๐Ÿก SustainableHomes Healthy Home
Section 1 of 10

Build a home that works for you

This questionnaire is for people who want a healthier, more self-sufficient home โ€” cleaner air, lower bills, better water, and less dependence on external systems. Takes 12โ€“15 minutes.

๐ŸŒฟ  Your responses generate a personalised Healthy Home report with actions ranked by health and financial impact. All data is confidential.
Your full name *
Email address *
WhatsApp number *
Your city *
Bangalore
Chennai
Delhi / NCR
Hyderabad
Kolkata
Mumbai
Your area / neighbourhood *

Your Home

Type of home *
1BHK
2BHK
3BHK
4BHK+
Independent house
Villa
Own or rent? *
Own
Rent
How many people live at home? *
1
2
3
4
5+
Does anyone at home have health concerns? *
This helps us prioritise the right recommendations for your household
Asthma / respiratory
Allergies / skin conditions
Children under 10
Elderly (60+)
No specific concerns
Select all that apply
Was any new furniture / renovation done in the last 6 months?
New MDF/plywood furniture releases formaldehyde for weeks โ€” affects indoor air quality
Yes โ€” significant renovation
Yes โ€” some new furniture
No โ€” nothing new

Indoor Air Quality

Indoor air is often 2โ€“10ร— more polluted than outdoor air. This section identifies the biggest sources in your home.

What cleaning products do you mainly use? *
Standard chemical brands (Lizol, Colin, Harpic)
Mix of chemical and natural
Mostly natural / plant-based
DIY (vinegar, baking soda)
Do you use mosquito repellents indoors? *
Coils release PM2.5 equivalent to 75โ€“137 cigarettes each. Plug-in liquids (All Out, Good Knight) are ~300x lower risk. Mats fall in between.
Coils โ€” regularly
Coils โ€” occasionally
Plug-in liquid (All Out / Good Knight)
Mats (heated element)
Natural alternatives (camphor, nets, screens)
Nothing / not needed
Do you use room fresheners or air fresheners indoors? *
Aerosol sprays and synthetic fresheners contain VOCs and phthalates that add to indoor air pollution.
Aerosol spray (Febreze, Air Wick etc.)
Plug-in electric freshener
Incense / agarbatti
Natural alternatives (camphor, essential oils, plants)
Nothing
How often do you ventilate your home (open windows)?
Daily โ€” morning and/or evening
A few times a week
Rarely โ€” windows mostly closed
Never โ€” AC runs most of the time
Do you have indoor plants at home?
Yes โ€” several (5+)
Yes โ€” a few (1โ€“4)
No, but I'd like to
No โ€” not interested
How often do you clean your AC filters?
Dirty filters recirculate mould and dust โ€” one of the most overlooked indoor health issues
Every 2โ€“4 weeks
Every 2โ€“3 months
Once a year only
Never / not sure how
No AC
Do you cook primarily on gas or induction? *
Gas cooking releases CO and NOx โ€” ventilation during cooking is critical
Gas stove
Induction only
Mix of both
Other
Do you use the kitchen exhaust fan while cooking?
Always
Sometimes
Rarely / never
No exhaust fan

Energy Self-Sufficiency

Reducing your dependence on the grid saves money and insulates you from rising electricity tariffs.

Monthly electricity bill *
Below โ‚น1,000
โ‚น1,000โ€“โ‚น2,000
โ‚น2,000โ€“โ‚น3,500
โ‚น3,500โ€“โ‚น5,000
Above โ‚น5,000
Are you registered for Gruha Jyothi? *
200 units FREE/month from Karnataka govt โ€” renters eligible! Register: sevasindhugs.karnataka.gov.in
Yes โ€” registered
No โ€” didn't know
Not sure
AC temperature setting
18โ€“20ยฐC
21โ€“23ยฐC
24โ€“26ยฐC
Above 26ยฐC
No AC
Type of bulbs used
All LED
Mostly LED
Mostly CFL
Mix / not sure
Have you considered solar panels or solar water heater?
Solar panels installed
Solar water heater installed
Considering it
Not yet

Water Self-Sufficiency

Bangalore faces a 500 million litre/day water deficit. A self-sufficient home minimises dependence on BWSSB and tankers.

