York-Poquoson TRIAD Senior Safety Survey
Exit this survey
1. To what extent do the following affect your life?
1
. Worry about going outside at night.
Worry about going outside at night.
Major Concern
Minor Concern
Very Little Concern
2
. Do you have a fear of being a victim of fraud or a con artist?
Do you have a fear of being a victim of fraud or a con artist?
Major Concern
Minor Concern
Very Little Concern
3
. Vandalism in your neighborhood?
Vandalism in your neighborhood?
Major Concern
Minor Concern
Very Little Concern
4
. Lack of public transportation
Lack of public transportation
Major Concern
Minor Concern
Very Little Concern
5
. Fear of robbery
Fear of robbery
Major Concern
Minor Concern
Very Little Concern
6
. Fear of burglary (home invasion)
Fear of burglary (home invasion)
Major Concern
Minor Concern
Very Little Concern
7
. Vendors knocking on your door
Vendors knocking on your door
Major Concern
Minor Concern
Very Little Concern
8
. Neglect by family members
Neglect by family members
Major Concern
Minor Concern
Very Little Concern
9
. Fear of personal abuse
Fear of personal abuse
Major Concern
Minor Concern
Very Little Concern
*
10
. Please state what sub-division and zip-code you reside in.
Please state what sub-division and zip-code you reside in.
Sub-Division
ZIP/Postal Code:
11
. Please indicate gender
Please indicate gender
Male
Female
12
. Do you live alone
Do you live alone
Yes
No
13
. Age group
Age group
55-65
65-70
70-75
75-80
80-85
Over 85
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