Digital Self Assessment

Park View Project (Digital Inclusion North Tyneside) Digital Self Assessment Form.

All information collected conforms to EU and Post Brexit UK GDPT requirements where data collected is securely stored and not shared to a third party.
For further information about Park View Project (Digital Inclusion North Tyneside) please go to our website: Park View Project

You can drop us a line at: C/O North Tyneside Disability Forum,

Shiremoor Centre,

Earsdon Road,

Shiremoor,

Newcastle Upon Tyne, NE27 0HJ

Tel: +44 01914661667

Email: office@parkviewproject.org.uk
Name*

PrefixFirst NameLast Name
Address (Optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Email*
example@example.com
Date of birth (Year recorded first)*

YearMonthDay
Date
Please enter your postcode

How old are you?

	Yes
Over 65
50 - 64
30 - 49
18 - 29
Under 18

Do you have children living at home?

	Yes	One only	More than one
Under 18
Over 18

What is your current status?

	Yes
Retired
Unemployed
Self employed
Adult student
School age
Employed
Not looking for work

Do you have a disability? If so, please tick all that apply. (Please skip this question if the question does not apply)

	Yes
Sensory (Hearing loss, Visual, other)
Physical
Intellectual (Learning Disability, Learning Disabled i.e Dyslexia)
Neurological
Chronic long term illness

What type of digital item do you have? Please tick all that apply

LaptopDesktopIpadTabletPhone
How often do you use your device? Tick one only. Select the item you use the most to answer this question.

EverydayOftenOnce per monthOccassional useNever

What do you usually use your device for? Please rate each one.

	Most of the time	Some of the time	Rarely	Never
Video calling
Social Media
Email
Chat (WhatsApp/Messenger/Other)
Shopping online
Banking
Looking for work
Health related information
Local government forms
Benifit claims

Do you have wireless/internet access at home?

	Internet ccess
Tel line
Satelite
Mobile

Do you agree with the the following statement: "Being online is a health hazzard and it can lead to social isolation".

1

2

3

4

5

1 is Agree, 5 is Strongly diasgreee

Digital Skills. Please answer yes or no for each statement.

	Yes	No
I can look for information online using a search engine?
I know that not all information is reliable?
I can save content (e.g. text, pictures, music, videos, web pages) and save them once saved and stored?
I can communicate with others using mobile phone, voice over IP (E.g. Skype), email or chat?
I can share files and content using simple tools?
I can use digital technologies to interact with online services such as banks, government, hospitals?
I am aware of social media sites and online collaboration tools?
I am aware that using digital tools certain communication rules apply (E.g. when commenting, sharing personal information?
I can produce simple digital content (E.g. text, tables, images, audio files) in at least one format using digital tools?
I can make basic editing to content produced by others?
I know that content can be covered by copyright?
I can apply and modify simple functions and settings of software and applications that I use (E.g. change default settings)?
I can take basic steps to protect my devices (E.g. using anti-viruses and passwords)?
I am aware that my credentials (username and password) can be stolen?
I know I should not reveal personal information online?
I know that using digital technology too extensively can damage my heath?
I can find support and assistance when a technical problem occurs when using a new device, program or application?
I know how to solve some routine problems (E.g. close programs, re-start computer, re-install/update program, check internet connection?
I know that digital tools can help me solve problems. I am also aware that they have their limitations?
When confronted with a technological or non-technological problem, I can use the digital tools I know to solve it?

In response to the following descriptions how does the word "Digital" make you feel? Select as many as apply from the following list: 1.Nervous 2.Anxious 3.Happy 4.Ambivalent 5.Overwhelmed 6.Effective 7.Necessary 8.Engaged 9.Excited 10.Confused 11.Curious 12.Frustrated 13.Challenged 14.Opportunity 15.Creative 16.Innovative. (Choose all descriptions that apply. Do not number them).

0/16
There are 12.5 million adults either not online or limited users of the internet. If you class yourself as one of them, can you please briefly describe the factors that affect you regarding barriers to using the internet? (Please keep to a maximum of 20 words. Please do not use puctuation marks).

0/20
Would you like further information about our project? Please answer Yes or No
Please verify that you are human*
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Park View Project (Digital Inclusion North Tyneside) Digital Self Assessment Form.