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Survey Example Essay

We the students of communication skills 14 are conducting a research paper regarding the causes and effects of smoking and drinking to 2nd year students of Centro Escolar University, Manila school year 2012-2013. Here are some questions below, please answer it by putting check on the answers provided before the line. Thankfully yours, (name of respondents) Researchers Questions For Drinkers:

1. Have you ever consumed alcohol?
__yes
__no
2. At what age did you start consuming alcohol? ________

3. . Why did you start consuming alcohol?
__ peer pressure
__family problems
__curiosity
__to have fun
Other(please specify____________)
4. Have you ever passed out or experience memory loss due to drinking? ___ yes
____no
5. What alcoholic beverages do you often drink?
____ beer
____ cocktails
____ rhum
____ whistkey
6. How often do you drink?
____ once a week
____ twice a week
____ once every two weeks
Others: (please specify) _____
7. Do you drink to escape pain, either physical or emotional? ___ Yes
___ No

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8. How does it affect your condition the next day?
____ makes you lazy
____ makes you feel sleepy
____ makes you feel out of the mood
____ makes you feel sick
9. Have you ever skipped or missed class because of drinking? ___Yes
___ No
10. How does it affect your performance in school?
____ gives you poor outcome in class participation
____ makes you feel lazy to come to class
____ makes you feel sleepy during class
____ gives you low grades
11. Have you ever skipped or missed class because of drinking? ___Yes
___No
12. Did you ever get into any fights while drinking?
___Yes
___No
13. Any future plans to stop?
___ Yes
___ No

Questions for Smokers:
1. When did you start to smoke?
____ 10-12 years old
____ 13-15 years old
____ 16-19 years old
Others: (Please specify) _____________
2. Why did you start smoking?
____ peer pressure
____ stress
____ curiosity
Other(please specify) ______________
3. What do you get from smoking?
____Relaxation
____ Habit
____Good time
Others(please specify) ___
4. Who among in your household smokes?
____Father
____ Sister
____Mother
____ Brother
Others(please specify) ____
5. How many sticks did you used when smoking?
____1 to 2 sticks
____ 2 to 3 sticks
____ 3 to 4 sticks
Others(please specify) ____________
6. How often do you smoke?
____ everyday
____ every other day
____ once a week
Others( please specify) ____________
7. What influenced you to start smoking?
____ peer pressure
____ to gain new experience
____ being done in the family
Other(please specify) _____________
8. Why do you smoke?
____Relaxation
____ Habit
____ Good times
Others(please specify)____
9. Are you aware of the effects of smoking to yourself and to the people around you? ____ Yes
____ No
10. Any future plans to stop?
____ Yes
____ No

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