Survey Tool

A Survey on Sexual Activity Towards the Discipline of Safe Sex Practice of Paramedical University
Students



Your participation in this survey is voluntary. You may refuse to take part in the research or exit the
survey at any time without penalty. You are free to decline to answer any particular question you do not
wish to answer for any reason.


Your survey answers will not require your personal information. Therefore, your responses will remain
anonymous. No one will be able to identify you or your answers, and no one will know whether or not
you participated in the study.


If you have questions at any time about the study or the procedures, you may contact my research
supervisor, Mrs. Dolores Mercado RN MN or via email at mdmercado@liceo.edu.ph. 


Please sign below if:

• You have read the above information
• You voluntarily agree to participate
• You are 18 years of age or older

Agree

Disagree

________________________________
Signature

Directions: Please do not put your name on the survey. Your responses are strictly confidential.
1. What is your sex? Circle your answer.
Male / Female

2.What is your current age? __________________

3. Are you a Liceo de Cagayan University College Student? Circle your answer.
Yes / No

4. What is your course? ________________

5. What is your current level in school? __________________

6. What is your sexual orientation? Circle your answer.

Interested in men Interested in women Interested in both men and women

7. Are you currently sexually active? Circle your answer.

Yes / No
If your answer is no, please return the questionnaire to the researcher. Thank you.
If yes, please continue answering the following numbers.

8. How often do you engage in sexual activity? Circle all that apply.
Multiple times A few times in Once a week A few times in Once a month
in a week the week a month

9. Which sexual behaviors do you involve in? Circle all that apply.
Having Having Having Having Having Having Having Having
sexual sexual sexual sexual sexual sexual sexual “one
intercours intercours intercours intercours intercours intercours intercours night
e with one e with e with the e with the e with e with e with stands” (o
partner multiple opposite same sex both the strangers friends ne-time
partners sex opposite sexual
and the intercours
same sex e with
random
people)

10. What sexual activities do you engage in? Circle all that apply.
Vaginal sex Anal sex Oral sex

11. Do you use condom during sexual intercourse? Circle your answer.
Yes / No

12. If yes, how often do you use condoms during sexual intercourse? Circle your answer.
All the time Most of the time Sometimes Often Not much

13. If no, please state a reason as to why you choose not to use condoms?
____________________________________________________________________________________

14. What other types of contraceptive methods do you currently use? Circle all that apply.
Condoms Pills IUD NONE Others please specify
___________________

15. Do you use another form of contraceptives along with the use of condoms? Circle your answer.
Yes / No

16. If so, what form of contraceptives do you use with condoms? Circle all that apply.
Pills IUD NONE Others please specify __________