Victim(s) of Crime and/or Tragic Circumstance Survey

This Confidential survey is only for those who have been a victim of a crime and/or tragic circumstance in their life over the past year, which can be defined as:

  • A crime could include an incident such as a robbery, vandalism, physical assault, sexual assault, etc.
  • A tragic circumstance (non-work related) could include a sudden death in the family, motor vehicle accident, house fire, etc.
  • A tragic circumstance (work related) could include a severe injury on the job, permanent loss of a job, etc.

The results of this survey will not only be posted on our site, but will also be used for a research article and training materials for Violence, Abuse & Injury Prevention.

While completing this survey, various unpleasant memories and emotions may arise. If so, we strongly recommend that you seek the appropriate emotional support that will assist you.

We've made the survey easy to fill out with many of the questions requiring either a yes or no answer.

A. Please let us know how you found out about this survey.

B. What Country do you live in?

C. Which State/Province/Territory do you live in?

D. Please indicate your gender
Male
Female

E. What is your age group?
Under 18 years of age
18-29 years of age
30-39 years of age
40-49 years of age
50-59 years of age
60-69 years of age
70 years of age or older

1. If you've been a victim of a crime such as a robbery, vandalism, physical assault, sexual assault, etc. over the past year, briefly describe what happened.

2. Did this crime involve the police in any way?

Yes
No

3. If you experienced any physical injuries as a result of this crime, did you seek medical attention?

Yes
No
No physical injuries

4. If you've been the victim of a tragic circumstance (non-work related) such as sudden death in the family, motor vehicle accident, house fire, etc. over the past year, briefly describe what happened.

5. Did this tragic circumstance (non-work related) involve the police in any way?
Yes
No

6. If you experienced any physical injuries as a result of this tragic circumstance (non-work related), did you seek medical attention?
Yes
No
No physical injuries

7. If you've been the victim of a tragic circumstance (work related) such as a severe injury, permanent job loss, etc. over the past year, briefly describe what happened.

8. Did this tragic circumstance (work related) involve the police in any way?
Yes
No

9. If you experienced any physical injuries as a result of this tragic circumstance (work related), did you seek medical attention?
Yes
No
No physical injuries

10. In any of the incidents in which the police were involved, was any form of emotional support such as a counselor, social worker, victim services, etc., offered to you?
Yes
No

11. If yes to question #10, briefly describe what type of emotional support was offered.

12. In any of the incidents in which you required medical attention, was any form of emotional support such as a counselor, social worker, victim services, etc. offered to you?
Yes
No

13. If yes to question #12, briefly describe what type of emotional support was offered?

14. If emotional support was offered, either through the police or medical personnel in any of the incidents, how helpful did you find the support?
Chose not to have any support
Not helpful at all
Somewhat helpful
Very helpful

15. If you chose to receive emotional support in any of the incidents, would you recommend that same type of support to someone else who experienced a similar incident that you did?
Yes
No

16. Whether police or medical personnel were involved or not, being a victim of a crime and/or tragic circumstance can have an emotional impact on the victim. Briefly describe how you've been able to mange the emotional impact of your particular incident(s).

17. If your particular tragic circumstance is work related such as a severe injury, permanent job loss, etc., briefly describe what kind of emotional support, if any, was offered by your employer.

18. If your particular tragic circumstance is work related such as a severe injury, permanent job loss, etc., briefly describe what kind of emotional support, if any, was offered by your union official(s) if you're a member.

19. If your particular tragic circumstance is work related such as a severe injury and resulted in some form of a Worker's Compensation claim, or other form of injured worker benefits, briefly describe what kind of emotional support, if any, was offered by any official(s).

20. We welcome any further comments that you may have on this topic.