A Sample of a Research Questionnaire


ASSESSMENT OF THE EMOTIONAL STATUS OF DRIVERS IN EDO STATE
“RESEARCH QUESTIONNAIRE

      This questionnaire is design to derive data pertinent to my research on the assessment of the emotional status of Edo state drivers. This research questionnaire aims at gathering information about the emotional status of Edo state drivers and possibly how it affects them while on the road, there-fore it is expedient that valid responses or information be filled as it will help facilitate my research in assessing the emotional status of Edo state drivers.
     
All data derived from this questionnaire will be considered confidential; there-fore it’s advised that respondents should input relevant and germane data. Please tick [     ] yes/no or specify others where necessary.

BASIC DATA {SECTION A}
1.     Age: 18-25 [     ]          25-30 [         ]          30-35 [         ]          35-40 [         ] 40-45 [    ]     above 45[   ]
2.     Gender/sex: male [    ]     female [      ]
3.     Qualification: SSCE/GCE [      ]       OND/HND [       ]      BSC [          ]                      MSC/MA [         ]    PHD [                     ] 
4.     Marital status: single [          ]          married [       ]        divorced [        ]

PERSONAL DATA {SECTION B}
Answer question 5-8 if married
5.     Family type: monogamy [        ]     polygamy [        ]
6.     Family size: 2-4 [        ]          4-6 [        ]         6-8 [       ]         above 8 [       ]        Others please specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
7.     How often do you spend leisure time with your family?   Everyday [   ] Once a week [      ]        Once a month [      ]       Others please specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
8.     Does the state or status of your family affect you emotionally?  Yes [      ]     no [      ]
9.     How many hours do you sleep per day? Below 3hours [      ]    3-5hours[      ]      5-8hours [      ]      above 8hours [      ]
10. On an average how many hours do you drive in a day? Below 4hours[    ]  Above 4hours [      ]     Can not specify [      ]
11.           How will you describe your work? stressful [      ]       not stressful [      ]   
12.           Monthly income: below 20,000 [       ]         20,000-40,000 [      ]      above 40,000 [      ]
13.           Do you consider your income as sufficient for you and your family?     Yes [      ]     no [      ]

SECTION C [Field Data]
14.           Do you take alcohol? Yes [        ]          No [       ]
Answer question 15-18 if yes
15.           Why do you take alcohol?  For pleasure [       ]  For health reasons [      ]  To calm my emotional turmoil [    ]      Others please specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _
16.           Does it affect you after in-take? Yes [      ]       No [      ]
17.           How do you feel after taking alcohol? Satisfied/relaxed [  ]     Dissatisfied/disturbed [      ]    Others please specify_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _
18.           With this, do you agree that alcohol affects your emotional pattern?             Yes [     ]    No [      ]

SECTION D
19.           Do you have any health challenge? Yes [      ]     No [       ]
Answer question 20-21 if yes
20.           Does the state of your health make you lose focus or ponder? Yes [       ]      No [      ]
21.           How has your health affected you emotionally? Please specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
22.           How do feel when you drive? Relaxed [      ]          disturbed [      ]
Answer question 23 if disturbed
23.           Why do you feel disturbed? Family needs [      ]       Expenses [ ]        health issues [      ]      Others please specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
24.           Do you agree that health challenges can possibly affect emotions?        Yes [    ]   No[     ]
25.           Do you agree that the family status of an individual could affect his/her emotions? Yes [      ]     No [  ]

Please note that all data gathered with this questionnaire is consider useful to the assessment of the emotional status of Edo state drivers therefore it is advised that the respondent to this questionnaire should input data that are concise and true.
Thank you.


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