Child Email Usage and Safety Template

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* 1. Do you have an email account?

Yes

No

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* 2. Have your parents said it is okay for you to use the internet?

Yes

No

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* 3. Do your parents know your passwords for all your email accounts?

Yes

No

Not sure

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* 4. How often do your parents let you use the internet by yourself, without an adult in the same room with you?

Always

Most of the time

About half the time

Once in a while

Never

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* 5. Where do you most often use the internet?

At home, in my own bedroom

At home, in a bedroom I share with someone else

At home, in a room that other family members can use

At school

At a friend's house

Some other place (please specify)

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* 6. How often are you bullied on the internet?

Extremely often

Quite often

Moderately often

Slightly often

Not at all often