Introduction

Question Title

Your Name

Question Title

Mobile

Question Title

Email

Please pick the event from above which bothers you the most and complete the following questions:
(This survey can be completed multiple times to report on separate events)

Question Title

Which event will you be rating (which number from above)?

Question Title

How long ago did this event occur?

Question Title

During this event...

  Yes No
Were you physically injured?
Was someone else physically injured?
Did you think that your life was in danger?
Did you think that someone else’s life was in danger?
Did you feel helpless?
Did you feel terrified?
Was there blood involved in the incident?
 

T