Water Fountain Survey

Please complete the following survey in order for us to gain an understanding of the number of water
fountain filters needed in your facility.

Name of Person Completing Survey 

 

 

 

 

Email Address 

 

 

 

 

Charter School Name 

 

 

 

 

School Facility Name 

 

 

 

 

. um 

How many individual water fountains are in your school? Please include all water
fountains indoors, outdoors, in cafeteria, in gym, etc. (Areas where there is both a high

fountain and low fountain should count How many of these water fountains do you know to be non-functioning, if any? 

 

 

Are you currently utilizing the water fountains in your building, or have you provided

alternative drinking water sources? 
Fountains only

0 Alternative source only

0 Both

Please list the brand name(s) of the water fountains in your building, as well as the

quantity of each brand. (ex. Elkay: 10, Haws: 10, Oasis: 12) 

 

 

 

 

Do your fountains have a water shut off valve? 
(D) Yes, 100% have a shutoff valve

About 75% have a shut off valve

0 About 50% have a shutoff valve

0 About 25% have a shut off valve

0 No, 0% have a shut off valve

0 Unsure if the water fountains have shut off valves

Does your building have a concession area with a sink?

(3) No
0 Yes

Please list the total number of ice makers and ice machines in your building. This count
should include ice mchines in kitchens, concession areas, training rooms, as well as ice

makers in refrigerators in teacher break rooms, nurse's station, etc. 

 

 

 

Please upload photos of your water fountains, concentrating on how water is supplied to

the fountain, to help us in determining how they are connected to the water system. 

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