---

---

MCS Lodging Questionnaire

Answering this questionnaire as regards your B&B, Hotel, Motel, Guest Ranch, Resort, Inn, or other place of lodging, will greatly assist travelers with MCS, such as ourselves.

MCS stands for Multiple Chemical Sensitivities. People with this condition often find it medically dangerous to be around fragrances, petrochemicals, strong cleaners, pesticides, herbicides, and toxic chemicals released from new construction, renovation, new carpeting, and new furniture.

Filling out this questionnaire will help us in deciding the safest places for us to stay in your area.

1. How familiar are you with MCS? Never heard of it ___; Vaguely Familiar ___; Some knowledge ___; Facility is designed with MCS safety in mind ___.
2. Number of non-smoking rooms ____. Number of rooms total ____. How are smoking rooms separated from other rooms? ______________________________
3. Are air fresheners used in the rooms? _____. What kind _______________________.
4. Are pesticides kept in the rooms? _____ How often are pesticides applied? ________
5. Are the rooms carpeted? _______. How new is the carpeting? __________. Is Carpet Fresh used on the carpets? _____.
6. Is there potpourri in the rooms? ________
7. Are there separate entrances to the rooms or is the only room entrance from an interior hall?_______________________
8. Does each room come with a bathroom? _______________
9. Are there scented candles in the rooms? ______ Are there scented soaps in the rooms? ____. Can these be easily removed by management for the duration of our stay? _____.
10. Can the windows be opened to air out the room? ______ Are there ceiling fans in the rooms to provide extra circulation?
11. Are the rooms air conditioned? _______ Are the rooms individually heated, or is there central heating? ______. Are there fireplaces in the rooms and if so are they wood or gas? _______.
12. What type of laundry detergent is used? _________________ Scented or unscented? ______ Is fabric softener used in the laundry? ______ Are Dryer Sheets used? _______
13. This place of lodging was built in ______. The last renovation was done in ______. How extensive was renovation? __________________________________________________

     Also please give us some idea of the costs/rates, and typically how soon in advance a reservation is needed.

Thank you very much for your time.