City-Owned Outdoor Recreation Facilities Survey
RequiredRequired Question(s)
Required 1.
Please tell us about you:

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

2.

Number of Outdoor Recreation Facilities (ORF) in your city?

 

50 characters left.
3.

Number of playground-only ORF?

 

50 characters left.
4.

Number of sports-only or combination sports/playground ORF?


 

50 characters left.
Required 5.

Do your facilities have a tobacco policy?

If your facilities don't have a smoke-free policy, please skip to question #11.

No
Yes
6.
Which of the following best describes your tobacco policy?   
Ban on all tobacco use (including smokeless tobacco)
Ban on smoking
Smoking restricted to certain areas
7.

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

 

No
Yes
8.

If you have a tobacco policy, is it communicated to sports teams utilizing your facilities?

 

If yes, please comment with how.

No
Yes
  • Comment:

  • 500 characters left.
9.

If you have a tobacco-free/smoke-free policy, how is it visibly communicated?

 

Please check all that apply

Entrance sign
Fence mounted sign
Stand-alone sign
Other  
10.

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

No
Yes
Required 11.

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 12.

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
Objections from city government or residents
Unsure
Other  
Required 13.

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

No
Yes
Required 14.

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

No
Yes