INSECT REPELLENT USAGE SURVEY QUESTIONNAIRE

Part I: Profile of the Respondent

Instruction: Please fill in the necessary information and put a check mark (√) on the space provided whenever
needed.

Name: ______________________________________________City:________________________

Gender: ____Male _____Female Civil Status: ____Single ____Married Age:________years old

Monthly Salary (in pesos): _____ below 8,000.00 Work Status:

_____ 8, 000.00 – 14, 999.00 ______Permanent
_____ 15, 000.00 – 29, 999.00 ______Probationary
_____ 30, 000.00 – 49, 999.00
_____ 50, 000.00 – above

Educational Background: Occupation Designation:

______ Grade School Graduate ____Others, please specify ___________________
______ High School Graduate ____Rank and File
______ Bachelor’s Degree Holder ____Middle Management
______ Master’s Degree Holder ____Top Management
______ Doctoral Degree Holder ____Business Owner

Part II: Usage of Insect Repellent

Instructions: The statements below will measure the extent of your usage of insect repellent. Please
respond honestly to the statements by checking (√) the box that corresponds to the number of your answer
using the following scale. Rest assured that the data gathered from this survey will be treated with utmost
confidentiality.

5 – Strongly Agree (SA)

4 – Agree (A) 2 – Disagree (DA)
3 – Neutral (N) 1 – Strongly Disagree (SDA)
5 4 3 2 1
INDICATORS SA A N DA SDA

1. I take protection against diseases or other things that could ruin my

health.
2. I am aware that insects carry different diseases and these can be
passed to humans through insect bites.
3. I use insect repellents or any protection against insect bites whenever
necessary.
4. I learned about insect repellent through advertisements.
5. I learned about insect repellent through my family and / or friends.
6. I learned further about insect repellent through reading books /
newspapers / magazines / google, etc.
7. I buy insect repellent because of its use.
8. I buy insect repellent because of its effectiveness.
9. I buy insect repellent because I tried it before.
10. I bring insect repellent whenever I travel to see nature.
11. I recommend bringing insect repellent to my family and friends
whenever they travel to see nature.
12. I feel that insect repellent helps in keeping me mosquito-free.
13. I believe that insect repellent helps prevent diseases such as dengue,
malaria, zika virus, etc.

Thank you very much for your support and cooperation!

Instructions:
1. Each group must survey 30 working respondents ages 18 and above.
2. Run the raw data and Analyze using the statistical tools:
 Frequency Count and Percentage Distribution (f and %) -These statistical tools
were utilized to present the profile of the participants.
 Mean and Standard Deviation (M and SD)
 Variance and Cronbach Alpha
3. Maximum of 2-3 pages analysis per group.
4. Submission date: Final Exam day August 24, 2018.