Survey and Community Assessment Tools

Community/Coalition Assessment Tools

The following section contains sample assessment tools for communities and coalitions that UDETC and/or communities have used to gather information.  Please feel free to modify them to fit your own community’s needs.  If you have any questions about how to use the assessment, or if you have sample assessment tools that you would like to share with others, please contact us at [email protected].

Sample Coalition Membership Checklist
The following checklist allows coalition members to rate the participation of the organizations in the areas of their importance to the work of the coalition, the feasibility of getting them involved, and if they already participate, the level of their involvement.
Sample Coalition Self-Assessment Tool
Completing the checklist will provide a general picture of a coalition’s stage of development and may point out areas in which technical assistance, training, or other support is needed.
Sample Community Assessment
This document contains a long list of possible data sources. Coalitions may use this tool to begin gathering important underage drinking related data in their own communities.
Sample Community Profile Exercise
A brief document that allows coalitions to ask community or other coalition members about specific underage drinking issues.
Join Together Publication – “How Do We Know We Are Making A Difference? A Community Alcohol, Tobacco, and Drug Indicators Handbook, 2005 Edition”

Provides good information about where to find local data.

Survey Instruments

The following section contains some sample surveys that UDETC and/or communities have used to gather information.  Please feel free to modify them to fit your own community’s needs.  If you have questions about how to use the surveys, or if you have sample survey instruments that you would like to include in this section, please contact us at [email protected].

Sample Alcohol Retail Survey
A brief survey to give to retailers and bartenders to find out how much they know about responsible beverage service and local laws.
Sample Alcohol-Policy Survey
A longer survey used to ask community members about their knowledge of alcohol issues including attitudes, policies, and enforcement.  The survey can be used as a focus group instrument or in more formal settings.  Source: Harwood, E.M., Wagenaar, A.C., and Bernat, D.H. Youth Access to Alcohol Survey–Summary Report (2002). Prepared for the Robert Wood Johnson Foundation by the Alcohol Epidemiology Program, University of Minnesota.  Visit for more information.

Sample Law Enforcement Survey
This survey is meant for law enforcement personnel and ask about their knowledge on and opinions toward underage drinking.
Sample Board Survey
This survey is to be given to coalition board members.  Each question asks about how the community coalition board is performing in several areas that are known to be important for coalition success.
Guide to Conducting Youth Surveys
This document provides information on how to conduct a youth survey and contains several different survey modules.

Top of Page

Medical Reviewer