Learning Collaborative Measures
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1. Over the last two weeks, how many times have you had five or more drinks of alcohol at a sitting?

(One drink of alcoholic beverage is defined as a 12 oz. beer, a 4 oz. glass of wine, 1.5 oz. of and 80- proof liquor)

Over the last two weeks, how many times have you had five or more drinks of alcohol at a sitting? (One drink of alcoholic beverage is defined as a 12 oz. beer, a 4 oz. glass of wine, 1.5 oz. of and 80- proof liquor) N/A, don’t drink

None

1 time

2 times

3 times

4 times

5 times

6 times

7 times

8 times

9 times

10 or more times

2. Within the last 12 months, have you experienced any of the following when drinking alcohol?

(Please mark the appropriate column for each row)

	N/A, don’t drink	No	Yes
Did something you later regretted	*Within the last 12 months, have you experienced any of the following when drinking alcohol? (Please mark the appropriate column for each row) Did something you later regretted N/A, don’t drink	Did something you later regretted No	Did something you later regretted Yes
Forgot where you were or what you did	Forgot where you were or what you did N/A, don’t drink	Forgot where you were or what you did No	Forgot where you were or what you did Yes
Got in trouble with the police	Got in trouble with the police N/A, don’t drink	Got in trouble with the police No	Got in trouble with the police Yes
Someone had sex with me without my consent	Someone had sex with me without my consent N/A, don’t drink	Someone had sex with me without my consent No	Someone had sex with me without my consent Yes
Had sex with someone without their consent	Had sex with someone without their consent N/A, don’t drink	Had sex with someone without their consent No	Had sex with someone without their consent Yes
Had unprotected sex	Had unprotected sex N/A, don’t drink	Had unprotected sex No	Had unprotected sex Yes
Physically injured yourself	Physically injured yourself N/A, don’t drink	Physically injured yourself No	Physically injured yourself Yes
Physically injured another person	Physically injured another person N/A, don’t drink	Physically injured another person No	Physically injured another person Yes
Seriously considered suicide	Seriously considered suicide N/A, don’t drink	Seriously considered suicide No	Seriously considered suicide Yes

3. In the past 12 months, how many times have you "pre-gamed" before going out?

In the past 12 months, how many times have you "pre-gamed" before going out? 0

1-2

3-4

5 or more

4. In the past two weeks, how many times have you "pre-gamed" before going out?

In the past two weeks, how many times have you "pre-gamed" before going out? 0

1-2

3-4

5 or more

5. Have you ever suffered from alcohol poisoning?

Have you ever suffered from alcohol poisoning? Yes

6. Have you ever received medical treatment (i.e. hospital, urgent care, campus health center) for alcohol poisoning?

Have you ever received medical treatment (i.e. hospital, urgent care, campus health center) for alcohol poisoning? Yes

7. Does UMES have an Alcohol Policy?

Does UMES have an Alcohol Policy? Yes

8. Do you know where you can find the UMES Alcohol Policy?

Do you know where you can find the UMES Alcohol Policy? Yes

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Learning Collaborative MeasuresExit this survey

Learning Collaborative Measures
Exit this survey