1. Age *
2. Sex *
○ Male
○ Female
3. What is your primary news source? *
○
Local
TV News
○ Local Radio
○
Newspaper
○ Cable News
(CNN, BBC, Fox)
○
Facebook
○
I
watch little/ no news
○ Other
4. If a catastrophe were to happen, what
do you think it would be? *
□ A. Natural for instance
a typhoon, tornado, or earthquake
□ B. Magnetic
Polar Shift
□ C. Global Oil
Crisis
□ D. Economic
Meltdown
□ E. Giant Solar
Flares
□ G. Blackout
□ H. Other
5. Some people believe that the world
would end on December 21, 2012, as predicted by the popular ancient calendar of
the Mayans. How likely or unlikely do you think that this prediction will be at
least correct? *
○ A. Very likely
○ B. Likely
○ C. Somewhat
likely
○ D. Very
unlikely
○ E. Unlikely
○ F. Somewhat
unlikely
6. If a devastating incident will
happen, do you think that you are prepared? *
○ Yes
○ No
7. Among respondents who think, they are
prepared; which of the following have you ever done to prepare for possible
catastrophe?
□ A. Store canned
or non-perishable food
□ B. Store drinking
water
□ C. Learn basic
survival skills, for example how to start a fire
□ D. Build a safe
place
□ E. Grow own
food like vegetables and fruits
□ F. Create own
source of power
□ G. Other
8. Among respondents who think, they are
NOT prepared; which of the following explain why you are not prepared for a
possible catastrophe?
□ A. I cannot
afford to buy and/or store particular supplies.
□ B. I don't know
what to stock up.
□ C. I don't have
time to do such preparation.
□ D. I don't
believe that the end of the world will happen.
□ E. Other
9. If the calamities that you chose a
while ago were to happen now, how will you address that situation that would
benefit you in the short and long run? *
10. Now, if things are in your favor for
you to prepare for such calamities, what would be your emergency plan? *
11. Do you agree that everyone can do a
little bit to ensure their preparedness for a possible catastrophe? *
○ Yes
○ No
