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pdfSynovate
360 Park Avenue South
New York, NY 10010
OMB Control No.: TBD
Draft 12/04/08
Month, Year
Respondent I.D. #____________________
DVD MPAA RATING SURVEY (MALL INTERCEPT)
MALL SCREENER
RESPONDENT’S NAME: ____________________________________________________________
ADDRESS: _____________________________________________________________________
CITY: _______________________STATE: ____________________ ZIP CODE: _______________
TELEPHONE NUMBER: _____________________________________
INTERVIEWER:___________________________________________ DATE: _________________
TIME STARTED:_____________ TIME ENDED: ___________ TOTAL TIME: ______________(MINS.)
CITY
Gaithersburg, MD ........................
Q.B AGE
Under age 30
30 – 39
40 – 49
50 – 59
Age 60 and over
SIGHT SCREEN FOR MALES AND FEMALES AGE 30 YEARS OF AGE OR OLDER
Hello, I’m _________ from Synovate a nationwide marketing research company. We are conducting
a survey in this area and I would like to ask you a few questions.
INITIAL REFUSALS
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A.
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RECORD GENDER OF RESPONDENT
Male ................................
Female.............................
Q.A OVER QUOTA FEMALE
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Q.A OVER QUOTA MALE
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HAND RESPONDENT CARD A
B.
What is your age? (“X” ONE RESPONSE.)
Under 30 .................
30-39
40-49
50-59
60 or over ...............
TERMINATE AND “X” NEXT NUMBER IN BOX BELOW.
ERASE AND RE-USE SCREENER.
Refused ..................
TAKE BACK CARD A
Q.B REFUSED
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C.
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Do you, or does any member of your household work for…? (READ LIST)
YES
An advertising agency ..................................................................
A marketing or marketing research company or department .........
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NO
IF YES TO ANY OF THE ABOVE, TERMINATE AND “X” NEXT NUMBER IN BOX BELOW. ERASE AND
RE-USE SCREENER.
Q.C SECURITY
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D.
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Within the past 3 months, have you been interviewed by a market research company in this mall,
or not?
No ...................................
Yes..................................
IF YES, TERMINATE AND “X” NEXT NUMBER IN BOX BELOW. ERASE AND RE-USE SCREENER.
Q.D RECENT PARTICIPATION
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E. How many children age 18 or under do you have currently living in your household?
ENTER NUMBER _________
IF ZERO, TERMINATE AND “X” NEXT NUMBER IN BOX BELOW. ERASE AND RE-USE SCREENER.
Q.E NO CHILDREN IN HOUSEHOLD
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F. And of these children how many are:
Age 6 or under
_________
Age 7 to 16
_________
Age 17 or 18
_________
IF Age 7 to 16 IS ZERO, TERMINATE AND “X” NEXT NUMBER IN BOX BELOW. ERASE AND RE-USE
SCREENER.
Q.F NO CHILDREN AGE 7 TO 16
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G. In the past year, have you:
Yes
No
Made a purchase from a fast food restaurant for
any of your children age 7 to 16?
Purchased or rented a video game for any of your
children age 7 to 16?
Purchased or rented a movie on DVD for any of
your children age 7 to 16? This could include a
movie watched alone, with your family, or with
friends.
IF PURCHASED OR RENTED A MOVIE ON DVD IS NO, TERMINATE AND “X” NEXT NUMBER IN BOX
BELOW. ERASE AND RE-USE SCREENER.
Q.F NO CHILDREN AGE 7 TO 16
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H. Do you usually wear glasses or contact lenses for reading or watching television?
Yes ................................................1
No..................................................2ÆSKIP TO Q.J
I. Do you have your glasses or contact lenses with you today?
Yes ................................................1
No..................................................2Æ TERMINATE AND “X” NEXT
NUMBER IN BOX BELOW. ERASE
AND RE-USE SCREENER.
Q.H/I VISION CORRECTION
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We are conducting a study today about a variety of topics related to movies and we’d like to
include your opinions. We think you will find it interesting. Would you be willing to participate?
Yes...............................................
ESCORT RESPONDENT TO FACILITY
TERMINATE AND “X” NEXT NUMBER IN BOX
BELOW. ERASE AND RE-USE SCREENER.
No ................................................
TERMINATE Q.K QUALIFIED REFUSAL
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| File Type | application/pdf |
| File Modified | 2008-12-04 |
| File Created | 2008-12-04 |