Home Safety Survey, Children 0-5 Years

Page 1 of 5

Closes 30 Nov 2021

Section One

Please answer the following questions to help us understand more about you and where you live, and whether your child has been injured or hurt at home. For example, being injured through a fall or cut, or being hurt through choking or taking medicine not meant for them, etc.

This will help us make sure we provide the right support, to the right families, in the right area.

1. What age is your child?
(Required)
2. What area of South Lanarkshire do you live in?
(Required)
3. Has your child ever had an accident in or around the home resulting in them requiring treatment? (Whether by you, medical professional, etc.)
(Required)

If yes, please answer questions four to seven. If no, please go to Section Two.

4. What was the cause of the most recent accident?
5. When was the most recent accident?
6. Who did your child require treatment from? (tick all that apply)
7. Was your child admitted to hospital?