Day Use on National Forests of Southern California

OMB # 0596-0129	Group #
Exp. X/XX/20XX	Date
FORM D	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. Have you observed any of the following conditions during your visits to this area? If so, please indicate how if it has negatively influenced the quality of your visits to this area. If you have not observed a condition then please circle n/a. For example, if you did not observe litter along a trail you would mark n/a. (Circle one number for each statement)

Influence of Conditions on Future Visits
Conditions	not influenced	slightly influenced	somewhat influenced	moderately influenced	very much influenced	not applicable
a. Campfire rings next to a trail	1	2	3	4	5	n/a
b. Fire pits with litter in them	1	2	3	4	5	n/a
c. Mountain bikes on non-authorized trails	1	2	3	4	5	n/a
d. Vandalism to facilities	1	2	3	4	5	n/a
e. Evidence of a wildland fire	1	2	3	4	5	n/a
f. Designated parking areas overflowing with vehicles	1	2	3	4	5	n/a
g. Evidence of a prescribed fire	1	2	3	4	5	n/a
h. Bathrooms that need to be cleaned	1	2	3	4	5	n/a
i. Evidence of campfires in non-designated areas	1	2	3	4	5	n/a
j. Litter along a trail	1	2	3	4	5	n/a
k. Visible smoke from a prescribed fire	1	2	3	4	5	n/a
l. Vandalism to signs	1	2	3	4	5	n/a
m. Vandalism to picnic tables	1	2	3	4	5	n/a
n. Erosion along trails	1	2	3	4	5	n/a
o. Restriction stating no fires on cooking grills or in fire pits	1	2	3	4	5	n/a
p. Dogs off leash	1	2	3	4	5	n/a
q. Vandalism to trees	1	2	3	4	5	n/a
r. Discourteous behavior of other people	1	2	3	4	5	n/a
s. Visitors wandering off designated trails or visible evidence of off-trail use	1	2	3	4	5	n/a
t. Large bonfires in the forest	1	2	3	4	5	n/a
u. Restriction of no fires when backpacking	1	2	3	4	5	n/a
v. Suppression of a wildland fire by fire fighters	1	2	3	4	5	n/a
w. Visible smoke from a wildland fire	1	2	3	4	5	n/a
x. Prohibition of fireworks in the forest	1	2	3	4	5	n/a

6. Your gender _____ Female _____ Male

7. Your age _____ years

8. 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

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

10. 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

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

___ English ___ Spanish ___ Other ___________

What language do you read most of the time?

___ English ___ Spanish ___ Other ___________

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

13. 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.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0129. The time required to complete this information is estimated at 8 minutes per response, including the time for reviewing instructions, searching data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

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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.