My Views on-line

Here is the opportunity for you to have your say online.
There is a series of questions that you can answer on line and submit to the partnership to be included in the Health Check.

Your views can only be accepted up to 22 March 2002.

1. Are you ? Male; Female;

2. Which of the following ages best reflects your current age ?
Under 16; 17-24; 25-39; 40-59; 60 and over;

3. Which of the following areas best describes where you live ?
Immingham; North Killingholme; South Killingholme; East Halton; Habrough; Stallingborough; Healing; Keelby; Great Limber; Ulceby; Wooton; Thorton Curtis; Brocklesby; Kirmington; Other (please State):

4. Who owns the home where you live ?
Me/My Family; Private Landlord; Local Council; Housing Association; Other: (Please state)

5. Which other people live in your home ?
Partner; Children; Parents; Other Relatives; No-one;

6. Which of the following best describes your current position ?
Full time work; Part time work; Self Employed; Unemployed; School; Post 16 Education; Retired; Carer/Homemaker;
Volunteer;

6a. If you are currently employed, do you work in Immingham ?
Yes; No; Not Applicable;

7. How do you travel around the area?:
Bus; Taxi; Car; Motorbike; Bicycle; Walk;
Other (please state)

8. If you use public transport are there many delays as a result of traffic problems?
Yes; No; Don't Know;

9. Where do you do your main shopping:
Immingham; Grimsby; Cleethorpes; Local Villages;
Internet;

10. How frequently do you use the shops in Immingham ?
Daily; Weekly; Monthly; Occasionally; Never;

11. Do you feel that there is enough choice of shops within Immingham?
Yes; No; Don't Know;

12. Does your home have a computer ?
Yes; No;

13. Is your home connected to the internet ?
Yes; No; Don't Know;

14. What type of television services does your home receive ?
Satellite (Sky); Cable (NTL); Digital (ITVDigital);
UHF (Standard 5 channels); None;

15. How often do you use the Leisure/Sports facilities in Immingham ?
Monthly; Fortnightly; Weekly; More than once a week;
Never;

15a. What do you think of the Leisure/Sports facilities ?
Excellent; Good; Average; Poor; Don't Know;

16. Do you belong as a member of a sports or Leisure club or Gym?
Yes (in Immingham); Yes (outside Immingham); No;

17. Are there enough facilities for young children (5 and below) ?
Yes; No; Don't Know;

18. Are there enough facilities for children aged 6 to 11 ?
Yes; No; Don't Know;

19. Are there enough facilities for teenagers aged 12 to 16 ?
Yes; No; Don't Know;

20. Are there enough facilities for young adults aged 17 upwards ?
Yes; No; Don't Know;

21. Are there enough facilities for disabled residents?
Yes; No; Don't Know;

22. Are there enough facilities for the senior age group aged 60 upwards ?
Yes; No; Don't Know;

23. Do you think that there is a problem with crime in Immingham ?
Yes; No;

24. Do you feel safe walking through the streets at night ?
Yes; No;

25. Have you been the victim of a criminal act in the last 12 months ?
Yes; No;

26. Do you vote in local elections ?
Yes; No;

27. Are you interested in local and national politics ?
Yes; No;

28. Do you currently recycle packaging material and/or newspapers ?
Yes; No;

29. If a kerbside collection service for recycled materials was set up would you use it ?
Yes; No;

30. Are you aware of your local community centre and the activities that take place there ?
Yes; No;

31. How would you rate your local community centre and its activities ?
Excellent; Good; Average; Poor; Don't Use It;

32. Does anyone in your household belong to a community group, a committee or get involved in local community activities ?
Yes; No; Don't Know;

33. How do you find out what is going on in Immingham and the local area ?
Evening Telegraph; Target; Community Newsletters;
Internet; Channel 7; Community/Resource/Youth Centres;
Word of mouth; Bus Advertisements;

34. Do you attend the Immingham Show or any other festivals in Immingham and its surrounding area ?
Yes; No;

35. Do you know about the Neighbourhood Forums in Immingham?
Yes; No;

36. Which of the following activities do you travel outside of Immingham for ?
Shopping; Sports/Leisure; Education/Training;
Socialising; Cinema; Theatre; Eating out;
Advice and Guidance; Live Music/Entertainment;

37. Are Immingham's streets and pavements in a good state of repair ?
Yes; No; Don't Know;

38. What do you most like about Immingham ?



39. What do you least like about Immingham ?



40. Would you like to be entered into a free prize draw to win either a mountain bike or an internet ready computer ?
Yes; No;

If yes please give your details below, your personal data will be maintained in accordance with the data protection act 1998 and will not be passed on to any third parties without your written consent.

Name:             

Address:          

Town/Village:  

Contact Telephone:

  



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