8/18/2019 Screener Questionnaire

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Respondent no: _____|_____|_____ 

RESPONDENT DETAILS:

Name: ____________________________________ Phone:__|__|__|__-__|__|__|- __|__|__|__|

Address: __________________________________ Date: ________________ 

Hello, my name is ___________________. I am from ________________, a consumer research rm.We are conducting a survey among women and I would like to ask you a few questions.

1. Code ender

!ale.................................. 1 TERMINATE

"emale.............................. #CONTINUE IF APPROPRIATE OTHERWISE

TERMINATE

#. What is your age$

years old.

%nder 1& years old 1 TERMINATE1&'#( years old

#CONTINUE (15%

QUOTA)

#)'#* years old+

CONTINUE (11%

QUOTA)

+'+( years old(

CONTINUE (10%

QUOTA)

+)'+* years old)

CONTINUE (10%

QUOTA)

('(( years old-

CONTINUE (11%

QUOTA)

()'(* years old

CONTINUE (12%

QUOTA)

)')( years old&

CONTINUE (12%

QUOTA)

))')* years old*

CONTINUE (10%

QUOTA)

-'-( years old 1

CONTINUE (9% QUOTA)

-) years old and over 11

TERMINATE

+. /o you, or anyone living in your household work for0 Y ES NO

n dvertising gency 1

!arket 2esearch com3any 1

 4he media 546, radio, 3ress78 1

9u:lic 2elations rm or de3artment 1

com3any involved in manufacturing, retailing or distri:ution of 3ersonal care3roducts or household 3roducts

1

com3any that manufactures /eodorants, ;avors or s3ecialty chemicals 1

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N

O

 Y E

S

Cold>sinus 3ro:lems including rhinitis 1

IF “YES” TERMINATE

sthma 1

llergic or sensitive>intolerant to foodsor ingredients

1

9regnant and>or nursing>:reast feeding 1

Currently wearing a cologne or/eodorant 1

?moker 1 Interviewer0 :e careful not to question a3erson who strongly smells of to:acco

-. Have you, or any mem:er of your family 3artici3ated in a marketing research study otherthan a 3olitical survey within the 3ast - months$

 =es.....................................1 TERMINATE 4echnical Certication   -

ther  

' 3age ' 2

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1. 4ell what :est descri:es your total household income :efore ta@es$ (SE!ECT ONE8

%nder D #,........................... 1 (TERMINATE)D #, ' D #*,***.................... #D +, ' D +*,***.................... +D (, ' D (*,***.................... (

D ), ' D )*,***.................... )D -, 'D-*,***777777777777..

-

D , ' D *,***.................... D &, ' D &*,***.................... &D *, ' D **,***.................... *D 1, or more...................... 1

11$ What :est descri:es your marital status$ (SE!ECT ONE8

(RECRUIT A MIX)

?ingle............................................................. 1!arried.......................................................... #

?e3arated>divorced........................................ +Widowed........................................................ (ther 5?3ecify8............................................... )

1#. !ention your working status$ (SE!ECT ONE)

(RECRUIT A MIX)

Working full time................................ 1

Working 3art time.............................. #

Homemaker....................................... +

?tudent.............................................. (

2etired............................................... )%nem3loyed>looking for a Eo:............ -

ther 5?3ecify8..................................

1+. /eodorants you have worn regularly in the 3ast - months$

/eodorant     1/eodorant F     2

/eodorant C     3

/eodorant /     4

/eodorant G     5/eodorant "     6

/eodorant     7

/eodorant H     8

/eodorant I     9

/eodorant    10

/eodorant      11

/eodorant A    12

/eodorant !    13

/eodorant <    14

' 3age ' 3

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/eodorant    15

/eodorant 9    16

/eodorant J    17

/eodorant 2    18

/eodorant ?    19

/eodorant 4    20

/eodorant %    21

/eodorant 6    22

/eodorant W    23

/eodorant K    24

/eodorant =    25

/eodorant L    26

/eodorant 1    27

/eodorant F1    28

/eodorant C1    29

/eodorant /1    30

/eodorant G1    31

/eodorant "1    32

/eodorant 1    33

/eodorant H1    34

/eodorant I1    35

/eodorant 1    36

/eodorant 1    37

/eodorant A1    38

/eodorant !1    39

/eodorant

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/eodorant %1    47

/eodorant 61    48

cele:rity /eodorant not listed here5?3ecify8

 49

ther 5?3ecify8

   

50

13. nd among the diMerent 3roducts you Eust mentioned, which one do you most often wear$ 5SE!ECT ON!YONE)

1+ F. How many :ottles of /eodorant do you currently own$ (SE!ECT ONE)

ne :ottle 1 4wo :ottles # 4hree :ottles +"our :ottles ("ive :ottles )!ore than ve :ottles -

' 3age ' 5