First tell us the Scope of your answers:

Are you answering for: just yourself, or your household of people?

Household Survey Items. Have you done this?  Results?

Home:
Trash/recycling: Use dump/transfer station, or have curbside pickup?
Do you segregate and recycle/reuse/donate/compost/turn-in all state mandated items?
     #1-2 plastics   #3-7 and other plastics   glass bottles   metal
     packing peanuts   styrofoam  motor oil  wood   yard waste
     kitchen waste   fluorescent bulbs   returnable containers
     corrugated cardboard   newspaper   other paper   plastic bags
     toxic batteries (lead, button, ni-cad)   electronics
     mercury containing devices (old thermometers, thermostats, etc.)
     toxic material (paint, cleaners, solvents, etc.)   construction waste
     refrigerators, air-conditioners (contain Fluorocarbon refrigerants)
     reusable items (give to Put&Take, Good Will, neighbors, etc.)
Furnace/Boiler: annual efficiency check/adjust
Filters: replace at recommended intervals on furnace/AC
How old is your furnace/boiler?
What is the setpoint on your water heater?
Install auto-setback thermostats
Water conserving toilets? Year installed?
Have you replaced most lights with compact fluorescents?
Do you have double/triple Window glazing?   Thermal blinds?
In summer, what temperature do you set the A/C?
What is your daytime temperature setting for heating?
What is your nighttime temperature setting for heating?
How much attic insulation?  Inches or R-value ?
Washer: front-load or top-load?
Do you wait until the dishwasher is full to run a load?
Do you use energy-saver drying on the dishwasher?
Do you have faucet aerators?
Have you had a Home Energy Audit done?
     If so have you followed the recommendations?
Have you insulated your hot water pipes in your basement?
How old is your refrigerator?    Is it an energy saver model?

Eating:
Do you use paper or cloth napkins?
Do you eat meat?  How many days/week?
% meat eaten which is naturally raised?
Do you have a vegetable garden?
% grains and vegetables organic or local?

Landscaping:
removed invasive plants?
Plant native species
Do you hire landscapers who use powered leaf blowers?
What do you put on your lawn?
   fertilizers  organic approved?
   pesticides  organic approved?
   herbicides  organic approved?
What do you put on your gardens?
   fertilizers  organic approved?
   pesticides  organic approved?
   herbicides  organic approved?
Do you water your lawn? Days/year?
Automatic underground sprinkler system in use?
Do you compost yard waste? kitchen waste?

Recreation:
How many miles do you fly on vacation annually? (2 people x 5000 miles = 10000 miles).
Do you own: powerboat? snowmobile? jet-ski?

Driving:
How often do you carpool to:
% work?   % meetings?   % kids events?
Miles traveled using public transportation in the past year.
Do you turn off headlights in the daylight? (see the reason)
Avoid fast starts and stops?
Check tires regularly for proper inflation pressure?
 
For each of your cars/SUVs/trucks please say:

• How many miles/year is it driven?
  
• What is its real average fuel mileage?
  
• How old is it?
  
• Is it a hybrid or biodiesel vehicle?
  
• Will you replace it with a more fuel efficient vehicle?
  

	miles driven/year	real mpg	Age	Hybrid/Biodiesel?	Plan to replace?
vehicle 1
vehicle 2
vehicle 3
vehicle 4

Electrical/Computer Related:
Do you:
shut down computers/printers/TVs not in use?
turn off lights in empty rooms?
turn off outside lights when no one is expected?
use recycled paper whenever possible?
use double sided printing when possible?
avoid colored paper?
purchase papers (printer, towels, toilet) containing high % post-consumer recycled?

Environmental Memberships Audit:

Do you Support with $$ and/ or your volunteer time ?

Local/Regional:  $$  time Mass Audubon Sudbury Valley Trustees Trustees of Reservations New England Wildflower Society Sierra Club Appalachian Mountain Club Adirondack (ADK) Mtn Club Sudbury Earth Decade Committee Manomet Center for Conservation Sciences Ocean Conservancy New England Wind Fund Habitat for Humanity UU Mass Action Mass Climate Action Network (MCAN) Others:

National/International:  $$  time National Audubon Society Defenders of Wildlife Friends of the Earth Greenpeace National Parks and Conservation Association National Resources Defense Council National Wildlife Federation Sierra Club The Nature Conservancy Water Environment Federation The Wilderness Society World Wildlife Fund Worldwatch Society UU Ministry for Earth Others: