GRADUATE SCHOOL DEPARTMENT

Educ. 103 – Statistics

AY 2019-2020
Journal Number : 3
Learning Facilitator : Marilyn Roguel
Student : Rosel Labrador
Date : June 8, 2020

Make at least five examples of questionnaires.

A. Survey Questionnaire about “Climate Change”.

Part I. General environment concerns

1. Please look at the following list of environmental issues and encircle the five issues that concern you the
most. Please only encircle five issues from the list:

Air pollution
Flooding
Climate change
The hole in the ozone layer
Extinction of species
Overpopulation (humans)
Radioactive waste
Traffic/congestion
Pollution of rivers and seas
Litter
Poor waste management
2. In your view, has air pollution ever affected your health?
3. Has air pollution ever affected the health of any of your family or friends?
4. Apart from effects on people's health, are you aware of any other effects of air pollution?
5. If yes, what other effects are you aware of? ________________________________________
_______________________________________________________________________________
6. Have you, in the last 5 years, experienced any form of flood damage (including to your home, garden or vehicle)?
7. Do you feel the pattern of weather is generally changing?
8. Have you heard of “climate change”?
9. Where have you heard about climate change? Check as many as you feel apply:
Television ____ Government agencies/ information ____
Radio ____ Public libraries____
Newspaper ____ Friends/ family _____
Internet ____
Specialist publications/academic journals ______
Environmental groups (e.g. Worldwide Fund for Nature) ____
School/ college/ university ____
Local council ____
Energy suppliers_____
Other: (Please write in _________________)
10. please indicate how much you would trust information about climate change if you heard it from.
A lot A little Not very Not at Can’t choose
Much all
A family member or a friend ------ ----- ------ ------- --------
A scientist ------ ----- ----- ------ -------
The government ----- ---- ----- ------ -------
An environmental organization (e.g. Worldwide
Fund for Nature) ----- ---- ------ ----- ------
The media (i.e. television, radio, newspapers) ----- ----- ------- ----- ------
How important is the issue of climate change to you personally? Very important _______
Quite important _______
Not very important ______
Not at all important_____
11. Who do you think should have the main responsibility for tackling climate change? Please check one only: "
International organizations (e.g. the UN) ______
The national government _____
Local government ____
Business and industry _______
Environmental organizations/ lobby groups (e.g. Worldwide Fund for Nature) ______
Individuals______
Other (please write in: ________________)
12. Have you ever taken, or do you regularly take, any action out of concern for climate change? " Yes ____
No____ Don't know _____
13. Please indicate how much you agree or disagree with the following statements about climate change by ticking
one on each row: strongly Neither Disagree
Agree Agree
a. We can all do our bit to reduce the effects of climate change _____ _____ _____
b. Climate change is inevitable because of the way modern society works _____ _____ _____
c. People should be made to reduce their energy consumption if it _____ _____ _____
reduces climate change
d. Climate change will improve the British weather ____ ____ ____
e. Climate change is just a natural fluctuation in earth’s ____ ____ ____
temperatures
f. I would only do my bit to reduce climate change if everyone else did as well ____ ___ ____
g. The government should provide incentives for people to look
after the environment ____ ___ ___
h. It is already too late to do anything about climate change ____ ___ ___
i. Human activities have no significant impact on global temperatures ____ ___ ___
j. Climate change is something that frightens me ____ ____ ___
k. Developing countries should take most of the blame for climate change ____ ____ ___
l. I am uncertain about whether climate change is really happening ____ ____ ___
 B. Environmental awareness level of secondary school students
Part I. A. Demographic Profile of the Respondent
Name:_________________________________________
Age:_________________
Grade level: ________________
Gender: Male__________ Female_____________
Part I. B. Family Background
a. Family Members
_________≤ 4 member
_________5-6 member
_________≥7 member
b. Parental Income
_________Low (3,000- 8,000/month)
_________Average (9,000-24,000/month)
_________High (25,000-100,000/month)
c. Parents Education Level
Father
Mother
Uneducated ___________
__________
Literate ___________
__________
Primary Education ___________
Secondary Education ___________
_________
University ___________
__________
d. Parental Occupation
_________ farmer
_________ Worker
_________ Government Worker
_________ Private Worker
_________ Retired
_________ Not Working
_________Deceased
Part II. Environmental Awareness
1. Do you think that you have sufficient information about environmental problems?
Yes No Maybe
2. If people keep producing and consuming like this, would there be a serious raw material
shortage?
Yes No Maybe
3. Have economic growth and technological developments damage the nature dangerously?
Yes No Maybe
4. Should there be limitations on economic growth in order to prevent destruction of the nature?
Yes No Maybe
5. Are developed countries more responsible for environmental pollution.
Yes No Maybe
6 Do you think this quote is true: “We do not inherit the earth from our ancestors.” We borrow it
from our children.”
Yes No Maybe
7 Is development of personal environmental awareness an important feature for protection of
the environment?
Yes No Maybe
8 Are you aware of activities of environmental club of your school?
Yes No Maybe
9 Do you recognize environmental non-governmental organizations?
Yes No Maybe
10 Do you know government agencies which deal with protection of the environment?
Yes No Maybe
11 Have you ever participate in an environmentalist group or organization?
Yes No Maybe
 B. SOLID WASTE MANAGEMENT
General Information
Please encircled your answers
1. Sex
1. Male
2. Female

2. Please mark your age group in the appropriate box.

1. 12 -15
2. 16 – 18
3. 19 – 21
4. 22 – 25
5. 26 – 30
3. How many people are currently living in your house?

