Community Infrastructure Questionnaire Camden Water & Local Environment Questionnaire Initial community fact-finding questionnaire about water, flooding, local infrastructure and residents’ observations. Why we are asking Local residents have raised concerns about water, flooding, local infrastructure and possible changes in health. We are beginning by finding out what people have actually seen, experienced or been told. This questionnaire does not assume that these things are connected. We want to establish what is happening, where and when, before drawing conclusions. Privacy: Please do not give your full address, names of other people, or private medical information. This questionnaire is designed for initial fact-finding.1. Where do you live?Street or general area only — please do not give your full address.2. How long have you lived in this area? Less than 1 year 1 to 5 years 6 to 10 years More than 10 years 3. Have you noticed any change in your tap water recently? Yes No Not sure If yes, what did you notice? Colour/cloudiness Smell Taste Sediment/particles Pressure Temperature Other Approximately when did you first notice it?4. Have you recently seen unusual flooding, standing water, leaks or water flowing in the street? Yes No Not sure If yes: where, when, and what did you see?5. Have you seen recent work being carried out on water, heating, drainage or other infrastructure nearby? Yes No Not sure If yes, what did you personally observe?6. Have you heard about work involving the large water tank/site at or near Regis Road? Yes No If yes, how did you learn about it? Saw it myself Council/contractor Neighbour/resident Social media Other What do you know about what happened?7. During the same period, have you or people in your household experienced any unusual symptoms or illness? Yes No Prefer not to say If yes, which symptoms? Headache Fever Cough/breathing problems Stomach upset Unusual tiredness Other Approximately when did they begin8. Did anyone seek medical advice or treatment? No GP NHS111 Pharmacy A & E/Hospital Other 9. Have you personally noticed other people locally appearing unusually unwell recently? Yes No Not sure If yes, approximately when and where? Please don't give people's names.10. Have you reported any water, flooding, drainage or related problem? Yes No If yes, to whom? Camden Council Thames Water Housing provider NHS/health service Other What response did you receive?11. Do you have evidence you would be willing to share? Photographs Video Correspondence Date/Times recorded Reference number from an authority Other 12. Is there anything else you think we should investigate?THANK YOU. This is an initial fact-finding exercise. Reports from residents will be compared with other evidence before conclusions are drawn. Please do not include names or private medical information about other people. Δ
