Lead Poisoning Prevention Program
style='mso-bidi-font-weight:normal'>Parent Lead Knowledge
Questionnaire
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I. General Informationstyle='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
style='mso-bidi-font-weight:normal'>a.style='font:7.0pt "Times New Roman"'>
style='mso-bidi-font-weight:normal'>Sex
style='layout-grid-mode:line'>___ Male style='mso-bidi-font-weight:normal'>e. What is your highest level of education
achieved?
style='layout-grid-mode:line'>___ Female ___
0-6th grade
style='font-size:5.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:7'> style='layout-grid-mode:line'>___ 7-9th grade style='mso-spacerun:yes'>
___ 10-12th grade style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>b.style='mso-spacerun:yes'> Ethnic Backgroundstyle='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-spacerun:yes'>
___ Some college/trade school
style='layout-grid-mode:line'> ___
Asian American ___
Graduated college
___ African
Americanstyle='mso-spacerun:yes'>
___ Some graduate school
___ Hispanicstyle='mso-spacerun:yes'>
___ Finished graduate school
style='layout-grid-mode:line'>___ White
___ Otherstyle='mso-tab-count:1'>
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f.style='mso-spacerun:yes'> Zip code _________style='layout-grid-mode:line'> style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
c. Has your child/children ever
been tested for lead poisoning?style='mso-spacerun:yes'>
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style='layout-grid-mode:line'> YESstyle='mso-tab-count:2'> NOstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
d. Do you think your
child/children could get lead poisoned?
style='mso-tab-count:1'> YES NOstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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II. INSTRUCTIONS:style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-spacerun:yes'> Please
answer TRUE, FALSE or style='mso-bidi-font-weight:normal'>DON’T KNOW to each of the following
questions:
style='mso-bidi-font-weight:normal'>1.style='font:7.0pt "Times New Roman"'>
style='mso-bidi-font-weight:normal'>Lead poisoning may cause serious learning and
behavioral problems in children.
style='layout-grid-mode:line'>TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
style='mso-bidi-font-weight:normal'>2.style='font:7.0pt "Times New Roman"'>
style='mso-bidi-font-weight:normal'>Lead can be found in the paint of homes built
before 1978.
style='layout-grid-mode:line'>TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
3. Lead found in the dirt cannot
harm children.
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
4. Frequent hand washing helps
prevent lead poisoning.
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
style='mso-bidi-font-weight:normal'>5.style='font:7.0pt "Times New Roman"'>
style='mso-bidi-font-weight:normal'>When renting an apartment, the owners are
required to tell renters about the possibility of lead in the paint.
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style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
style='mso-bidi-font-weight:normal'>6.style='font:7.0pt "Times New Roman"'>
style='mso-bidi-font-weight:normal'>One way for children to get lead poisoned is
having lead dust on their hands and then putting their hands in their mouths.
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style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
7. It is safe to cook, serve and
store food in imported pottery and ceramic ware.style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
8. Lead cannot be passed from a
pregnant woman to her unborn child. style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='layout-grid-mode:line'> TRUEstyle='mso-tab-count:2'> FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
9. Some herbal or traditional home
remedies contain lead.
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
10. A child with lead poisoning always appears sick.style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
11. The only way to find out if your child has lead poisoning is to have
him/her take a blood lead test.
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
12. It is okay to sand or scrape old painted wood.style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
13. A healthy diet high in iron and calcium helps lessen a child’s chance
of becoming lead poisoned.
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
14. Lead poisoning can be prevented.
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
15. Parents, who work with lead at their jobs or have hobbies that
involve lead, can bring lead home
on their clothes.
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style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
16. Parents may ask their children’s doctor to test them for lead even if
the doctor has not
mentioned it before.style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
17. Cleaning floors with a wet mop and washing windowsills with a damp
cloth helps remove lead
dust.style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
18. Washing children’s toys often helps prevent lead poisoning.style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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style='font-size:11.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>style='mso-tab-count:1'> TRUE FALSEstyle='mso-tab-count:2'> DON’T KNOWstyle='font-size:9.0pt;mso-bidi-font-size:10.0pt;layout-grid-mode:line'>
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