Social Value Engine

Easy Read adaptation for local user testing

High Street Resident Survey: Easy Read

This is an Easy Read adaptation. It is for testing with local people before the baseline survey.

It is not a validated scale. It is not an official government evaluation tool. It is not a funding requirement.

This is a paper resource. Print it, or use your browser to Save as PDF.

It is not an electronic form. You cannot type answers into this page. This page does not save or collect any answers.

Original version: High Street Resident Baseline and Follow-up Survey.

For staff only: prepare before use

Do not give this sheet to residents until every point below is done.

  • Do not issue the sheet with local details missing. Add the responsible organisation, the purpose, who will see responses, storage and deletion arrangements, the privacy notice, and a contact for questions or accessible formats. Explain any response-matching and withdrawal limits. Fill in the resident boxes on the next page.
  • Adults only. This sheet is intended for adults. Arrange suitable safeguarding and consent procedures before involving children.
  • Test with local users. Try this Easy Read version with a few local residents before baseline. Use the printable local testing pack for a neutral facilitator script, anonymous feedback checklist and revision log. Check the place boundary, wording and completion time. Note the format used.
  • Freeze the version. Use the same version, the same questions, the same answer choices in the same order, and the same four-week period for baseline and follow-up.
  • Place boundary. Replace [place] with one named street or area. Explain its boundary to residents.
  • Collection record. Complete the record box at the top of the resident sheet.
  • Read choices neutrally. Allow time and privacy. Offer an independent interpreter or supporter chosen by the resident.

Resident sheet

Staff record

Place and boundary:

Round: Baseline / Follow-up    Date:

Collection location and format:

About this survey

A high street with shops

We are asking about your experience of [place].

This helps to improve local plans and services.

A hand raised, meaning your choice

Taking part is voluntary. It is your choice.

You can skip any question. You can stop at any time.

A shield, meaning your services are safe

Your answers will not affect services you receive.

A calendar showing four weeks

Please think about the past four weeks.

Answer even if you have not visited [place].

A name card crossed out

Do not write names.

Do not write details that could show who anyone is.

Your privacy and who to contact

Staff must fill in these boxes before you get this sheet.

Who is asking and why:

Who will see answers, how they are kept and when they are deleted:

Privacy notice, matching answers, and taking answers back (withdrawal):

Who to contact for questions or other formats:

Questions 1 to 5

A box with a tick

Thinking about the past four weeks, how much do you agree or disagree with each statement?

Read each sentence. Tick one box for each question.

Question 1. Access

I can get to [place] when I want to.

This is about getting there.

Think about the past four weeks.

  1. Strongly disagree
  2. Disagree
  3. Neither agree nor disagree
  4. Agree
  5. Strongly agree
  6. Don't know or not applicable
  7. Prefer not to say

Question 2. Access

I can use the services or activities I need at [place].

This is about using what you need there.

Think about the past four weeks.

  1. Strongly disagree
  2. Disagree
  3. Neither agree nor disagree
  4. Agree
  5. Strongly agree
  6. Don't know or not applicable
  7. Prefer not to say

Question 3. Belonging

I feel that I belong at [place].

This is about how you feel there.

Think about the past four weeks.

  1. Strongly disagree
  2. Disagree
  3. Neither agree nor disagree
  4. Agree
  5. Strongly agree
  6. Don't know or not applicable
  7. Prefer not to say

Question 4. Feeling safe

I feel safe when spending time at [place].

This is about feeling safe there.

Think about the past four weeks.

  1. Strongly disagree
  2. Disagree
  3. Neither agree nor disagree
  4. Agree
  5. Strongly agree
  6. Don't know or not applicable
  7. Prefer not to say

Question 5. Feeling welcome

[place] feels welcoming to me.

This is about feeling welcome there.

Think about the past four weeks.

  1. Strongly disagree
  2. Disagree
  3. Neither agree nor disagree
  4. Agree
  5. Strongly agree
  6. Don't know or not applicable
  7. Prefer not to say

Question 6. Optional comment

You do not have to answer this question.

What, if anything, has helped or made it difficult for you to use or spend time at [place] in the past four weeks?

You can write about good things or bad things. Or you can say that nothing has changed.

Please do not write names or details that could show who anyone is.

Question 7. Visits

In the past four weeks, how often have you visited [place]?

Tick one box.

  1. Never
  2. Once
  3. 2–3 times
  4. About weekly
  5. Several times a week or more
  6. Prefer not to say
A notice board for sharing results

Thank you.

We will share a summary and what we do next. Staff fill in where and when: