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8/18/2019 Screener Questionnaire
1/5
Respondent no: _____|_____|_____
RESPONDENT DETAILS:
Name: ____________________________________ Phone:__|__|__|__-__|__|__|- __|__|__|__|
Address: __________________________________ Date: ________________
Hello, my name is ___________________. I am from ________________, a consumer research rm.We are conducting a survey among women and I would like to ask you a few questions.
1. Code ender
!ale.................................. 1 TERMINATE
"emale.............................. #CONTINUE IF APPROPRIATE OTHERWISE
TERMINATE
#. What is your age$
years old.
%nder 1& years old 1 TERMINATE1&'#( years old
#CONTINUE (15%
QUOTA)
#)'#* years old+
CONTINUE (11%
QUOTA)
+'+( years old(
CONTINUE (10%
QUOTA)
+)'+* years old)
CONTINUE (10%
QUOTA)
('(( years old-
CONTINUE (11%
QUOTA)
()'(* years old
CONTINUE (12%
QUOTA)
)')( years old&
CONTINUE (12%
QUOTA)
))')* years old*
CONTINUE (10%
QUOTA)
-'-( years old 1
CONTINUE (9% QUOTA)
-) years old and over 11
TERMINATE
+. /o you, or anyone living in your household work for0 Y ES NO
n dvertising gency 1
!arket 2esearch com3any 1
4he media 546, radio, 3ress78 1
9u:lic 2elations rm or de3artment 1
com3any involved in manufacturing, retailing or distri:ution of 3ersonal care3roducts or household 3roducts
1
com3any that manufactures /eodorants, ;avors or s3ecialty chemicals 1
8/18/2019 Screener Questionnaire
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N
O
Y E
S
Cold>sinus 3ro:lems including rhinitis 1
IF “YES” TERMINATE
sthma 1
llergic or sensitive>intolerant to foodsor ingredients
1
9regnant and>or nursing>:reast feeding 1
Currently wearing a cologne or/eodorant 1
?moker 1 Interviewer0 :e careful not to question a3erson who strongly smells of to:acco
-. Have you, or any mem:er of your family 3artici3ated in a marketing research study otherthan a 3olitical survey within the 3ast - months$
=es.....................................1 TERMINATE 4echnical Certication -
ther
' 3age ' 2
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1. 4ell what :est descri:es your total household income :efore ta@es$ (SE!ECT ONE8
%nder D #,........................... 1 (TERMINATE)D #, ' D #*,***.................... #D +, ' D +*,***.................... +D (, ' D (*,***.................... (
D ), ' D )*,***.................... )D -, 'D-*,***777777777777..
-
D , ' D *,***.................... D &, ' D &*,***.................... &D *, ' D **,***.................... *D 1, or more...................... 1
11$ What :est descri:es your marital status$ (SE!ECT ONE8
(RECRUIT A MIX)
?ingle............................................................. 1!arried.......................................................... #
?e3arated>divorced........................................ +Widowed........................................................ (ther 5?3ecify8............................................... )
1#. !ention your working status$ (SE!ECT ONE)
(RECRUIT A MIX)
Working full time................................ 1
Working 3art time.............................. #
Homemaker....................................... +
?tudent.............................................. (
2etired............................................... )%nem3loyed>looking for a Eo:............ -
ther 5?3ecify8..................................
1+. /eodorants you have worn regularly in the 3ast - months$
/eodorant 1/eodorant F 2
/eodorant C 3
/eodorant / 4
/eodorant G 5/eodorant " 6
/eodorant 7
/eodorant H 8
/eodorant I 9
/eodorant 10
/eodorant 11
/eodorant A 12
/eodorant ! 13
/eodorant < 14
' 3age ' 3
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/eodorant 15
/eodorant 9 16
/eodorant J 17
/eodorant 2 18
/eodorant ? 19
/eodorant 4 20
/eodorant % 21
/eodorant 6 22
/eodorant W 23
/eodorant K 24
/eodorant = 25
/eodorant L 26
/eodorant 1 27
/eodorant F1 28
/eodorant C1 29
/eodorant /1 30
/eodorant G1 31
/eodorant "1 32
/eodorant 1 33
/eodorant H1 34
/eodorant I1 35
/eodorant 1 36
/eodorant 1 37
/eodorant A1 38
/eodorant !1 39
/eodorant
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/eodorant %1 47
/eodorant 61 48
cele:rity /eodorant not listed here5?3ecify8
49
ther 5?3ecify8
50
13. nd among the diMerent 3roducts you Eust mentioned, which one do you most often wear$ 5SE!ECT ON!YONE)
1+ F. How many :ottles of /eodorant do you currently own$ (SE!ECT ONE)
ne :ottle 1 4wo :ottles # 4hree :ottles +"our :ottles ("ive :ottles )!ore than ve :ottles -
' 3age ' 5
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