Social Sustainability Questionnaire Template
What is the highest level of formal or school education that you have completed?
No school
Primary school
Some secondary school
Finished secondary school
Trade training
University (undergraduate)
University (postgraduate)
What is your age? (Please write how many years old you are.)
(Or if you are unsure or do not want to give your exact age, please fill in one of the age-range boxes.)
16–19
20–29
30–39
40–49
50–59
60–69
70–79
80–89
90+
Don’t know
What is your gender?
Female
Male
Financially speaking, how would you describe your household?
Well-off
Comfortable
Struggling
Poverty-stricken
Compared to other people of the same age, how would you describe your health?
Generally good
Sometimes good; sometimes poor
Generally poor
I don’t know
Have there been times in the past twelve months when you did not enough money for the health care that you or your family needed?
Yes
No
With whom do you live?
Alone
As a single person with children
With just your husband/wife or partner
With your husband/wife/partner and another person or persons—child or adult
With others (not your family) (For example, friends or housemates)
With one or both of your parents and/or brothers/sisters
With extended family (That is, including, but going beyond parents and/or siblings)
How many people live in your household presently?
1
2
3
4
5
6
7
8
9
10
More than 10
For how many years have you lived in your current locality? (That is, in this local place or area)
(Or if you are unsure please fill in one of the year-range boxes.)
less than 1 year
1–5 yrs
6–10 yrs
11–20 yrs
21–50 yrs
more than 51 yrs
What or whom do you identify as your main community?
The place in which you live (including village, town, neighbourhood, suburb, city, territory, etc.)
A particular group of people (including extended family, ethnicity, clan, tribe, nation, etc.)
Your place of work (including both formal and or informal places)
Your place of education (including school, university, etc.)
A cultural or political institution (including sporting club, political party, etc.)
Your place of worship (including church, synagogue, mosque, temple, etc.)
How satisfied are you with being part of your community?
Very Satisfied
Satisfied
Neither Satisfied nor Unsatisfied
Dissatisfied
Very Dissatisfied
Thinking about your own life and personal circumstances, how do you respond to the following questions?
Rows
Very Satisfied
Satisfied
Neither Satisfied nor Unsatisfied
Dissatisfied
Very Dissatisfied
How satisfied are you with being part of your community?
How satisfied are you with the environment where you live?
How satisfied are you with your personal relationships?
How satisfied are you with the balance between your work and social life?
How satisfied are you with how safe you feel?
How satisfied are you with your life as a whole these days?
To what extent do you agree or disagree with the following statements?
Rows
Strongly agree
Agree
Neither Agree nor Disagree
Disagree
Strongly disagree
I can influence people and institutions that have authority in relation to my community.
Decisions made in relation to my community are generally made in the interests of the whole community.
Outside experts can be trusted when dealing with local issues.
Governments make decisions and laws that are good for the way I live locally.
I feel comfortable meeting and talking with people who are different from me.
Most people can be trusted most of the time.
Experts will always find a way to solve environmental problems.
My identity is bound up with the local natural environment and landscape.
Conserving natural resources is unnecessary because alternatives will always be found.
Wealth is distributed widely enough to allow all people in our locality to enjoy a good standard of living.
Current levels of consumption in our locality are compatible with an environmentally sustainable future.
I feel that I can influence the generation of meanings and values in relation to our way of life.
In order to conserve natural diversity, economic development should be excluded from substantial wilderness areas.
Across our locality there is good access to places of nature.
To what extent are you concerned that the following issues might impact negatively on the people living in your locality?
Rows
Not at all concerned
A little concerned
Concerned
Very Concerned
Passionately concerned
Global economic change.
Global climate change.
Globally-fuelled political violence.
Globally-transmitted cultural values.
A slump in the local economy.
An incapacity to meet local needs for basic resources such as energy or water.
A decline in the vitality of local cultural institutions.
The corruption of local political institutions.
To what extent do you agree or disagree with the following statements?
Rows
Strongly agree
Agree
Neither Agree nor Disagree
Disagree
Strongly disagree
Technological innovation has served to liberate me in positive ways from limits that I have experienced in the past.
I am free to express my beliefs through meaningful creative activities.
My work allows me to fully express my identity.
Places of learning, health, recreation and faith are distributed across our locality in a way that ensures good access by all.
Our government should support economic growth as one of its highest priorities.
Continuing economic growth is compatible with environmental sustainability.
People should learn to live with people who are culturally different from themselves.
People living in our locality are free to celebrate publicly their own rituals and memories, even if those rituals are not part of the mainstream culture.
Outsiders are comfortable coming to live in our locality.
Keeping our economy sustainable requires that we place limits on the activities of foreign-owned businesses.
Keeping our economy sustainable requires that untrained migrants or refugees are excluded.
Keeping our economy sustainable requires that our needs for a wide range of consumer goods are fulfilled.
Submit Form
Should be Empty: