CHILL'D-Out: A Heat and Health Risk Factor Screening Questionnaire

What to know

CHILL’D OUT. Use this questionnaire with your patients to assess risk factors for health harms from heat or poor air quality. Then, create a Heat Action Plan with your patient. If there is limited time, cover the bolded questions.

Assess these risk factors

Cooling

  • Does your patient have working air conditioning?
  • Can they check and control indoor temperatures where they live?
  • Do they have an electric fan?
  • Do they know how to locate a cooling center if needed?

Housing

  • Does your patient have stable housing?
  • Do they live on a higher floor of a multi-story building where they may be exposed to more heat?
  • Are they regularly exposed to indoor air pollutants such as secondhand smoke or mold?
  • Do they have a portable air purifier or a filter in their HVAC system?

Isolation

& mobility

  • Does your patient have a neighbor, friend, or family member who can check on them during hot days?
  • Does their mobility limit their ability to seek cooling in their home or elsewhere?

eLectricity

  • If heat leads to a power outage, does your patient have a plan for refrigerated medications and/or electric medical devices?

Learning

  • Does your patient check the daily and hourly weather forecast to know the hottest time of the day? Can they access the HeatRisk tool?
  • Where does your patient get information about how to protect their health from heat? What measures do they take to do so?

Drugs

  • Does your patient take medications that increase risk from heat exposure?

Outside

  • How much time does your patient spend outdoors on hot days for work, sports, or recreation?
  • Are they exposed to outdoor air pollution at home, work, or elsewhere, such as a major roadway, construction site, industrial facility, or frequent wildfire smoke?
  • Do they have allergies to grass, weeds, and tree pollens?

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