4. How many are less than 12 years:

5. How many are more than 12 years:

Solid Waste Management

6. Have you ever heard about solid waste management?
Yes No
If yes, in what way? (One or more answers)
1. Over radio
2. Over TV
3. In public meeting
4. In school
5. On poster
6. Other_____________
7.What type of solid waste comes out your school? (One or more answers)
1. Paper and carton
2. Plastics (bags/bottles)
3. Food waste
4. Tins/cans
5. Others__________
8. In what type of container do you collect waste? (One or more answer)
1. Carton
2. Waste bucket
3. Plastic bag
4. Bin
5. Other______
9. How often is the waste container emptied?
1. Once a day
2. Twice a day
3. Once a week
4. Other________
10. Are there any bins outside the classroom?
Yes No
11. Do you think the waste disposal method is a problem in your school?
Yes No
12. What problems do you think exist in your school are as for waste management?
a. _______________________________________________________________
b. _______________________________________________________________
c. _______________________________________________________________
d. _______________________________________________________________
13. How do you evaluate the state of solid waste collection in your school area?
1. Good
2. Fair
3. Not good
14. Do you know if there is a waste management center in Ormoc City
Yes No
15. Are you satisfied with the waste management process in Ormoc City Solid waste
management center?
Yes No
16. Have you ever heard about the importance of recycling?
 Yes No
17. If yes, do you agree to solid waste recycling?
Yes No Not Sure

Environmental Impact
18. Do you know about environmental impact of solid waste?
Yes No
19. Do you ever notice waste in the road, land, or public area?
Yes No
20. Do you ever notice waste in water resources such as the rivers, lakes, sea, etc….?
Yes No
21. Do you notice burning waste in public area?
Yes No
22. Did you ever hear of health problems due to solid waste?
Yes No
23. Do you notice the presence of the following in and around school bin?
1. Odor
2. Mosquitoes and cockroaches
3. Rats
4. Other _______________________
24. Overall, how would you rate the quality of the environment in Ormoc City as compared to
the environment you had 5 years ago?
Much better
A little better
The same
A little wore
Much worse
Survey Questionnaire
C. Level of Awareness about Earthquake
Name (Optional)___________________________  Year level: ______
Position: Teacher/Sister/Student/Worker:(Underline)
Direction: Read the statements carefully concerning earthquake awareness. Put a
check mark on the space indicating your behavior concerning earthquake. Honestly
answer the questions.
STATEMENTS 5 4 3 2 1
(Strongly (Agree (Undecided (Disagree (Strongly
Agree) ) ) ) Disagree)
1.I am ready all the time
for an earthquake.
2.I already have a
background knowledge
about earthquake safety
measure.
3.I have already mastered
the route of the building
during earthquake.
4.I participated some
earthquake drills.
5.I observed the duck,
cover, and hold method
during earthquake.
6.I prioritize awareness in
local, regional, and
national level in
earthquake.
7.I have been a
participant in a disaster
risk education seminar
and training.
8.I recognize the
importance of making
conversations about
earthquake with family
members, neighbors,
relatives, friends, and
colleagues.
9.I am aware of the
shelter areas or
evacuation centers and
open spaces in case of an
earthquake.
10.I am fully aware and
informed about the
evacuation system and
plan in my locality.
11.I actively participated
in disaster-awareness
campaigns focusing on
earthquakes.
12.I think my
house/building is well
designed to withstand an
earthquake.
13. I know where to
evacuate when an
earthquake happens.
14. I attended first aid
training.
15. I gain enough
knowledge about
earthquake from experts
who works or conducts
activities for disaster-
reduction and
management.
16.I know the significance
of sharing knowledge of
experiencing an
earthquake
17. I am already aware of
the necessary precautions
as a preparation for an
earthquake.
18. I am prepared with
emergency kits and bags
in case of an earthquake.
19. I really do understand
what the best way is to
prepare for an
earthquake.
20. I am aware that 70%
of all injuries that occur in
earthquakes are caused
by people being hit by or
stumbling over fallen
objects such as furniture,
 glassware, appliances,
and pictures on the walls.

