Household Beverage Container Survey

Household Beverage Container Survey
Interviewer
Interviewer First NameInterviewer Last Name
Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Questionnaire Statement
The ACME Society is conducting a survey on Beverage Containers across X. The purpose of this survey is to find out how many beverage containers we have in the country. The questions will be based mainly on the type of beverage drinks that you purchase and what you do with the containers after using it. Beverage drink includes water, soft drinks, milk and alcohol. Locations will be indicated in the report, individuals will not be personally identified in any discussion of the study. However, results of the survey will be shared with the X government departments and publicly. By taking part in this questionnaire, you are agreeing to allow your responses to be used in this study. Please tell us if there is any information you would like to be kept confidential. Thank you very much for taking the time to answer the questions.
Interviewee Background
Name
Interviewee First NameInterviewee Last Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Age
Gender
Other
Occupation
Number of adult living in this house?
Number of children living in this house?
How often do you or other people living in this house go shopping?
Where do you go shopping?
Other
Do you purchase beverage drinks?
What kind of beverage drinks do you buy?
How often do you buy these beverage drinks?
Rows Daily Weekly Montly Few times in a month Less than once a month
Water 1 2 3 4 5
Soft drinks 6 7 8 9 10
Plain milk 11 12 13 14 15
Flavored milk 16 17 18 19 20
Alcoholic drinks 21 22 23 24 25
How many do you buy?
Rows Less than 5 5-10 11-20 More than 20
Water 26 27 28 29
Soft drinks 30 31 32 33
Plain milk 34 35 36 37
Flavored milk 38 39 40 41
Alcoholic drinks 42 43 44 45
What are the sizes?
Rows Less than 300ml 300-600ml 601-1500ml More than 1500ml
Water 46 47 48 49
Soft drinks 50 51 52 53
Plain milk 54 55 56 57
Flavored milk 58 59 60 61
Alcoholic drinks 62 63 64 65
What material are they made of?
Rows Aluminium cans Plastic bottles Pouches Carton/Box Glass bottles Steel
Water 66 67 68 69 70 71
Soft drinks 72 73 74 75 76 77
Plain milk 78 79 80 81 82 83
Flavored milk 84 85 86 87 88 89
Alcoholic drinks 90 91 92 93 94 95
Comments
What influences your decision when buying drinks?
Rows Check boxes
Taste 96
Brand 97
Container material 98
Price 99
What do you do with all the empty beverage containers when you finished using them?
Complete question 16 A to C only if the interviewee said they REUSE plastic and/or glass bottles. If not move to Question 17.
If you reuse glass and plastic bottles, how many times would you reuse it before throwing it away? (Answer this question only if "reuse" box is checked in Q14).
Rows Once Twice Up to 10 times More than 10 times
Glass bottles 100 101 102 103
Plastic bottles 104 105 106 107
What are you reusing the glass bottles for?
What are you reusing the plastic bottles for?
Complete Question 17 only if the interviewee said they SELL plastic and/or glass bottles. If not move to Question 18.

Rows	Daily	Weekly	Montly	Few times in a month	Less than once a month
Water	1	2	3	4	5
Soft drinks	6	7	8	9	10
Plain milk	11	12	13	14	15
Flavored milk	16	17	18	19	20
Alcoholic drinks	21	22	23	24	25

Rows	Less than 5	5-10	11-20	More than 20
Water	26	27	28	29
Soft drinks	30	31	32	33
Plain milk	34	35	36	37
Flavored milk	38	39	40	41
Alcoholic drinks	42	43	44	45

Rows	Less than 300ml	300-600ml	601-1500ml	More than 1500ml
Water	46	47	48	49
Soft drinks	50	51	52	53
Plain milk	54	55	56	57
Flavored milk	58	59	60	61
Alcoholic drinks	62	63	64	65

Rows	Aluminium cans	Plastic bottles	Pouches	Carton/Box	Glass bottles	Steel
Water	66	67	68	69	70	71
Soft drinks	72	73	74	75	76	77
Plain milk	78	79	80	81	82	83
Flavored milk	84	85	86	87	88	89
Alcoholic drinks	90	91	92	93	94	95

Rows	Check boxes
Taste	96
Brand	97
Container material	98
Price	99

Rows	Once	Twice	Up to 10 times	More than 10 times
Glass bottles	100	101	102	103
Plastic bottles	104	105	106	107

If you sell plastic and/or glass bottles, how much do you sell it for?

Rows	Less than 50vt	50-100vt	101-200vt	201-300vt	301-400vt	401-500vt	> 500vt
Plastic bottles (less than 1L)	108	109	110	111	112	113	114
Plastic bottles (more than 1L)	115	116	117	118	119	120	121
Glass bottles (Les than 1L)	122	123	124	125	126	127	128
Glass bottles (more than 1L))	129	130	131	132	133	134	135

Comments
Which containers can you recycle in Vanuatu now?
Rows Check boxes
Aluminium cans 136
Plastic bottles 137
Glass bottles 138
Would you support a recycling program in Vanuatu?
Would you take a bottle back for no reward?
If there is a buy-back scheme, what's the smallest amount of buy-back per bottle for you to participate? (empty & full)
Can we count all the beverage bottles in your house and yard?
Comments

Rows	Check boxes
Aluminium cans	136
Plastic bottles	137
Glass bottles	138

Rows	Less than 300ml	300-600ml	601-1500ml	More than 1500ml
LPB Plain milk without straws
LPB Plain milk with straws
LPB Flavored milk without straws
LPB Flavored milk with straws
LPB soft drinks without straws
LPB soft drinks with straws
Water(Plastic)
Soft drinks (Plastic)
Plain milk (Plastic)
Flavored milk (Plastic)
Drink pouches (Plastic)
Alcoholic drinks (Aluminium)
Soft drinks (Aluminium)
Water (Glass)
Alcoholic drinks (Glass)
Soft drinks (Glass)
Soft drinks(Steel)

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Household Beverage Container Survey

Questionnaire Statement

Interviewee Background