Remediation Survey for Child Care Centers, F-02994 (03/2022)

Survey of Child Care Centers Participating in the Water Sampling Program

The following questions allow child care centers participating in testing and remediation of lead in water to share their experiences after participation. Reported information will be used to improve processes and communication materials for future water sampling and remediation of lead in water hazards in child care centers. Please provide as much information as possible. While sharing your contact information is optional, we encourage you to include this information so we can continue to improve the process and follow up with additional assistance as needed. If you have any questions, please contact Jeff Raiche-Gill at Jeffrey.RaicheGill@dhs.wisconsin.gov.

Tell us about yourself and the center you are completing this survey for:

1. Name of the center:

2. Center address (Street/City/State/Zip):

3. What is your position at the child care center?

4. Email address: This question requires a valid email address.