2. Does anyone in your family ill or have trouble sleeping?
(circle one) yes no
3. How long have you lived in your present home or worked in your present office?
4. If this evaluation is for a business what type of business do you have?
5. What do you know about the landlord or previous tenants?
6. Where in your home/office is your hobbie space, bedrooms, bathrooms, child's rooms or office space?
7. In the space below draw a simple outline of your home or office including windows and doors, include directions (north, south, east, west). Denote streets which surround your home or office. Include how busy or inactive the street noise is.