Climate Change Impact Survey

Climate Change Impact Survey
Help us understand how climate change is affecting individuals and communities. Your responses will support research and policy development.
What is your age group?
Where do you currently reside?
How would you rate your awareness of climate change issues?
Which of the following climate change effects have you observed in your area? (Select all that apply)
Other

To what extent do you agree with the following statements about climate change?

Rows	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Climate change is primarily caused by human activities.
Climate change is already impacting my community.
Climate change will have serious consequences in the future.

Have you or your household experienced any direct impacts from climate change (e.g., property damage, health issues, displacement)?
What actions have you personally taken to reduce your impact on climate change? (Select all that apply)
Other
How concerned are you about the impacts of climate change on future generations?

1
2
3
4
5
6
7
8
9
10
1 is Not concerned, 10 is Extremely concerned
Where do you get most of your information about climate change?
Other
Please share any additional comments or experiences related to climate change impacts in your community.
Would you like to be contacted for follow-up research or updates?
If yes, please provide your email address.
example@example.com
Should be Empty:

Select theme: