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* 1. What is your gender?

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* 2. Please indicate/select your age category below.

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* 3. What is the highest level of school you have achieved or the highest degree you have received?

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* 4. Which of the following categories best describes your employment status?

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* 5. How much total combined money did all members of your HOUSEHOLD earn last year?

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* 6. Which province and region do you live in?

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* 7. How long have you been living in this province? Number of years.

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* 8. Are you a member of any religious congregation?

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* 9. Do you read a newspaper or magazine at least once a week or not at all?

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* 10. Do you listen to the radio at least once a week or not at all?

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* 11. Do you watch television at least once a week or not at all?

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* 12. Do you own a mobile phone

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* 13. Are you in an intimate partner relationship?

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* 14. In your opinion, which of the following acts are gender-based violence?

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* 15. In your opinion is a wife/husband/partner justified in hitting or beating his/her wife/husband/partner in the following situations?

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* 16. If you are married or in an intimate relationship, have you ever been hit or beaten by your wife/husband/partner in the following situations?

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* 17. If you are married or in an intimate relationship, have you ever hit or beaten your wife/husband/partner in the following situations?

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* 18. Has your husband or wife or partner, ever done any of the following to you?

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* 19. Have you ever done any of the following to your husband or wife or partner?

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* 20. Has anyone, other than your husband or wife or partner, ever done any of the following to you?

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* 21. Have you ever done any of the following to someone other than your husband or wife or partner?

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* 22. If you are married or in an intimate relationship, did the following ever happen as a result of what your husband/partner did to you?

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* 23. If you are married or in an intimate relationship, did the following ever happen as a result of what you did to your husband/partner?

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* 24. Do you drink alcohol?

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* 25. If you are married or in an intimate relationship, does your husband/wife or partner drink alcohol?

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* 26. Did your father hit or harm your mother?

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* 27. Did your mother ever hit or harm your father?

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* 28. If you are married or in an intimate relationship, has your wife's or husband's father ever bashed her or his mother?

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* 29. Have you ever been harassed or bullied at school or in your place of work by any of the following?

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* 30. Did the following ever happen as a result of what happened to you at work or at school?

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* 31. Thinking about what you yourself have experienced among the different things we have
been talking about, have you ever tried to seek help?

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* 32. Thinking about the experiences you have had, how many days do you think you have had
to miss work or other activities such as church, school and family functions in the last 12 months because
of physical or emotional problems due to violence?

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* 33. If you did seek help, who was it from?

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* 34. If you you went to the police, what was the result?

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* 35. Have you ever told anyone about this?

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* 36. In your opinion, is ending gender based violence in Papua New Guinea important?

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* 37. In your opinion, what is your provincial government, school or employer doing well to end gender-based violence in the country?

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* 38. In your opinion, what could your provincial government or employer or school do better to end gender-based violence.

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* 39. In your opinion, what should your provincial government or employer be doing more of to end gender based violence?

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* 40. In your opinion, who should be responsible in your provincial government, school or employer for seeing that the rates of gender based violence are lowered?

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