Monthly water bill *
Below โ‚น200
โ‚น200โ€“โ‚น500
โ‚น500โ€“โ‚น1,000
Above โ‚น1,000
Included in maintenance
Do you rely on water tankers? *
No โ€” BWSSB supply is sufficient
Occasionally (summer only)
Regularly โ€” several times a month
Society manages โ€” not sure
Does your building have rainwater harvesting (RWH)? *
BWSSB mandates RWH for all buildings on 1,200+ sq ft plots. Non-compliance risks water supply disconnection.
Yes โ€” working
Yes โ€” unsure if working
No
Not sure
Leaking taps at home? *
No leaks
1โ€“2 taps leaking
3+ taps leaking
Not sure
RO purifier โ€” what happens to reject water?
Standard RO wastes 3 litres for every 1 litre purified
Drains away โ€” not reused
Collected and reused
Connected to flush/washing machine
No RO purifier
Bathing habit
Bucket bath
Short shower (<5 mins)
Long shower (10+ mins)
Mix of both

Waste & Self-Sufficiency

Composting closes the loop โ€” turning kitchen waste into garden fertiliser and reducing your dependence on the city's waste system.

Do you segregate dry and wet waste? *
Yes, consistently
Sometimes
No
Just started
Do you compost food/wet waste? *
Yes โ€” active composting
No, but want to start
Not sure how
Not interested
Balcony / outdoor space available?
Decent balcony
Small balcony
Terrace access
No outdoor space
How do you dispose of e-waste? *
Certified collector (Zolopik, Hasiru Dala)
Kabadiwala
Manufacturer take-back
Regular trash
Stored at home โ€” unsure
Do you grow any food at home? (balcony garden, herbs etc.)
Yes โ€” balcony vegetable garden
Yes โ€” herbs only
No, but interested
No โ€” not possible / not interested

Healthy Food & Consumption

What you eat and buy directly affects your health, your bills, and how self-sufficient your home feels.

Where do you mainly buy groceries? *
Local market / sabzi mandi
Supermarket
Online (BigBasket, Zepto)
Mix
Do you buy seasonal and local produce?
Yes, always
Sometimes
Rarely
Don't know what's seasonal
Food delivery orders per week
0
1โ€“2
3โ€“5
6+
Do you use eco-friendly cleaning & personal care products?
Yes โ€” mostly natural brands
Mix of both
Standard chemical brands
DIY natural cleaners
How often do you buy new clothing? *
Rarely โ€” only when needed
Occasionally (once a season)
Frequently (monthly)
Very often
Do you prefer natural fibres and sustainable materials?
Yes โ€” cotton, linen, khadi, bamboo
Sometimes
No โ€” whatever is available
Not aware of the difference

Nature & Wellbeing

A truly healthy home connects you to nature and supports your mental wellbeing โ€” not just your energy bills.

How connected do you feel to nature in your daily life?
1 โ€” Very disconnected10 โ€” Very connected
5
Do you have access to natural light in main living areas?
Yes โ€” excellent natural light
Some natural light
Minimal โ€” mostly dark
Would you like to create a small garden, herb patch or balcony green space?
Yes โ€” very interested
Yes โ€” but not sure how
I already have one
Not interested
What does a healthy home mean to you? *
The more specific you are, the better we can tailor your report

Your Goals

Which areas do you most want to improve? *
Indoor air quality
Water self-sufficiency
Energy savings
Composting & waste
Healthy food & consumption
Home garden & nature
All of the above
Select all that apply
Biggest barrier to a healthier home?
Cost
Time
Awareness
Others at home not on board
Renter constraints
Budget for improvements
Zero cost only
Up to โ‚น1,000/month
Up to โ‚น3,000/month
Happy to invest more
What does success look like? *

Photo Checklist

WhatsApp these to your auditor after submitting.

๐Ÿ“ฑ  Send to your auditor's WhatsApp after submitting. Clear photos give you a much more personalised report.
Please confirm you'll share these
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๐Ÿ“„ Electricity bills โ€” last 2 months Required
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๐Ÿšฟ All bathroom taps + showerheads Required
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๐Ÿณ Kitchen โ€” exhaust fan, stove, tap Required
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โ„๏ธ AC unit + filter close-up Required
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๐ŸŒฟ Balcony / outdoor space Optional
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๐ŸŒง RWH system if present Optional
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๐ŸŽฅ Short walkthrough video Optional
๐Ÿก

Thank you!

Your Healthy Home questionnaire has been submitted. You'll receive your personalised report within 48 hours.

Your Submission

Nameโ€”
Emailโ€”
Areaโ€”
Form๐Ÿก Healthy Home

๐Ÿ“ฑ Don't forget to WhatsApp your photos to your auditor!

๐ŸŒฟ SustainableHomes ยท An Ecolove India Initiative