Geocode: 63210 San Diego 501 Interview Date: Subway Card # given: [Text written like this should NOT be read out loud and is only intended as support instruction for you] [Please fill in the bubbles by writing an X or filling it in] ⃝ ⃝ Hello, my name is ___________ and I’m conducting a survey to better understand housing situations and help provide better services. Can I ask you two quick questions? Yes [Continue survey] No [STOP survey and thank respondent] ⃝ ⃝ Where did you sleep last Street or sidewalk Emergency shelter ⃝ ⃝ Thursday night/Friday Vehicle (car, van, RV, truck) Transitional housing ⃝ ⃝ morning (Jan 25th/26th)? Tent/Hand-built structure Motel/Hotel ⃝ ⃝ Park, beach or riverbed House or apartment ⃝ ⃝ Abandoned building Jail, hospital, treatment program ⃝ ⃝ Bus, transit station, airport Safe Haven ⃝ ⃝ bridge/overpass Couch surfing ⃝ ⃝ Any other housing Woods or outdoor ⃝ ⃝ encampment Other location: [specify] [STOP survey and thank respondent for ⃝ their time] Has another volunteer asked Yes [STOP survey and thank respondent for their time] ⃝ you these same questions No ⃝ about where you were staying Know/Refused ⃝ last Thursday night? Would you like to take a 20 minute survey? You will get a $10 Subway gift card for your time. You can refuse to answer any question or end the survey at any time. Your answers are confidential and will only be used to improve the quality of our services. Would you like to continue? Yes No [Continue survey] [STOP survey and respondent for their time] ⃝ ⃝ Including yourself, how many adults or children in your Adults Children household slept in the same (Over 18) (Under 18) location with you last Thursday night? [Individuals who slept with other adults and/or children in the same location are considered a household. If other household individuals are present, use one survey form but interview each individual separately. If other household individuals are not present, ask if they will answer for them.]
Geocode: 63210 San Diego 501 Interview Date: Subway Card # given: [Text written like this should NOT be read out loud and is only intended as support instruction for you] [Please fill in the bubbles by writing an X or filling it in] ⃝ ⃝ Hello, my name is ___________ and I’m conducting a survey to better understand housing situations and help provide better services. Can I ask you two quick questions? ⃝ Yes [Continue survey] ⃝ No [STOP survey and thank respondent] Where did you sleep last Thursday night/Friday morning (Jan 25th/26th)? ⃝ Street or sidewalk ⃝ Vehicle (car, van, RV, truck) ⃝ Tent/Hand-built structure ⃝ Park, beach or riverbed ⃝ Abandoned building ⃝ Bus, transit station, airport ⃝ bridge/overpass ⃝ Woods or outdoor encampment ⃝ Other location: [specify] ⃝ Emergency shelter ⃝ Transitional housing ⃝ Motel/Hotel ⃝ House or apartment ⃝ Jail, hospital, treatment program ⃝ Safe Haven ⃝ Couch surfing ⃝ Any other housing [STOP survey and thank respondent for their time] Has another volunteer asked you these same questions about where you were staying last Thursday night? ⃝ Yes [STOP survey and thank respondent for their time] ⃝ No ⃝ Know/Refused Would you like to take a 20 minute survey? You will get a $10 Subway gift card for your time. You can refuse to answer any question or end the survey at any time. Your answers are confidential and will only be used to improve the quality of our services. Would you like to continue? ⃝ Yes [Continue survey] ⃝ No [STOP survey and respondent for their time] Including yourself, how many adults or children in your household slept in the same location with you last Thursday night? Adults Children (Over 18) (Under 18) [Individuals who slept with other adults and/or children in the same location are considered a household. If other household individuals are present, use one survey form but interview each individual separately. If other household individuals are not present, ask if they will answer for them.]
2018-Working-Survey-1.docx