调研问卷模板英文版

Helpful hints for completing this questionnaire•The questionnaire should be completed by any resident aged 18 or over living at this address.•Please read each question carefully and tick a box to indicate your answer.•In most cases you will only have to tick one box but please read the questions carefully as sometimes you will need to tick more than one box.•Answer the next question unless asked otherwise.•Once you have finished please take a minute to check you have answered all the questions that you should have answered.•The survey consists of 7 pages and should take no longer than 10 minutes to complete.•If you have any queries about the questionnaire please do not hesitate to contact Miller Associates on 023 8081 2329•Once you have completed the questionnaire please return in the pre-addressed envelope supplied by 24 September 2008. You do not need to add a stamp•If you cannot find or did not receive the pre-addressed envelope please send to Miller Associates, Freepost (S) 4120), TOTTON, Southampton, SO40 7EW (you do not need to add a stamp) or call 023 8081 23291. Thinking generally, which of the things below would you say are most important in makingsomewhere a good place to live? Pick tick up to FIVE boxes only in the left column below2. And thinking about your local neighbourhood (within 15-20 minutes walking distance of where youlive), which of the things below, if any, do you think most need improving? Please tick up to FIVE boxes in the right column below3. Overall, how satisfied or dissatisfied are you with this neighbourhood as a place to live? Please tickone box only4. How strongly do you feel you belong to your local neighbourhood? Please tick one box only5. Would you say your local neighbourhood is a place you enjoy living in? Please tick one box only6a. To what extent do you agree or disagree that your local neighbourhood is a safe place to live? Please tick one box onlyb. To what extent do you agree or disagree that Basingstoke town centre is a safe place? Please tick one box onlyc.To what extent do you agree or disagree that other parts of the borough are safe places generally? Please7. Thinking about your local neighbourhood , how much of a problem do you think are……. Please tickone box per row8. Generally how safe do you feel in the following situations? Please tick one box per row9. If you do not feel safe in any of these situations, why do you say this? Please write in below10. Most of us worry at some time or other about being a victim of crime. How worried are you abouteach of the following……….? Please tick one box per row11a. Of the following, who do you think contributes significantly to improving the safety of living in this area? Please tick as many as applyb. And who do you think makes the prime contribution to improving the safety of living in this area?12a. In order for patrols in this area to be most effective in tackling crime (e.g. burglary, assault), which of the following do you feel it is most important for them to have? Tick as many as apply12b. In order for patrols in this area to be most effective tin tackling anti social behaviour (e.g. groups on the streets, vandalism, noise), which of the following do you think it is most important for them to have? Tick as many as apply12c. And which two do you think it is most important to have? Please tick two only13. To what extent do you agree or disagree that your local neighbourhood is a place where peoplefrom different backgrounds get on well together? Please tick one box only14. To what extent do you agree or disagree that the following groups in your local neighbourhood areable to get the services and support they need? Please tick one box per row15. To what extent do you agree or disagree with each of the following? Please tick one box per row16. Thinking about your local community facilities (e.g. village hall, community centre), how satisfied areyou with each of the following? Please tick one box per row17. In the last twelve months have you given unpaid help to any groups, clubs or organisations in any ofthe following ways? Please tick as many as apply18. To what extent do you agree or disagree that you can influence decisions affecting your localneighbourhood (within 15 to 20 minutes walking distance)? Please tick one box only19. If you want to change something in your local neighbourhood or have an idea about making the areaa better place to live in, what are you most likely to do about it? Please tick one box only20. In the last twelve months have you………? Please tick as many as apply21. And in the last twelve months have you taken part in a consultation about local services or problemsin your area in any of the following ways? Please tick as many as apply22. How well informed do you feel about each of the following? Please tick one box per row23. Are you male or female? Please tick one box only24. What was your age on your last birthday? Please write in below25.How long have your household been living in their current accommodation? Please tick one box only26. How long have you/your household been living in this area?27. In which of these ways does your household occupy your current accommodation?28. Which of the following do you regard as your local neighbourhood? Please tick one box only29. How many adults aged 18 or over are living here? Please tick one box only30. Which of these activities best describes what you are doing at present? Please tick one box only31. Do you have any long-standing illness, disability or infirmity? (Long standing illness means anythingthat has troubled you over a period of time or that is likely to affect you over a period of time) Please tick one box only32. Does this illness or disability limit your activities in any way? Please tick one box only33. To which of these groups do you consider you belong? Please tick one only34. Which of the following areas of the borough do you live in? Please tick one only35. Please write in your postcode below?36. Do you have any other comments to make about the content of this questionnaire or your localneighbourhood? Please write in below37. Would you be interested in signing up to become involved in future consultations about local decisions and services? This would involve completing questionnaires sent to you by post about three or four times a year as part of a reside nts’ panel. If so, please provide the following information.(PLEASE NOTE: For prize draw entry there is no need to provide your name and address as the unique identifier on this questionnaire allows us to link it to the address of the person completing the questionnaire –this is the only way in which we link the questionnaire to your address. You only need to give us your contact details if you wish to sign up for the residents’ panel.)Title: Mr/Mrs/Ms/OtherFirst name _______________________Surname _______________________Address ___________________________________________________________________________________________________________________________Postcode ____________E-mail ___________________________Daytime telephone number ___________In complying with the Data Protection Act 1998 Basingstoke and Deane Borough Council confirms that it will process personal data gathered from this form only for the purposes relating to the ongoing Basingstoke and Deane Borough Council and partner consultations.。