D.SMOKING HABITS AND ATTITUDES SURVEY

Name (Optional): _____ Grade 6-7-8-9-10-11-12 (Circle one)

Age: Sex: Male Female_
A. Check one statement (and only one) THAT BEST DESCRIBES YOUR SMOKING
HABITS AT PRESENT.
1. ( ) I have NEVER SMOKED.
2. ( ) I have tried smoking but ONLY to see what it is like. I do not smoke at present.
3. ( ) I used to smoke at least one day a week, but I quit.
4. ( ) I do not smoke every day, but I do smoke at least Once a week.
5. ( ) I smoke cigarettes just about every day, but less than half a pack a day.
6. ( ) I smoke half a pack or more of cigarettes just about every day.
B. AT WHAT AGE DID YOU SMOKE YOUR FIRST CIGARE1TE: Age__ Never
Smoked_
C. DO YOUR PARENTS SMOKE? (Check one)
Father only _______
Mother only _______
Both Parents _______
Neither Parent ______
D. Check YES or NO on the following questions.
1. Do you approve of boys smoking? Yes_____ No______
2. Do you approve of girls smoking? Yes_____ No _____
3. Do you smoke in mixed company? Yes ____ No _____
4. Do you smoke in front of your parents? Yes ____ No _____
E. HOW DO YOUR PARENTS FEEL ABOUT YOUR SMOKING? (If you don't smoke,
how would they feel if you did smoke?) (Check one).
 Mother Father
1. Approve. All right. ______ ______
2. They are against it. ______ ______
3. They would not allow me to smoke. ______ ______
4. They don't care. ______ ______
5. I don't know. _______ ______
F. I DON'T SMOKE BECAUSE: (Check one)
1. ( ) It will harm my health.
2. ( ) I don't want to get the habit. of it.
3. ( ) It doesn't look good.
4. ( ) -It's too expensive.
G. I SMOKE BECAUSE: (Check one)
1. ( ) I enjoy it.
2. ( ) Smoking relaxes me.
3. ( ) It has become a habit.
4. ( ) I want to be part of the crowd.
H. OTHER YOUNG PEOPLE SMOKE BECAUSE: (Check one)
1. ( ) They enjoy it.
2. ( ) Smoking relaxes them.
3. ( ) It has become a habit. Adults.
4. ( ) They want to be part of the crowd.
I. AT THE PRESENT TIME: I SMOKE ________ I DO NOT SMOKE_______
J. I Do__________, DO NOT _________ believe that cigarette smoking causes lung
cancer, heart disease, and other chest diseases.
E. BULLYING SURVEY QUESTIONNAIRE
Read the following statements concerning bullying at school and respond based on your
direct knowledge as a student. In addition, please provide the personal information
regarding gender and grade level.
Male ___________ Female ___________ Grade Level ___________
Please answer the questions using the following definition for bullying.
Bullying is the repeated, negative behaviors between one or more individuals together
with aggression or intentional harm (physical or emotional). Incidents of bullying include
an imbalance of power between perpetrator (the bully) and the victim. The imbalance of
power may be in one or more of the following areas:
• Social power • Financial power
• Physical power • Athletic power
• Intellectual power
1. I have observed classmates being bullied at school during the past 12 months.
Agree Unsure
Disagree
If the answer to #1 is Agree, on average, how many times have you observed
this behavior?
a. Once a day
b. Several times a day
c. Once a week
d. Several times a week
e. Only a few times in the 12 months
2. I have been the victim of bullying by another student during the 12 months.
Agree Unsure Disagree
If the answer to #1 is Agree, on average, how many times have you observed this
behavior?
a. Once a day
b. Several times a day
c. Once a week
d. Several times a week
e. Only a few times in the 12 months
3. I have observed one or more of my friends being bullied during the past 12 months.
Agree Unsure Disagree
4. The teachers at this school try to reduce bullying.
Agree Unsure Disagree
5. The administrators at this school try to reduce bullying.
Agree Unsure Disagree
6. The counselors at this school try to reduce bullying.
Agree Unsure Disagree
7. If I were bullied at school, I would tell a teacher or other staff member.
Agree Unsure Disagree
8. If I were bullied at school, I would tell my parents.
Agree Unsure Disagree
9. I believe there is a need for a bullying prevention program at my school.
Agree Unsure Disagree
10. Bullying is addressed in the student handbook.
Agree Unsure Disagree
11. I believe there is adequate adult supervision of students at school.
Agree Unsure Disagree
12. Counselors at my school are involved in bullying prevention.
Agree Unsure Disagree
13. I believe teachers in this school are consistent and fair in their approach when
bullying is observed or reported.
Agree Unsure Disagree
14. I believe the principal or other administrators in this school are fair and consistent in
their approach when bullying is observed or reported.
Agree Unsure Disagree
15. I have personally observed students participating in bullying behaviors in the
following locations. Please circle all that apply.
Student Commons/Hallways Restrooms
Playground/Recess Classroom
Extracurricular Activities School Bus
Cafeteria Locker Rooms
Physical Education Class On the Way to or From School
16. I have observed classmates being bullied or harassed online.
Agree Unsure Disagree
If the answer to #16 is Agree, I told (circle all that apply):
a. No one
b. My parent
c. Another student
d. A teacher or other adult at school
17. I have been harassed or bullied online.
Agree Unsure Disagree
If the answer to #17 is Agree, I told (circle all that apply):
a. No one
b. My parent
c. Another student
d. A teacher or other adult at school
18. If you have observed bullying at school, or if you have been bullied, please use the
space below to describe what you have seen or experienced. Please be as specific as
possible.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

19. What suggestions do you have for the prevention of bullying at this school?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________