We are seeking community input as we review and update the Shire’s Smoke Free Environment Policy.

This survey will ask you about your preferences for Smoke Free environments.

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* 1. Privacy Statement: The information you provide on this form is being collected by the Mornington Peninsula Shire in accordance with its Privacy Policy, the Privacy and Data Protection Act 2014 and the Health Records Act 2001. The Shire is collecting this information for the purpose of determining the Smoke Free Environment Policy. The information will be used by the Shire for this purpose and it may be used for a related secondary purpose. You may access information you have provided to the Shire at any time and make corrections if you believe that information is incorrect. The Shire’s Privacy Policy can be viewed on the Shire’s website at www.mornpen.vic.gov.au.

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* 2. Are you currently a smoker?

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* 3. Are you concerned by the number of people who smoke?

  Choose
(a) In the general community
(b) In disadvantaged communities
(c) Before the age of 18

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* 4. Is exposure to second-hand smoke a concern to you?

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* 5. Is exposure to 'vaping' a concern to you?

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* 6. Would you support more smoke free public environments on the Mornington Peninsula?

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* 7. Would you support smoke free environments in Shire owned/managed properties and public areas on the Mornington Peninsula?

  Choose
outdoor dining and drinking areas
leisure centres
recreation reserves - playing, viewing and service areas
bushland reserves
public beaches - all public areas
council offices
foreshore camping areas
playgrounds
galleries
libraries
public halls
shire events
other public areas

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* 8. Would you support designated smoking areas (places where people CAN smoke) in Shire owned/managed properties and public areas on the Mornington Peninsula?

  Choose
outdoor dining and drinking areas
leisure centres
recreation reserves - playing, viewing and service areas
bushland reserves
public beaches - all public areas
council offices
foreshore camping areas
playgrounds
galleries
libraries
public halls
shire events
other public areas

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* 9. Would you support the installation of butt bins next to smoke free environments on the Mornington Peninsula?

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* 10. Would you support smoke free environments in all public areas on the Mornington Peninsula - including those not owned/managed by the Shire?

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* 11. Should the Shire provide incentives for business owners to provide smoke free environments?

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* 12. Do you think the following would help council officers enforce smoke free local laws on the Mornington Peninsula?

  Choose
Education
Warnings
Fines
Signs

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* 13. Do you have any other comments?

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* 14. What town is your primary residence (home) located in?

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* 15. What is your gender?

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* 16. What is your age group?

If you would like to be kept up to date about this policy development, please complete the following fields:

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* 17. What is your name?

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* 18. What is your contact number?

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* 19. What is your email address?

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