Day Use on National Forests of Southern California

OMB# 0596-0129	Group #
Exp. X/XX/20XX	Date
FORM B	Site Location

Welcome to Your National Forest!

To help understand visitor preferences and provide the best services possible at day use sites on the National Forests of Southern California, we are asking if you will take about 8 minutes to fill out this questionnaire. Your participation is voluntary. All responses will be kept anonymous.

1. Have you ever been to this site before? ____ No ____ Yes

If yes, about how many times in the past 12 months? _______times

If yes, about how many years have you been coming here? _______years

2. Do you plan to return to this site again in the next 12 months?

____ No ____ Yes ____ Don’t know

3. Which of the following statements describe why you visit this recreation site? (Check all that apply)

___	Being at this site reminds me of my childhood recreation experience.	___	I am comfortable with this site because I have been here before.
___	This site is close to my home.	___	This site is peaceful and quiet.
___	Visiting here is affordable.	___	I meet my friends and/or family here.
___	This is my first visit to this site.	___	I like the activities I can do here.
___	Other (Please describe) _____________

4. Please indicate which of the following activities you participated in while on the visit to this National Forest when our field team contacted you. (Check all that apply)

___	Fishing	___	Picnicking/barbeque
___	Swimming/wading	___	Rock climbing
___	Hiking	___	Photography
___	Nature study (for example, bird watching, identifying wildflowers, rock study)	___	Collecting berries, mushrooms, or other
___	Relaxing	___	Other, please specify __________________

5. Concerns about my safety from crime have changed the way I do things at this recreation site in the following ways. (Check all that apply to your safety concerns)

___	I choose to recreate in areas with other people already there.	___	I pay more attention to what is going on around me.
___	I carry a cell phone.	___	I dress conservatively.
___	I chose this site over others because I think it’s safe.	___	I leave my itinerary with friends or family.
___	I am concerned but have not changed the way I do things.	___	I am not concerned about my safety from crime at this site.
___	Other (Please describe) _______________________________________________________________

6. How concerned are you about each of the following at this recreation site? Please circle the one number that best describes your level of concern. If you are not sure, mark ‘dk’. (Circle one number for each statement)

Level of Concern at this Site
Concerns	not at all concerned	slightly concerned	somewhat concerned	very concerned	extremely concerned	don’t know
a. Gangs are moving into area	1	2	3	4	5	dk
b. Drug dealers moving into area	1	2	3	4	5	dk
c. Police are around more	1	2	3	4	5	dk
d. Traffic, speeding	1	2	3	4	5	dk
e. Threats to my health or life by wildfire	1	2	3	4	5	dk
f. Vandalism to signs	1	2	3	4	5	dk
g. Vandalism to trees	1	2	3	4	5	dk
h. Security of my car from break-ins	1	2	3	4	5	dk
i. Someone harassing me	1	2	3	4	5	dk
j. Carving of names, initials, or messages on trees	1	2	3	4	5	dk
k. Discourteous behavior of other people	1	2	3	4	5	dk
l. Dogs walked off leash	1	2	3	4	5	dk

7. How concerned are you about each of the following in the neighborhood where you live? Please circle the one number that best describes your level of concern. If you are not sure, mark ‘dk’. (Circle one number for each statement)

Level of Concern in Neighborhood
Concerns	not at all concerned	slightly concerned	somewhat concerned	very concerned	extremely concerned	don’t know
a. Gangs are moving into area	1	2	3	4	5	dk
b. Drug dealers moving into area	1	2	3	4	5	dk
c. Police are around more	1	2	3	4	5	dk
d. Traffic, speeding	1	2	3	4	5	dk
e. Threats to my health or life by wildfire	1	2	3	4	5	dk
f. Vandalism to signs	1	2	3	4	5	dk
g. Vandalism to trees	1	2	3	4	5	dk
h. Security of my car from break-ins	1	2	3	4	5	dk
i. Someone harassing me	1	2	3	4	5	dk
j. Carving of names, initials, or messages on trees	1	2	3	4	5	dk
k. Discourteous behavior of other people	1	2	3	4	5	dk
l. Dogs walked off leash	1	2	3	4	5	dk

8. Your gender _____ Female _____ Male

9. Your age _____ years

10. What was your last year of school completed? (Please circle the number of the last year of school completed)

Elementary School	Middle School	High School	College	Graduate School
1 2 3 4 5	6 7 8	9 10 11 12	13 14 15 16	17 18 19 20

11. Are you of Hispanic or Latino origin? ___ Hispanic or Latino ___ Not Hispanic or Latino

12. What racial category or categories best describes you? (Please select one or more)

___	American Indian or Alaska Native	___	Native Hawaiian or Other Pacific Islander
___	Asian	___	White
___	Black or African American

13. What language do you speak most of the time?

___ English ___ Spanish ___ Other ___________

What language do you read most of the time?

___ English ___ Spanish ___ Other ___________

14. Place of birth _____ United States _____ Other country __________________________

15. What is your annual household income (before taxes)?

_____ $25,000 or less

_____ $25,001 - $50,000

_____ $50,001 - $75,000

_____ $75,001 - $100,000

_____ $100,001 or more

Thank You So Much!

Enjoy your stay on your National Forest.

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To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.