Survey of Community Activities

This survey lists some questions you might want to ask an organization to better understand activities occuring in your community. Depending on the objectives of your group, you could add or delete questions.

Sample Activity Survey

Organization:  
Contact Person:  
Address:  
Phone:  
Email Address:  
Type of Organization:  
Target Population(s) Served:  


During the past year, did you provide any classes/lectures addressing [insert specific risk factor]?

  • If so, how many?
  • What participant fees/costs were associated?
  • How many people participated?
  • Are these classes held off site? If so, where?

Do you offer any screening or assessment programs?

  • How many people participated?

Did you provide any special events or promotion activities?

Did you have any other organization co-sponsor any of your classes or special events?

Do you have print materials or videos regarding (name specific risk factor) available to the public?

  • Are there consumer costs/fees associated with these materials?

Which classes/programs do you plan to continue?

Do you plan to offer any new classes/programs in the next year?