EmailMeForm
Lacloche Community Safety and Wellness Survey
Notice of Collection: Personal information is collected on this form under the legal authority of the Municipal Act, 2001, S.O. 2001, Chapter 25, s.227 (b) & (c). It is being collected by the Community Safety and Well-being Committee to obtain demographic information associated with responses to this survey and to develop initiatives to enhance community safety and well-being.
What is your Postal Code?
What community do you live in?
Espanola
Massey
McKerrow
Nairn
Sagamok
Webbwood
Other
3. Select the one that best applies to you.
I work in this community
I live in this community
I both work and live in this community
I am a seasonal Resident who has a permanent residence elsewhere
I have faced challenges such as poverty, injustice or abuse
Yes
No
What option best represents your situation?
Business owner
Employee of a private company
Volunteer or not for profit employee
Health care sector employee
Education sector employee
Government employee
Student
What does community safety and well-being mean to you?
Please rank the community safety and well-being priorities/concerns in your community as listed below
Not Important
Somewhat Important
Important
More Important
Extremely Important
Access to services
Access to health care
Accessibility for persons with disabilities
Affordable Housing
Age Friendly initiatives
Aging in Place
Community belonging
Coordination between services in the Community
Crime prevention
Food security
Healthy childhood development
Homophobia
Housing and homelessness
Human trafficking
Injury prevention
Intimate partner violence
Mental Health Services
Opportunities for employment and employment skills development
Personal and overall community security and safety
Poverty and income
Racism
Substance misuse/addictions
Support for youth that are vulnerable/at-risk
Traffic safety
Are there any other community safety and well-being priorities in your community?
In your opinion, what ideas should be included in a Community Safety and Well-Being Plan to enhance safety and well-being in your community? (free text field, limited characters)
Please select the age group that best describes you?
16-17
18-29
30-39
40-49
50-59
60-69
70-79
80+
Prefer not to answer
Please indicate your level of HOUSEHOLD income in 2019
$0
Under $10,000
$10,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$149,999
$150,000+
Prefer not to answer
Other Comments
Are you interested in participating in the development of the Community Safety and Wellbeing Plan by becoming a Steering Committee Member or, a subcommittee member?
Yes
No
Name
First
Last
Mailing Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Telephone
###
-
###
-
####
Email
Confirm your email
Likely Population Representation
Youth
Senior Citizen
Health Care Provision
Education
Social Services
Emergency Services
Indigenous Representation
Areas of interest