Download:
pdf |
pdfSURVEY LOG
Today’s date:
Island
Weather:
Hello! Boston Harbor Islands National Park Area is conducting a
survey to gather your visit experience on [Name of the island].
Your participation is voluntary. The questionnaire will take about
15 minutes to complete, would you like to participate?
IF YES: Thank you—here’s a questionnaire for you to fill out. Please hand
this back to me when you are done on your way back to the mainland. I also
have 3 quick questions I’d like to ask
Inter- Start & Interval
viewer stop - every
nth
initials times,
breaks
Time
First time visitor?
Zip code or name of
country
IF NO: Could I ask you a few quick questions that will help us to
understand more about the people visiting the island today?
1) Is it your first time visiting the island?
2) What is your zip code (or name of the country)?
3) What is your age?
Observe and note the person’s gender
Age
Gender
COMMENTS:
explain reason for refusal, "other"
group, etc.
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
Yes
No
M
F
TOTALS
OMB Control Number 1040-0001
Current Expiration Date: XX-XX-XXXX
______ _____
Office Use Only
File Type | application/pdf |
File Title | CONTACT & FRONT-END INTERVIEW FORM |
Author | Margaret |
File Modified | 2012-01-19 |
File Created | 2012-01-19 |