Pupils - Survey Form

School toilet survey

This survey was carried out on _________________________________________ (date)

by _____________________________________________________________ (your Name)

at _____________________________________________________________ (your school)

Begin your survey by saying "Excuse me. I am carrying out a survey on what people think of our school toilets. Would you mind answering a few questions?" Then ask them the questions below. Let them tell you what they think, and don’t show what you think.

Before you start, write down if you're talking to a boy or a girl.

Girl

Boy

1. How old are you?

2. What year are you in?

3. What do you think of the toilets?

Really Horrible

Quite Bad

Okay

Nice

4. When do you use the toilets at school?

Never

Sometimes

Only when I have to

Whenever I need to

5. Which of these describe the pupils' toilets? Tick more than one box if needed:

Toilets blocked or not working	No hand towels
Not enough toilets	Smoking in toilets
Locks don't work	Bullying in toilets
No toilet paper	Not enough time to use the toilet
Smell or mess	Toilets are too far away
People can look over/under	No warm water for washing hands

Something else:

6. (For girls only): Do the toilets have tampons or towels in them for you to use?

Yes

7. (For girls only): What do the toilets have for throwing tampons and towels away?

Tick all that apply.

Special bins

Special bags

Ordinary rubbish bin

Nothing

8. Do you wash your hands after using the toilet?

Yes

Sometimes

9. Have you seen any misbehaving in the toilets?

If yes, tick all the boxes that apply.

None	Throwing wet toilet paper	Breaking doors
Blocking sinks or toilets	Graffiti	Bullying
Smoking
Something else: ________________________________________________________

10. Have you ever been bullied in the toilets?

Yes

11. If you need to go to the toilet during class, are you allowed to go?

Yes, without asking	Yes, if I ask
Sometimes	Never

12. Are toilets locked/out of bounds for any part of the day?

Yes

If yes, when? _______________________________________________________________

13. In breaks or lunchtime break are you allowed to use the toilets?

Whenever I need	Only at a certain time
Only if I ask	Not at all

14. Would you like to say anything else about your toilets? Can you suggest ways they could be improved?

Thank the person for helping with your survey