

___Yes ___ No

If yes, please contact (Name and phone number) to request the information.
Section F: Questions about Technical Assistance Resources Provided to the 

Community 

These questions will help the U.S. EPA better understand how to provide the most effective 

technical assistance resources at sites.

F-1. Do you know of any assistance U.S. EPA has provided to help you and other 

community members/groups better understand technical and scientific information 

regarding the site cleanup?

____Yes _____No (Please skip to question F-3) 

F-2. How was technical assistance provided to your community? (check all that apply)

____ Through a Technical Assistance Grant (TAG)

____ Through Technical Assistance Services for Communities (TASC)

____ Through U.S. EPA site staff

____ Through assistance from a local, regional or national organization/entity/university

____ Through a Pediatric Environmental Health Specialty Unit (PEHSU)

____ Through a Technical Assistance Plan (TAP)

____ Through Technical Assistance for Public Participation (TAPP)

____ I do not know how the assistance was provided

____ Other (Please 

specify):__________________________________________________________

Please rate how useful each of the following has been in helping community members 
better understand information about the site and take a more active role in the 

process: 

a. Community informational 

newsletters and/or factsheets.

Not 

Helpful

Somewhat 

Helpful Helpful Very Helpful

Not 

Applicable

b. Presentations by experts to explain 

technical site information to the 

community.

Not 

Helpful

Somewhat 

Helpful Helpful Very Helpful

Not 

Applicable

c. Community informational 

workshops/trainings.

Not 

Helpful

Somewhat 

Helpful Helpful Very Helpful

Not 

Applicable

d. Redevelopment planning. Not 

Helpful

Somewhat 

Helpful Helpful Very Helpful

Not 

Applicable

e. U.S. EPA provides facilitator or 

mediator to help the community.

Not 

Helpful

Somewhat 

Helpful Helpful VeryHelpful

Not 

Applicable

f. U.S. EPA assists community 

groups that want to help the 

community understand or 

participate in the site cleanup 

process. 

Not 

Helpful

Somewhat 

Helpful Helpful Very Helpful

Not 

Applicable

g. Other (Please specify): 

___________________________

Not 

Helpful

Somewhat 

Helpful Helpful Very Helpful

Not 

Applicable

F-3. If technical assistance has not been provided to your community, which of the 

following activities could help you and other community members/groups better 

understand technical and scientific information regarding the site cleanup? (Check all 

that apply)

____ Community informational newsletters and/or factsheets.

____ Presentations by experts to explain technical site information to the community.

____ Community informational workshops/trainings.

____ Redevelopment planning.

____ U.S. EPA provided facilitator or mediator to help the community.

____ U.S. EPA gave assistance to one or more community groups that wanted to help the 

community understand or participate more actively in the site cleanup process.

____ Other (Please 

specify):__________________________________________________________

____ I don’t feel that any technical assistance is needed.

Section G: General Information [REQUIRED Section]
This section must be included at the end of all surveys.

G-1. Is there anything else you would like to tell us about the U. S. EPA’s community 

involvement efforts or about the cleanup activities at this site?

______________________________________________________________________________

______________________________________________________________________________

______

______________________________________________________________________________

______________________________________________________________________________

______

Thank you for taking the time to share your views with us. If you would like to be on the 

U.S. EPA’s mailing list, please contact (Name, Telephone Number).