Private Outdoor Recreation Facilities Survey
RequiredRequired Question(s)
Required 1.
Please tell us about your Outdoor Recreation Facility (ORF).

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
City:
Postal Code:

2.

Who owns this facility?

 

50 characters left.
Required 3.

Does your facility have a tobacco policy?

If your facility doesn't have a smoke-free policy, please skip to question #9.

No
Yes
4.

Which of the following best describes your tobacco policy?

Ban on all tobacco use (including smokeless tobacco)
Ban on smoking
Smoking is restricted to certain areas
5.

Are electronic nicotine delivery systems (eg. e-cigarette type devices) included in your policy?

No
Yes
6.

Is your policy communicated to sports teams utilizing your ORF?

 

If yes, please comment with how.

No
Yes
  • Comment:

  • 500 characters left.
7.

How is your policy visibly communicated?

 

Please check all that apply

Entrance sign
Fence mounted sign
Stand-alone sign
Other  
8.

Would you like to be included on our free publicized list to promote smoke-free/tobacco-free recreation options in Sarpy County?

No
Yes
Required 9.

What are the benefits of having a tobacco-free/smoke-free policy?

 

Please check all that apply. 

Eliminating tobacco litter
Establishing better role models for youth
Promoting community well-being
Reducing youth opportunity to tobacco
Unsure
Other  
Required 10.

What are the biggest obstacles to implementing a tobacco-free/smoke-free policy?

 

Please check all that apply.

Concern of legality of policy
Complaints from users of the ORF
Enforcement
Sporting association board member objections
Unsure
Other  
Required 11.

Would you like to be contacted with free information on how to implement a tobacco-free/smoke-free policy?

No
Yes
Required 12.

Would you like to be added to our email list for quarterly updates?

No
Yes