Example of a safety questionnaire

Below are the questions of the local safety questionnaire and their response alternatives as well as possible explanations for the questions for copying by the organisers in the municipality. So this is not an ongoing survey.

1.    Do you feel that your neighbourhood is safe?
Yes
No

2.    To what extent do you consider crime and disorder to be a problem in your neighbourhood?
Not at all
Very little
Little 
Large
Very large

3.    Do you think that the level of violence or threat of violence in your neighbourhood has become lower or higher in recent years?
Much higher
Higher
About the same
Lower
Much lower
Don’t know

4.    Have you witnessed a fight or any other act of physical violence in your neighbourhood in the past 12 months?
I have not
Once
Twice
3-4 times
Over four times

5.    During the past 12 months, have you been afraid of being a victim of violence in your neighbourhood after dark or at night? (Select the option that best fits your situation)
Not once
Once or twice
Several times
I do not go out at night because of fear of violence
I do not go out at night for other reasons

6.    Is there an area close to your home (within a radius of about one kilometre) that you avoid because of the threat of violence?
No
Yes, one place
Yes, several places

7.    Here you can provide more details on your answers. For example, give the reason why you feel that the place or places are unsafe or dangerous and the location of these places. 

8.    During the past 12 months, have you considered relocating from your current neighbourhood because of crime or disturbing behaviour in public places?
No
Once
More than once

9.    Have you experienced discrimination and/or harassment in your city of residence? Has the harassment been caused by one or more of the following reasons? (You can choose more than one answer)
Old age
Young age
Origin, nationality, language
Religion
Political activity
Other beliefs or opinions
Family relations
Disability, state of health
Gender
Sexual orientation
Other reason, what?

10.    Both private individuals and households can be victims of various types of property offences. Have any of the following happened to you or other members of your household in the city of your residence in the past 12 months?
The car has been vandalised or damaged in an attempted burglary
Motorcycle, scooter or moped stolen
Bicycle stolen
Electric scooter or equivalent stolen
Burglary or theft (including an attempt) from a permanent housing
Burglary or theft (including an attempt) from a holiday home
Burglary or theft (including an attempt) from a storage space, cellar/basement, attic etc.
Damage to property other than a car

11.    Here you can provide more details about your answer to the previous question.

12.    Have you had any of the following happen to you in the city of residence in the past 12 months?
You have been verbally harassed (screaming, cursing)
You have been threatened with violence at home
You have been threatened with violence outside your home
You have been threatened with violence online
You have been a victim of violence
You have been a victim of intimate partner violence (physical)
You have been sexually harassed
You have been a victim of sexual violence
You have been a victim of a robbery (theft by violence or a threat of violence)
Theft of personal belongings outside the home, such as wallet, credit card or mobile phone
You have been scammed so that you have not received a product, good or service even though you paid for it
Your debit or credit card has been used without permission, or money has been stolen from your account in some other way
Your personal information has been stolen or misused to commit theft, fraud or other offence
Other, what?

13.    How worried are you that in the next 12 months you will become a victim of the following crimes or incidents in your municipality/city?
Not at all worried - Slightly worried - Moderately worried - Extremely worried

Your property is stolen
Your property is damaged
An attempt to break into your home
Being a victim of a traffic accident
Being threatened with violence
Being a victim of violence
Being a victim of a sexual offence
Being a victim of sexual harassment
Being a victim of other forms of harassment
Someone is trying to sell you drugs
Being a victim of fraud 

14.    How often are you concerned about the following issues?
1 = Never – 5 = All the time

Immigration
Racism
Extremist political movements
Social inequality
Hate speech
Restrictions on freedom of speech
Accidents at home
Vandalism
Drug use
Drunk driving
Intoxicated people
The transfer of surveillance from the public sector to the private security sector 

15.    How big of a problem do you consider the following to be in your neighbourhood? 
Not at all a problem – Minor problem – Moderate problem – Serious problem

Aggressive or drunk people in public places
Young people behaving disorderly in public areas
Littering or uncleanliness of the environment
Graffiti, vandalism and other intentional damage to property
Drug sellers or users
Loud neighbours or loud partying
Other, what?

16.    What do you think would be effective solutions to crime and disorder issues in your city or neighbourhood? (You can select multiple options)
More effective supervision of premises that sell alcohol
More effective supervision of underage drinking
Increased police supervision of public places
Increased camera surveillance (CCTV)
Better street lighting and rapid replacement of broken lamps
Better maintenance (e.g. cleaning up litter, removing graffiti)
Better maintenance of bushes and trees (e.g. along footpaths) 
Other

17.    Have you had any of the following accidents in your area of residence in the past 12 months?
Falling over
Slipping
Falling off
Traffic accident
Other accident
No accidents in the past 12 months

18.    Do you think the accident was caused by?
Slippery streets (loose gravel or slippery leaves)
Insufficient sanding of icy streets
Lack of snow ploughing
Bumpiness of streets
Environmental inaccessibility
Insufficient street lighting
Other reason

BACKGROUND INFORMATION

19.    What is the main building type in your neighbourhood?
Apartment buildings
Semi-detached or row houses
Single-family houses

20.    Have you lived in your current residential area?
Over a year (> 12 months)
Less than a year (< 12 months)

21.    What is the postcode of your residential area?

22.    Is your residential area in?
In the city centre
Within an urban area
In a sparsely populated area

23.    Is your apartment?
Owned residence
Private rental residence
Municipal rental residence
Leasehold property
Other

24.    Gender
Male
Female
Other
Prefer not to say

25.    What age group do you belong to?
15-19
20-29
30-39
40-49
50-59
60-69
70 or over

26.    Marital status
Single
Married or in a registered partnership
Living together with a partner
Separated or divorced
Widow

27.    Do you have children aged under 18 in your household (you can select multiple options)
Children under 7 years old
Children aged 7-12 years old
Children aged 13-17 years old
No children under 18 years old

28.    Which of the following education have you completed or are you currently completing? (you can select multiple options)
University degree
Polytechnic degree
Associate's degree or professional higher education qualification (previous)
Matriculation examination
Vocational or specialised vocational qualification
Primary, secondary or elementary school
None of the above

29.    Which of the following do you think best describes your current situation? 
In employment (including part-time retirement)
Unemployed
Retired
Student
Out of employment for reasons other than unemployment, retirement or education

30.    Do you or someone in your household own or use any of the following: This background question relates to the question 10. For example, you can only be a victim of a car crime if you own a car. This allows the results of the questionnaire to show how many car owners have been victims of a car related offences (select all the appropriate options).
Car
Motorcycle, scooter or moped
Bicycle
Electric scooter or equivalent
Holiday home