1.

 How old are you?

_____________________

Sexual harassment is any form of unwanted verbal, non-verbal or physical conduct of a

sexual nature that creates an intimidating, hostile, degrading or offensive environment.
This can include physical contact, invasion of personal space, suggestive remarks,
unwanted comments on dress and appearance, jokes of a sexual nature or the display of
sexually offensive material in a public space.

2.Have you ever experienced sexual harassment?

Yes
No
Not sure

3. How often has this happened to you?

Daily
Weekly
Monthly
Only once
2-4 times
5-10 times
Never
Other (please specify)

4.What type(s) of sexual harassment have you experienced?

Unwanted physical contact
Suggestive remarks
Jokes of a sexual nature
Display of sexually offensive materials in a public space
Unwanted comments on dress or appearance
Invasion of personal space
Staring or Leering
Intimidating presence (e.g following at close proximity)
None

5. How did this make you feel?

Afraid
Nervous
Embarrassed
Angry
 Uncomfortable
Upset
Degraded
Intimidated
Defiant
Neutral (used to the behavior or it is expected)

6. Where did this happen to you?

Work
School
Public transport
Street
Shop
Public building
Other (please specify)

7.Did this happen in the city you live in? If no, please tell us where in the space provided
Yes
No
Not sure
Other (please specify)

8. Who did this to you?

Friend
Colleague
Classmate
Stranger
Service provider
Employer
Other (please specify)

9. Did you feel you needed support or help with this?

Yes
No
Not sure

10. If yes, did you get the support you needed?

Yes
No
 Not sure

11. Who supported you?

Friends
Family
Helpline
Counselling service
Public service
Advocacy agency
No one
Other (please specify)

12. Do you feel you have been pushed or forced to do anything differently because of
your experience of sexual harassment? (e.g not walk a certain route, change of dress
etc.)
Yes
No
Not sure

14. If yes, how?

* 15. Amina - the muslim women's resource centre provides a free helpline which can
provide you with support on a number of issues including sexual harassment. Have you
previously heard about our helpline?
Yes
No
Not sure

16. Would you contact the helpline if you would like support in the future?
Yes
No
Not sure