| 1. Where did you first hear about Child Safety at Home: Mission Possible? |
| The TV advertisement |
| The radio advertisement |
| TV story about Child Safety at Home: Mission Possible |
| Radio story about Child Safety at Home: Mission Possible |
| Newspaper |
| Word of mouth |
| From seeing a copy of the Home Safety Checklist |
| Internet |
| Other, Please Specify: |
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| 2. If you have seen or heard the television or radio advertisements, what was the main message you remember? |
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| 3. Thinking about the television advertisement, do you agree or disagree with each of the following statements? |
| I enjoyed watching the advertisement |
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| The advertisement told me something new |
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| The advertisement is aimed at me |
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| I can relate to the situations presented in the advertisement |
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| The advertisement makes it clear that there are hidden dangers in and around my home |
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| The advertisement makes me think about how I can improve safety in and around my home for my child |
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| The advertisement is a positive step in educating parents about the potential hazards relating to child safety at home |
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| This advertisement makes me want to check my home to ensure it is safe for my child |
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4. Were there any parts of the advertisements you found unclear or confusing?
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, If Yes, please describe the issue briefly
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| 5. Did you visit the Child Safety at Home: Mission Possible website after seeing or hearing the advertisements? |
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| 6. Have you downloaded the Home Safety Checklist for use in your home? |
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, If No, proceed to(Finally a few questions for classification purposes question 12.)
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| 7. Did you have any problems downloading the Home Safety Checklist? |
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, If Yes, please describe any issues briefly
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| 8. Have you completed the Home Safety Checklist? |
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, If you have only completed some sections, which ones?
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| 9. Have you made any physical changes to your home as a result of using the Home Safety Checklist? |
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, If Yes, please specify
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| 10. Have you made any changes to your behaviour as a parent/carer from of using the Home Safety Checklist? |
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, If Yes, please specify
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| 11. Did you have any problems accessing any of the web links provided on the associated Links page? |
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, If Yes, please describe any issues briefly
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*12. How many children do you care for/have responsibility for, on a regular (daily) basis?
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| , please specify how many and their age(s) |
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| *13. For each of the children aged 0-4 years old that you are regularly responsible for, complete the following table: |
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*14. Are you a:
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| Parent |
| Step parent |
| Aunt/Uncle |
| Grandparent |
| Friend |
| Paid carer |
| Older sibling, or |
| Other , Please Specify |
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| *15. Are you: |
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| *16. To which of the following age group do you belong? |
| Less than 18 years |
| 18-20 years |
| 21-24 years |
| 25-29 years |
| 30-35 years |
| 36-39 years |
| 40-45 years |
| Over 45 years |
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*17. What is your postcode?
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| Your feedback is appreciated. Thank you for helping make Child Safety at Home: Mission Possible! |
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