Community Alcohol Survey-Adopted from FACE
This survey will provide information on the availability, density, marketing, consumption, and prevention of underage age alcohol  and adult over consumption. Thank you for your time.
Sign in to Google to save your progress. Learn more
Please identify below if you are youth or adult completing the survey? *
If you identified as an adult above, which sector do you belong to below (choose as many as you like).
Are there opportunities to engage in healthy, alcohol-free activities in the community? *
Are special events such as rodeos, community fairs or car shows in your community alcohol free? If no please complete the next four questions. *
If not are there non-alcohol related activities available?
Clear selection
Are non-alcoholic beverages available?
Clear selection
Are ID's checked when a person purchases an alcoholic beverage
Clear selection
Are adults consuming more alcoholic beverages at these events?
Clear selection
Are beer/alcohol bottles littering neighborhoods or other areas of the community? *
Are activities such as red-ribbon week, the Great American Smoke out, Drinking and Driving Awareness, Underage Drinking Awareness or AIDS campaigns advertised and promoted within the community? *
Is there a community coalition on alcohol issues? *
Do students know what their school policies are regarding student alcohol use? *
Do students know the consequences of breaking school polices related to alcohol use? *
Do parents support school policies on alcohol? *
Do students support alcohol policies on alcohol? *
Do students believe adults will experience consequences if they assist or enable students who violate school alcohol policies? *
Do students think polices are consistently enforced? *
Does your school have a student handbook available that identifies alcohol policies? *
Do students think that alcohol use contributes to their problems? (Problems may include low grades, suspension from school, problems with parents and/or teachers or problems with the law.) *
Do students distribute handouts or fliers for parties where alcohol will be available? *
Are there health promotion posters visible at school?  (health promotion posters might include topics such as not smoking, or using tobacco products, having a healthy diet and not using drugs or alcohol) *
Does your school have a student assistance program? *
How many retail convenience stores are located in your community? *
How many of the retail convenience stores sell alcoholic beverages other than beer (wine, liquor, pre-mixed alcohol) *
Is beer located in coolers next to soda pop and milk? *
Are there any signs posted stating that a person must be 21 to purchase and/or consume beer/alcohol? *
Are there any promotional alcohol displays? If yes answer next question to the best of your ability. *
How many?
Do promotional alcohol displays have raffles or drawings to win something?
Clear selection
Are promotional alcohol displays placed below the eye-level of an adult, where children can easily view it?
Clear selection
Are convenience store cluttered with alcohol advertisements?
Clear selection
Do you have designated liquor stores in your community that specifically sell package liquor store in your community?
Clear selection
How many package liquor stores are in the community?
Do liquor stores have signs stating that a person must be 21 to enter?
Clear selection
How many bars (which can include separate bar areas located inside a restaurant or stand alone bar) are located in the community?
Are bars, liquor stores or convenience stores that sell alcohol located near neighborhoods or schools?
Clear selection
Do alcohol outlets in your community target students in their advertisements and promotions?
Clear selection
Do bars feature advertising that promote high-risk drinking, such as price discounts or happy hour?
Clear selection
How many billboards are there in the community?
How many billboards  in the community advertise alcohol?
Are convenience stores cluttered with alcohol advertisements on the windows?
Clear selection
How many (average)?
Do local businesses carry alcohol-related merchandise? (e.g., beer mugs, shot glasses, t-shirts with alcohol logos)
Clear selection
Does merchandise such as posters or clothing have pro-drinking messages?
Clear selection
Does merchandise such as posters or clothing have health promotion messages?
Clear selection
Are local business littered with beer bottles and cans?
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy