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Breathe Easy with Smoke Free Hickman County

Answer our short survey and sign the petition to support a smoke free ordinance in Hickman County, Kentucky. It's NOT about the smoker, it's about the smoke!

Question Title

* 1. “Secondhand smoke” is smoke or aerosol from someone else’s cigarette, cigar, pipe, or e-cigarette that you breathe. How often would you say you are exposed to secondhand smoke at work or in public places?

Multiple times a day

Every day

A few times a week

A few times a month

Never

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* 2. Do you have an allergy/sensitivity (e.g., asthma, sneezing, watery eyes, etc.) that is triggered by exposure to
either indoor and/or outdoor tobacco smoke?

Yes

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* 3. Would you support a comprehensive smoke free ordinance in Hickman County Kentucky that would prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars?

Yes

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* 4. How has secondhand smoke or e-cig aerosol impacted you? Why are smoke-free workplaces and public spaces important to you?

Question Title

* 5. To submit your survey, please complete the form below.

Name *

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Breathe Easy with Smoke Free Hickman County

Question Title

* 1. “Secondhand smoke” is smoke or aerosol from someone else’s cigarette, cigar, pipe, or e-cigarette that you breathe. How often would you say you are exposed to secondhand smoke at work or in public places?

Question Title

* 2. Do you have an allergy/sensitivity (e.g., asthma, sneezing, watery eyes, etc.) that is triggered by exposure toeither indoor and/or outdoor tobacco smoke?

Question Title

* 3. Would you support a comprehensive smoke free ordinance in Hickman County Kentucky that would prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars?

Question Title

* 4. How has secondhand smoke or e-cig aerosol impacted you? Why are smoke-free workplaces and public spaces important to you?

Question Title

* 5. To submit your survey, please complete the form below.

* 2. Do you have an allergy/sensitivity (e.g., asthma, sneezing, watery eyes, etc.) that is triggered by exposure to
either indoor and/or outdoor tobacco smoke?